THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: TUESDAY, June 28, 1994 TAG: 9406240030
SECTION: FRONT PAGE: A14 EDITION: FINAL
SOURCE: By MICHAEL J. BONO, M.D.
DATELINE: 940628 LENGTH: Medium
It's Saturday morning and you're working on a home-repair project. You misjudge your aim and accidentally hammer your index finger, probably breaking it. You call your HMO and are told to come to the office on Monday. By evening the throbbing is too painful for you to sleep. Is this an emergency?
{REST} As a specialist in emergency medicine with eight years of experience treating the full range of illnesses and injuries for which people seek treatment in emergency departments, I was surprised to find that some officials would object to the individuals in the cases above seeking relief in an emergency department.
The lack of concern or compassion displayed for the very real pain and suffering that brings patients and families to emergency departments like mine was demonstrated by the recent release of a Department of Health and Human Services survey. The claim that a large number of visits to emergency departments for conditions like those above proves that emergency care is an expensive replacement for regular medical care, including preventive services, distorts the reality of how our citizens receive emergency care.
The American College of Emergency Physicians (ACEP) and Upjohn Co. conducted a national survey in 1992 which found that most Americans rarely use the emergency department - only 40 percent had sought emergency care for themselves or a family member in the past 12 months. Of those reported going for a non-emergency, 16 percent went because they believed it was an emergency at the time and another 25 percent turned to the emergency department when their doctor's office either was closed, told them to go to the emergency department or couldn't give them a timely appointment.
As an emergency physician, I know that people do come to the emergency department for mild conditions. I also know that delaying treatment for certain conditions is not only painful and frightening, but can be dangerous. Ear infections often occur along with infections of the blood, nearby bone or the brain, and repeated infections could possibly cause deafness. Sore throat may be epiglottitis, a potentially life-threatening condition.
The pain of indigestion may really be a heart attack. Can we expect the public to tell the difference between emergencies and other serious conditions when we doctors can't without tests?
We all agree that emergency care is no substitute for routine care, but comparing the costs for preventive services or an office visit to the care provided in an emergency department is silly and clouds the real issues. Often, an office-based physician must send patients elsewhere for tests and have them return for analysis and to prescribe the course of treatment. These tests, analysis and treatment all occur with a single visit to the emergency department.
ACEP supports many provisions in the president's health-care plan, including the concept of universal coverage. As the physician group that currently provides the major source of care to the uninsured and underinsured, emergency physicians believe that the president is right to make health-care reform a major priority of his administration.
But we need to remember that emergency care is a vital community resource, like fire or police, and our citizens will demand that the current level of quality and availability be maintained. Emergency departments operate around the clock, seven days a week, and of necessity are staffed to accommodate maximum readiness. Any plan that would cut costs by preventing patients from using the emergency department when they believe it is necessary would be wrong, and worse, it would be dangerous. by CNB