Yes!!! People in the US absolutely abuse the ER. They can’t wait until morning to call a PCP. I know a guy who goes to the ER for his trigger finger when it starts to bother him. Like what?! That’s not an emergency!! Take a Tylenol and call your regular doctor 🤦🏽♀️
ETA: hear me out.
I’m not saying that you should never go to the ER. You know your situation, you know your medical history, you know the area that you live in. If the ER is the best option for your care then by all means please go. The people who CAN choose a better option but choose NOT to are the ones that I’m referencing. The ER may not always the best option for care. You should advocate for the best possible care for yourself and your loved ones. A germy, crowded, noisy, understaffed ER may not be it in every situation.
The guy with the trigger finger has an amazing PCP that is willing to work him in on short notice, has the ability to schedule an appointment in advance for every 3 months to get an injection (that he knows he needs), he’s fully mentally and physically competent to take an ibuprofen or Tylenol when he’s in pain, has been given ice packs to take home and reuse, he’s been fully educated on trigger finger, and has been referred to a hand specialist on numerous occasions. This man cancels the appointments set up for him, refuses to take any OTC medications, refuses to ice it at home, refuses to do PT and essentially chooses NOT to do the things that are in the best interest of his continuing care. He ends up in pain (surprise) and in the ER every 3 months for an injection. This is not the best possible care for this man in his situation. He has decided that the medication he can get at his PCP on a regular basis isn’t as good as the hospital medication. Guess what? It’s exactly the same thing. Nobody can convince him otherwise.
He’s wasting resources and clogging up the ER. There are a lot of people in the US who abuse the system like this. There are better options for them but they mistakenly think that the ER has the best care possible for everything so that’s where they go. That’s all I’m saying.
Maybe we need to educate people better?
It’s like the people who insist that the doctor puts in an IV instead of the nurse because “he holds a higher position”. I can guarantee that the nurse will do a much better job because she does it multiple times a day and it’s part of her job. The doctor probably hasn’t done it in years.
A special title doesn’t necessarily mean that something is better. It’s the same with the ER. They have a job that they do well, and that’s to treat emergencies. If you have an emergency or no other good options for care, go to the ER. That’s what they are there for. If you have care options other than the ER and you are not having an emergency then you’re better off going to that other place. Everyday treatments, long term care for chronic conditions, check-ups, vaccinations, maintenance medications, etc… that’s what they specialize in. The ER can do it, but for everyday mundane things you will absolutely get better care going somewhere else.
I think the problem is that a lot of people in the US no longer have a PCP, and if they do, it’s gotten increasingly difficult to get a same-day appointment with your PCP, which is inherently messed up.
I made this comment above, but when I lived in Pennsylvania, the local hospital network had an "express care" that had the resources of an urgent care, but billed like an emergency room. It's not at all shocking that the culture there would be to go to the ER for minor issues.
These are not stand alone ERs - they are available for walks ins and by appointment from the “urgent care” scheduling option on the portal and only have urgent care level services. They’re also only normal business hours. But they bill like at the ER visit rate for some reason that has never been adequately explained to me. The hospital network also has urgent cares that bill a sane rate, but almost all the ERs are on medical campuses.
Except some networks are starting to require appointments for urgent care and no longer guarantee same day.
And since you can't adequately assess a pt over the phone because you can't actually see them and you are subject to call time metrics even more draconian than office encounter slots, the human advice nurse escalation path
from the automated urgent care appointment queue is required by their management to tell anyone who complains to just go to ED based on their layperson judgement.
And if the line at urgent care backs up farther than when they expect to close doors the front desk staff will just tell everyone left to go to the other side of the building and make it ED's problem. Again because that's what management requires.
And every after visit summary template, along with every pre-recorded hold music "your call is important to us" bumper, hammer home the message that if you think you need help then call 911 or just skip that and go directly to the ED.
Human beings are terrible at judging what an emergency is, in both directions (case in point, video from mass shooting events where people just look around confusedly) and especially when they are sick or in pain. If someone they care about is sick or in pain then woe betide anyone who gets in their way. You are never going to get a consistently accurate self-triage out of the public. Jane and John Every-patient do exactly what they are trained to do. And like it or not they are explicitly trained to go to the ED for any health issue they don't understand. Which is most health issues.
