post by Bill Gardner
This is a problem, for several reasons. First, having lots of non-emergent cases in an ER may delay care for people who need it right now. Second, an emergency department is not set up to follow patients after they are treated, so emergency care for patients with chronic health problems is not as good as primary care. Finally, because emergency departments are designed to handle trauma (and to handle several severe trauma cases at the same time), they are 'over built' and inefficient for routine primary care; so performing primary care in an emergency setting increases health costs.
And if you visit an urban emergency department, you will also notice that the apparently non-emergent cases are poor people and, depending on the neighborhood, people of color. Health care workers sometimes develop an attitude about this: "Don't these people realize that they would be better off seeing a primary care provider?" or, less charitably, "Are they too lazy to get a primary care doctor?"
But this is blaming the victim. In today's NEJM, Arthur Kellermann and Robin Weinick argue that
The fact that many ED visits could be managed in primary care settings does not mean that such care is available. In fact, ...high rates of ED use for ambulatory care–sensitive conditions are a strong indicator of poor access to care — not poor judgment on the part of patients.
They summarize the research showing that lack of access to primary care drives emergency department use:
In 1994, research assistants posing as Medicaid patients telephoned a random sample of primary care doctors and clinics in 10 cities to determine whether Medicaid patients could get treatment for minor problems without visiting an ED. The callers were successful only 26% of the time. When office staff members were asked to suggest an alternative, the most common advice was no advice. The next most common recommendation was “Go to an ED.” In 1996, researchers who were posted in 56 EDs nationwide interviewed 6187 walk-in patients over a single 24-hour period. When asked why they chose an ED for care,... 45% thought they had a medical emergency or were too sick to go elsewhere; 19% said they were sent to the ED by a health care professional.
So why don't the poor have access to primary care in the US? That is for another post. But do not blame the poor for this problem.