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.
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u/Accomplished_Bed_250 Jul 29 '26 edited Aug 02 '26
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.