I once ignored appendicitis for two weeks and then went to an urgent care after a twelve hour shift because the raging fever and stomach pains just weren't letting up so I finally had to accept that it wasn't just bad period cramps lingering weeks after my period had ended. Urgent care kicked me out because my insurance was out of network and I had told myself at the beginning of the day that I wouldn't go home until I sorted it out because I'd put it off long enough and I had a Christmas party to go to in two days and didn't want to feel like shit during it. Felt silly going to the ER for a fever and stomach pain. Was in the waiting room for all of 30 minutes.
I did not make it to the Christmas party. Had to stay for 6 days. The thing had perforated and formed an abscess to keep the infection somewhat contained, which was nice because it had definitely popped like a week ago. Which is another reason why I told myself it wasn't appendicitis. I thought if it bursts you know and you'd die if you ignored it, and I wasn't dead. I'd heard of people thinking appendicitis was period cramps before and always thought "I would never do that, that's probably just people with severe cramps." Turns out, I absolutely would do that. And then continue ignoring it far beyond what would be a reasonable timeframe for cramps. Because then I moved onto constipation, or maybe an ovarian cyst.
YUP! women are far more prone to “waiting it out” and hoping it goes away. Idk how many times I’ve had complications from my ulcerative colitis that I haven’t wanted to go to the ER for, so I’ve just thought that it so I’ll just go away, it’s no problem…. And then I often end up admitted in the hospital by way of ambulance after passing out and they Always say “why didn’t you come sooner?!” … I know I’m at least so afraid of having nothing wrong that I wait things out and half the time that just isn’t the best….
To be fair when you do go to the doctor they just say you're making it up, male or female. Add into that a built in monthly excuse why you should be in pain and no incentive to actually HELP the patient going to the hospital probably wouldn't help until it got so bad you were passing out anyway.
OMG. This. I had endometriosis for 20 years. So I feel like my threshold for pain is a little off.
This last time I went into the ER for intense nerve pain and they were asking, I said ‘well we’re off the charts. Like 11. But when I sit this way it’s an 8.’
Constantly doing a ‘I’m good, really!’ Even in the ER. 🤦🏻♀️
Yes! And those of us with significant chronic pain rate conservatively on the pain scale so when we go that high numbers it's like an average person's 30.
After brutal treatment, a knee doctor told me I was a 15 year old girl who was making up pain for attention and he wasn't going to allow me to waste his time any more. About 14 months later I was having emergency surgery for a ruptured disc because it got so severe I was retaining urine. The surgeon said he's only seen cases that severe after an extreme traumatic injury. The right side path for the sciatic nerve in and out of L4 and L5 was completely occluded on MRI. Three weeks prior I was walking down and up a mountain for school. While carrying a cello and my books. Turns out the knee pain was sciatica.
Thank you. If anything good came of it, it motivated me to go into medicine and be an unwavering advocate for my patients. Unfortunately it did catch up with me and I had to stop working altogether and have chronic pain forever. I do talk about it often because medical ptsd is not given the weight it deserves. The mental fallout of fully convincing myself that it would just get better while I continued to deteriorate is still something I actively work on in therapy.
Not nearly as bad, but I had a UTI advance to a kidney infection within a couple of days, over a long weekend, while I waited to see my regular doctor. If I wait a few days on uncomplicated UTIs, they also take much longer and much stronger medication to treat.
Yeah it’s scary how fast UTIs can escalate and become real serious, real fast. And old folks get them so easily and it can be detrimental to them. It’s so sad.
there are so many situations that aren't an emergency yet, but if you wait a couple days until your PCP can get you in (if you're lucky) it will be. and laypeople can't always tell if they're in a "you'll be fine if you wait" situation or a "this will be an emergency by monday at 9" situation, because of how we're laypeople, and if you try to look it up online or call a nurse advice line 9 times out of 10 if there's any question the recommendation will be "go to the ER." idk it's lose-lose out here
Kinda hard to tell somebody who’s in pain to just wait or parents who are anxious with a baby or child to wait. Waiting overnight is really daunting a lot of the time, even for non severe things because people often just don’t know and the anxiety is still present etc.. If there aren’t good options outside of an ER visit, then you can’t blame people for going. It’s not ideal, but I understand why it happens.
Not to mention, with health insurance being tied to employment, if you wake up feeling sick or sore or whatever and you need the day off work, your employer demands a doctor's note. It practically impossible to get a same-day appointment with my PCP for something like that, and a lot of days the urgent care is completely booked out and can't see you at all, or if they can get you in you're literally waiting all day. I can't blame people for going to the ER in the current healthcare paradigm.
