The article explains:
When someone comes into the Medical Center Hospital ER, they’re assessed to determine the severity of their ailments.
“They’ll all be seen by an ER physician,” Divisional Director for Emergency Services Dena Mikkonen said.
If the injury or illness is determined to be minor, they’ll be directed to a local clinic rather than be treated in the ER.
But if that person chooses to remain in the ER and have their minor ailment treated there, they will have to pay a $250 deposit, MCH Business Office Director J.R. Edmiston said.
This sounds reasonable. This helps keep the ER capacity freed up to handle true emergencies and encourages people who do not have dire emergencies to use care that is more appropriate for their condition.
Of course, there was the predictable criticism (also from the article):
Federal law requires ER physicians to look at everyone who comes to the ER and treat those who have life-threatening illnesses or injuries, but depending on the initial ER examination for a referral is problematic, said Andrew Fenton, president elect of the California chapter of the American College of Physicians.
Based on the examination a doctor has to decide whether or not the person’s injury or illness requires a stay in the ER.
“Asking a physician to make such a determination is challenging in a short period of time,” Fenton said.
While I think this criticism is overblown, Fenton ignores that the patient can decide to stay by making the $250 deposit.
With everything there are trade-offs. There are no perfect solutions. A lot of things are justified by cherry-picking the trade-offs that suit our view.
At some point a physician will make a bad call (humans are fallible), misdiagnose and send a patient off that needed emergency treatment. Folks like Fenton will grab on to those stories and say this is bad policy and it’s worth treating everyone in emergency rooms “if we could just save one life”.
And they won’t give due consideration to all the trade-offs.
First, misdiagnosis and mistreatment occurs within the emergency room now. We’ve all heard these stories. It’s not immediately clear how this new approach would increase misdiagnosis of life-threatening symptoms.
In fact, this approach may improve diagnosis and treatments of minor ailments. Sending the patient to another doctor could be better because second opinions from other doctors may catch things the first doctor missed.
That’s one positive trade-off Fenton would miss.
Also, he will not likely consider how many additional lives were saved by focusing ER resources on true emergencies.
He won’t understand that the opportunity cost for saving that “one life” may be two or three lives, because cramming the ER with patients with other minor ailments to save that one life-threatening misdiagnosis in a thousand (or more) may take ER capacity away from folks with true emergencies.
Fenton offers one trade-off to support his side. The urgent care facilities may not have the facilities to do all the tests they need. But, I think that’s a big maybe. Again, with the second doctor checking, they may have a better chance of getting a good diagnosis than had the person stayed at the emergency room.
Fenton might say to me, You wouldn’t want to be the one person with the misdiagnosis.
To which I would respond, No. But you haven’t convinced me this will actually cause anymore misdiagnosis than occurs now. Further, I also don’t want to be one of the two or three people with true emergencies that don’t get treated because the emergency room capacity is used by people with minor ailments. At that point, the emergency room has ceased being an emergency room. Much like how health insurance has ceased being insurance.