How to use your Emergency Room

The more I work in the Emergency Department, the more I grow tired of the misuse of the facility. Just last night I had to evaluate someone with 1 year of groin pain and another patient with 10 years of back pain. Another patient who was not mine has been seen 3 times this month (16 days, not 30). One woman with "multiple complaints" brought her daughter in with her because of bad headaches and severe stomach pain.

The Mother-daughter "Two-for" started out well. I took a thorough history of the 9-year-old daughter which came up with only some non-specific symptoms like subjective fever, congestion, cramping pain, etc. After the physical which was essentially normal, I began evaluating Mom. Little girl interrupted the exam with more information for me at which the mom gets annoyed and says that it is her turn. She then partially covers view of her mouth and whispers to me that there is nothing actually wrong with her daughter she just likes to be seen when she(mom) brings her in. All of this would normally not phase me, but I chose this "Two-for" to be more efficient since there were 4 patients waiting to be evaluated. Mom actually had the nurses triage the girl, make up a chart and put both of them in the computer. With the chart made up, I have to do a full evaluation for fear of the hospital being sued, and document the encounter. The staff physician then has to see the patient also and do more documentation. The chart then goes to the nurses for discharge, then to billing to be put into the computer and sent to insurance companies if the patient has insurance. If she does, the paperwork gets sent to the insurance company who has someone look at the encounter and inevitably decide that this wasn't an emergency and then sends notice back to the hospital that they will not be reimbursed. The hospital then gets to decide whether it is worth while to attempt to collect from the patient. It will almost certainly not be beneficial and the hospital eats the cost of the encounter.

As for the pain patients, there are very few scenarios where 10 years of back pain culminates into an emergency. This particular man came in because his pain was affecting his sleep and he was getting short with his wife. This will be his 3rd ER visit this year. An ER visit costs between 7 and 30 times more than an office visit or urgent care visit.

Groin pain guy came in because it had finally become too much. There had been no change in symptoms and he had already been seen by 3 different specialists. I did not ask what help he was expecting from physicians trained for emergencies when he had already seen 3 specialists.

In summary:
Inability to sleep is never an emergency. See your Primary doctor or psychiatrist
Chronic pain without new symptoms is never an emergency. See your primary or psychiatrist
Medication refills are never an emergency. (symptoms due to not having medication can be an emergency). See your primary.
Very, very rarely are you justified in having a family visit to the ER. Some good times to have a family visit are after a car accident, if two kids were to smash their heads together, if siblings are all acutely ill with identical symptoms that are suggestive of emergency.

If you are a health care provider doing time in the Emergency Department, your obligation for patient education still applies. Talk about the misuse of medical resources and the increased cost of getting care through the ER.