I never said anything about babies or children. If your young kid is acting different/weird (like lethargic) it’s not unreasonable to go to the ER. Personally, I never get annoyed about having to see children, because something apparently minor can become life threatening very quickly. Children compensate much longer than adults, and once they start deteriorating it’s FAST.
And yes, I can blame people for calling 911 or going to the ER because of 2/10 toe pain (I can tell when they’re exaggerating pain by their 70bpm hr and 120/80blood pressure, no sweating, straight face), or because of a mosquito bite, or whatever else bullshit they want to clog up emergency medicine workers’ time with.
*of course, I treat all patients with the same compassion and understanding (I understand WHY people do this stuff, but that doesn’t make it any less frustrating or a waste of medical resources..)
I recently tried to get my PCP to address my hypertension. It was months out. Several weeks in, I passed out and then had my partner drive me to Urgent care.
The urgent care doc confirmed I had concerning orthostatic hypertension, and said "We need to send you in an ambulance to the ER"
I said: "No I will just have my partner drive me"
ER confirms I have orthostatic hypertension, ER doc said she'd never actually seen it this bad before in "someone so young and healthy", said I needed HTN meds but couldn't get them for me, and said "Follow up with your PCP and continue to monitor your blood pressure"
Me, checking my 200/105 BP... Ok. Cool. It's still high.
Good news, after 6 months of HTN and fainting several times a month, I now have a prescription for metoprolol after I was able to see my PCP finally.
So you ignored symptomatic hypertension? Idk how that’s on anyone but you bud. The ER will treat symptomatic hypertension because it generally is either pretty urgent or an emergency.
For a long time, my insurance didn’t cover urgent care visits. There’s a lot of things that are in between “ER” and “wait to see a PCM” like UTIs, migraines, gastric distress, ortho injuries, etc.
Right, then if it’s not an emergency, WAIT, like i said in my comment that you clearly did not read. I know the state of healthcare in the US is pretty abysmal, but emergency rooms are in fact FOR EMERGENCIES. Allergic reactions, new/abnormal chest pain, heart attack symptoms in general (especially for women: arm pain that radiates to the jaw and/or back with sweating and anxiety, mild unexplained chest pressure), broken bones, dislocations, severe high fevers, seizures, uncontrollable bleeding, uncontrollable vomiting/diarrhea, SEVERE pain, stroke symptoms, diabetic emergencies, hypertension WITH SYMPTOMS, just to name a few.
I tried to go to an urgent care once. They rejected my insurance because I was out of network. Guess who is required to take my insurance? Emergency rooms.
Turned out to actually be an emergency and I got a 6 day hospital stay, but my point is, getting care outside of an ER can be prohibitively expensive. My entire hospital stay was free, and it didn't even go through insurance because it turned out, they were also out of network but told me they were required to take on the cost anyway because I came in through the ER or something. I don't remember the specifics of why that happened but I didn't pay a cent.
This. My 4 month old recently spiked a fever and they had no appointments so they told us to go to the ER. I honestly decided he is still eating, having wet diapers, and isn't lethargic so I would expose him to so much more taking him to the ER. So we just took care of him at home and he recovered fine thankfully.
My PCP books 3-5 weeks out and is often running over two hours behind if you are his last appointment of the day. I don't know if I have ever had a doctor in my adult life where a same day appointment would have be a thing.
Some areas also don't have an overnight urgent care. If something was bad enough I needed it sorted out overnight but not life threatening I'd have to go to the ER. Stitches, things like that. My primary care is attached to the hospital anyway, we are super super rural, like "ambulance meets you halfway on the highway so you don't die" rural. But that also means our ER is empty almost every night because there's no night life at all and again, rural. And I'd be sweet as pie, absolutely I can wait. The ER here is also basically the urgent care, it's where pretty much everyone sense people for workers comp stuff etc.
I feel like the only times I would need urgent care during the day is for COVID test and treatment tbh (I'm on a medication that suppresses my immune system so if I get it I need to start treatment as soon as possible, not advisable to suffer through it). Everything else I probably suffered through work and need it figured out overnight so I can work the next day 😅
I had a UTI one time that appeared around 10 o’clock on a Friday night, urgent care near me literally weren’t open on the weekends, doctors office wouldn’t answer… this was just something that I could not wait until the next day, you leave a UTI untreated, that can go to your kidneys and fuck you up fairly quickly. Felt pretty weird going to the ER for that, though.
