An ER Dilemma

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"To Go to the Emergency Room—Or Not" ["On Health & Money,"] brings to light two common and disturbing patient conundrums.

To help people know when they are facing a medical emergency, the American College of Emergency Physicians (ACEP) has developed an online Emergency manual. As for insurance, ACEP has long maintained that coverage should be based on the initial symptoms—and not be denied following diagnosis—because patients should not be forced to self-diagnose, especially when deciding to wait for care could prove deadly. This dilemma should also remind us all that it is potentially dangerous for anyone critically in need of immediate emergency care to have to wait for any reason. Yet, ERs nationwide are plagued by overcrowding, long waits and other related problems. And while several factors—including a lack of reimbursement for care provided and shortages of staff and other resources—contribute, non-urgent patients are not to blame. Indeed, a federal study has found that 86 percent of emergency department patients truly should be there, with many facing unacceptable wait times. Worse yet, these dangerously long patient waits are only going to increase with continued federal cuts, and with greater emergency-care demands caused by aging baby boomers. Amidst all the complexity and confusion, one thought remains clear: America should not be left waiting for answers. We need more clarity on coverage as well as comprehensive health care reform to help shore up emergency care.

Linda L. Lawrence, MD, FACEP

American College of Emergency Physicians