Two Voices from an Emergency Room

Wednesday, October 3rd, 2007
This post was written by Melanie Matthews

We’ve heard much from hospital and health plan management about strategies to reduce non-emergent care in their emergency rooms.

During a September 26, 2007 audio conference on the topic, Dr. James Glauber, medical director for Neighborhood Health Plan of Massachusetts said:

Why should we worry about emergency department use beyond the strictly financial? Well, as I said, it is, for many types of ER visits, an inefficient use of health care resources, both in terms of dollars and the medical personnel involved in serving people in emergency room – specifically I mean emergency department visits that don’t require the resources or personnel available in emergency rooms. We want, and I think our goal in managed care is to promote the use of medical homes for our members and inclusive within that definition of medical homes is that medical homes can provide for the care of acute health problems when they arise for our members. We’d also like to empower our members, who are patients, with the self-care knowledge, so that they don’t need to rely on the emergency room for problems that don’t require the emergency room.

To offer additinoal perspective, healthcare blogger Panda Bear, M.D., an ER resident in a medium-sized Emergency Medicine program in an academic setting, chronicles a typical night in his ER, which includes very few emergency cases.

He concludes:

Contrary to the popular belief among critics and sour-grapers of Emergency Medicine, although we see some minor complaints (”I couldn’t urinate for an hour but now I can”) we do not do primary care. Oh sure, patients make attempts to get us to manage their chronic problems but you need to avoid the temptation. You cannot do decent primary care on a patient who you have never seen and will probably never see again and certainly not within the confines of an Emergency Department visit. We do not do drive-by pap smears, in other words.

Imagine how things would slow down if we did.

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