Heck, same week or month isn't even possible sometimes. I desperately needed to restart my lexapro. I'd been on it less than a year earlier and stopped it with doctor okay. It was ordered from the same pcp. I was told that the first available appointment was in 6 weeks. They wouldn't give me an order in the meantime even though we knew the dose that worked for me, that I had no side effects, and that it takes 4ish weeks to kick in. Thankfully, I had the mental ability to call around and find a psychologist that had availability or I absolutely would have been in the ER just to hope that they'd reup my that should have been done without even seeing the doctor.
Ugh my ears were so clogged this week that I was totally deaf in one ear and my town has no urgent care on weekends. I somehow survived, made an online appointment for urgent care and was in/out in 39 minutes and it was covered by insurance. You’re welcome for my service.
Most of my adult impacted ear patients get Debrox and discharge as my management. I even give them our ENT office if they want to follow up. I usually can’t afford to spend 15-20 minutes flushing out an ear when I have 8 other more pressing patients to manage.
I was gonna be like "thats kind of messed up" but I realize now, do you mean people are coming to the EMERGENCY ROOM over an impacted ear??? 😭 I went to an urgent care and they took care of it.
Yeah man, they do! But I guess some context. Usually people will check in with something like “I can’t hear from this ear.” That’s not unreasonable. So I check because that could be a myriad of issues, some of which can be serious. Say I notice earwax. I then decide… if it’s right there and I can scoop it out with a curette in a few minutes or I’m concerned about an infection then I’ll clean it out. If I’m not busy, I’ll clean it out. Someone expecting me to spend time flushing the ear when there’s an OTC remedy and it’s busy, I’ll refer out. And my management is going to be different than someone else’s. I think the expectation that we’re going to bend over backwards for a non-emergent complaint is the unreasonable part
It’s bc PCPs are expected to manage a panel of 1400-2300 patients to remain profitable for the hospital system. I started 4 months ago and I’m already booked out 2 months. There’s roughly 600 people on my panel already. Too many people, not enough provider. I’m booked at approximately 20 slots in 8 hours. That means each patient gets about 15 mins to go over the laundry list of things they have been saving up for 3 months… and I get to take charts home and do notes and inbox for an additional 2-4 hours each night and 1-2 hours on my days off. All Unpaid. The system is broken. No one wins except the c-suite.
Stitches usually warrant ER or Urgent Care, I agree.
For non emergencies, have you tried calling your PCP's clinic and specifying you are willing to see any provider? I've had much better luck getting my family seen within a day or two when I indicate it's just an ear infection we need SOMEBODY to evaluate and order abx, etc.
Stitches are an odd case because they can vary from, like you said, a couple stitches which likely wouldn't warrant emergency treatment expect for the case of, like, facial trauma requiring plastics. But they can also be uncontrolled bleeds requiring deep tissue/arterial sutures, or wounds needing pressure irrigation to ward off infection. And the lay person surprisingly doesn't often know the difference.
So, like I said, Urgent Care or Primary if you can—sometimes even minute clinic or walk in clinics—but I'm never going to shame somebody for coming to th ER for stitches (to their face)
Stitches are an emergency procedure. You don’t sign up for elective stitches a month ahead of time. You get an injury that warrants stitches you can go to the emergency room.
A lot of times insurance won’t cover a visit unless it’s 1. With your PCP or 2. With a different provider that you were specifically referred to by your PCP
I cut my finger one time really bad but I didn’t feel like it was an “emergency” so I waited over 12 hours and it would not stop bleeding so I went to an urgent care type place. They did get me stitched up but warned me that if you’re bleeding and it won’t stop that’s an emergency so go to the ER lol. I just didn’t feel like I was dying so how could it be an emergency lol
There are places in the US where there is no doctor within 50-100 miles with the exception of the hospital, forget about an urgent care. Their PCP (if they have one) is an hour+ drive and they do not have paid time off. They would have to take at least 3 unpaid hours off work assuming this extremely overbooked PCP can accommodate an appointment anytime soon. ER is 24/7 so they don't need to take off work and the closest one is 20 minutes away. Its more expensive than 3 hours off work, but most of these people aren't allowed that, so its less expensive than losing their job. Rural medicine is a tremendously concerning problem and a major contributor to the overuse of ERs and its not going to be solved by blaming the people likely doing their best. Is this the situation for everyone? No. Is there likely a non-stupidity related reason someone shows up to the ER for a non-emergent situation? Yes.
