Second Opinion: ‘Just Go to the ER’
Leap, Edwin MD
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Our speciality has long struggled with the problem of diversion, and it raises many questions, professional, financial, and ethical. Most medical centers choose to accept all patients, and live with overwhelmed, understaffed departments, mostly with the intent of doing the right thing but also to avoid the risk of litigation!
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Image ToolsRecently, I began to contemplate the other form of diversion that is systematically crushing the emergency care system. A kind of diversion that affects finances, staffing, and ultimately, the proper care of the sick, injured, and dying entrusted to us. Moral diversion: the displacement of moral responsibility to another, out of convenience.
What I mean is this. One of the unintended but devastating consequences of our current health care system is that it allows the progressive cascade of moral responsibility for patients, providers, insurers, and politicians until the problem in question lands itself squarely in an emergency department.
It's ironic, really. EMTALA was meant as a fundamentally moral law. It was intended to provide excellent, timely emergency care to the poor and helpless of society. Now, by making emergency departments the final common pathway, by tying the hands of hospitals against any refusal of care, it has given much of our medical care system an endless “Option B.”
Option B is this: Go to the ER. Have you called your physician's office lately? The voice prompt will always say, “If this is an emergency, hang up and dial 911,” or “If this is a medical emergency, go to the nearest emergency room.”
Fair enough. Some people need to be prompted to go to the hospital when sick so they will not languish at home with dangerous conditions. And some facilities and private offices simply can't be available to answer questions (or meet patients) all the time.
But those situations are not the main problem. Witness the progressive exodus of physicians from call schedules and from hospitals. I understand why physicians leave. I'm not suggesting their motives aren't sound. Many primary care physicians, however, are no longer available for consultation or for admissions of their sicker patients. Often, when their patients need to be admitted, they simply say, “Go to the ER.” The implication is that the ER doc will figure it out, and make things happen. The subtext is, “My moral obligation is discharged because someone else will do it.”
http://journals.lww.com/em-news/Fulltext/2011/04000/Second_Opinion___Just_Go_to_the_ER_.7.aspx
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that he had to die, I hope it was not race related, but I don't know how often people were tested for Ebola in the ER before his death. Rest in peace Mr. Duncan 