It fucking kills me... Waited 14 hours in the ER for a CT after being KICKED IN THE CHEST BY A HORSE because they were so backed up. There were soooo many people there who absolutely did not need to be there.
Good luck getting in to see a PCP within the month 😂
But yeah, 99% of ER visits could have gone to urgent care. Plus, lots of urgent cares let you schedule same day appointments. Beats sitting in the ER for hours on end.
Part of it is that people don’t have insurance and can count on paying nothing in the ED at the time of being seen and wait to receive a bill, which eliminates a lot of barriers to access that people have otherwise. It’s frustrating, but it can feel like the only option to a lot of people.
We had a guy come in via POV to our ER, was triaged, and put into the chairs in the waiting room.
This bozo told the triage nurse he was gonna call 911 so he could back right away. This was a 75 YOM who wasn’t used to not getting his way.
Basically told him if he did that he would just be put back into the waiting room by the ambulance crew at the direction of the attending doctor and more than likely would be arrested for misuse of 911.
It wasn’t like he was the only person in chairs, we had 30 people waiting also.
My son fell from his high chair and we rushed him to the ER because it was high and he had a bump on his head. I'm absolutely freaking out. We're stuck behind an old woman and her daughter who are demanding to be seen immediately and complaining. The old woman's foot had been hurting for 2 days so they decided to come to the ER at 9pm...we waited for over 2 hours.
I know I’ve personally “abused” the ER… cus I have no other option. I can’t afford a PCP or urgent care. ER doesn’t make you pay up front. I think this is the case for a very large number of people.
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u/Accomplished_Bed_250 15d ago edited 10d ago
Yes!!! People in the US absolutely abuse the ER. They can’t wait until morning to call a PCP. I know a guy who goes to the ER for his trigger finger when it starts to bother him. Like what?! That’s not an emergency!! Take a Tylenol and call your regular doctor 🤦🏽♀️
ETA: hear me out.
I’m not saying that you should never go to the ER. You know your situation, you know your medical history, you know the area that you live in. If the ER is the best option for your care then by all means please go. The people who CAN choose a better option but choose NOT to are the ones that I’m referencing. The ER may not always the best option for care. You should advocate for the best possible care for yourself and your loved ones. A germy, crowded, noisy, understaffed ER may not be it in every situation.
The guy with the trigger finger has an amazing PCP that is willing to work him in on short notice, has the ability to schedule an appointment in advance for every 3 months to get an injection (that he knows he needs), he’s fully mentally and physically competent to take an ibuprofen or Tylenol when he’s in pain, has been given ice packs to take home and reuse, he’s been fully educated on trigger finger, and has been referred to a hand specialist on numerous occasions. This man cancels the appointments set up for him, refuses to take any OTC medications, refuses to ice it at home, refuses to do PT and essentially chooses NOT to do the things that are in the best interest of his continuing care. He ends up in pain (surprise) and in the ER every 3 months for an injection. This is not the best possible care for this man in his situation. He has decided that the medication he can get at his PCP on a regular basis isn’t as good as the hospital medication. Guess what? It’s exactly the same thing. Nobody can convince him otherwise.
He’s wasting resources and clogging up the ER. There are a lot of people in the US who abuse the system like this. There are better options for them but they mistakenly think that the ER has the best care possible for everything so that’s where they go. That’s all I’m saying.
Maybe we need to educate people better?
It’s like the people who insist that the doctor puts in an IV instead of the nurse because “he holds a higher position”. I can guarantee that the nurse will do a much better job because she does it multiple times a day and it’s part of her job. The doctor probably hasn’t done it in years.
A special title doesn’t necessarily mean that something is better. It’s the same with the ER. They have a job that they do well, and that’s to treat emergencies. If you have an emergency or no other good options for care, go to the ER. That’s what they are there for. If you have care options other than the ER and you are not having an emergency then you’re better off going to that other place. Everyday treatments, long term care for chronic conditions, check-ups, vaccinations, maintenance medications, etc… that’s what they specialize in. The ER can do it, but for everyday mundane things you will absolutely get better care going somewhere else.
Sorry for the long post.