Scalpel and Nurse K are flaming each other like nobody’s business. Should the ED (not the ER, folks) be used for trivial complaints?

Get out your asbestos-coated monitor, grab some popcorn (put it by the monitor and it will pop itself), and take a look here and here.


  1. Scalpel’s approach is as a businessman – increased convenience for patients. This is not unreasonable, but there is no doubt it accelerates the trend of escalating costs, and does not enhance health care quality. This is costing the people who pay for health care (govm’t, insurance co’s, whatever) more than it should, and since we as physicians can’t seem to limit these expenditures, someone else will.
    Interesting he practices in Texas. A recent article in The New Yorker sheds some light on this.
    The author investigates an area in Texas with the highest per capita Medicare expenditures, and finds exactly this stuff going on. Yet quality measures are not that good.
    Opponents of these practices there include a cardiothoracic surgeon who sounds a lot like Nurse K. We should be maximizing quality of care, but since that’s hard to measure, it’s really hard to pay for it.
    More care |= Quality care.

    • Both sides have valid arguments.

      I think that Scalpel takes his “this COULD be an emergency” argument a little too far, but his point is well taken.

      In a true free-market system, Scalpel’s approach is entirely appropriate. You want to pay $500 for an ED visit for sinus congestion so that you don’t have to miss a day’s work? Not very cost effective, but that’s your decision. Hospitals should be kissing the butts of people who choose to pay for their medical care in that manner. Unfortunately, medicine isn’t a free-market system. A majority of patients at many hospitals pay *nothing* for their care.

      That’s where Nurse K’s position comes in. In effect, she’s rationing care at the triage window. Should people who pay nothing have unlimited access to emergency medical care?

      Scalpel argues that we don’t have to provide emergency care for those with non-emergencies, but sending non-emergent cases home is what caused the whole University of Chicago debacle. Legally we don’t have to provide nonemergent care, but in the eye of public opinion, apparently we do.

      I bet if Nurse K was able to collect a $25 co-pay from every patient who registered, there would be a lot less animosity.

  2. The ED can be used for trivial complaints. The ER is for emergencies only.

    Unfortunately, the ER is dead.

    • In the emergency “department,” patients with trivial complaints can go to the waiting “room”.
      If you only have an emergency “room”, everyone sits together.
      If you were still blogging, I’d come over to your place and beat you about now, big sis.

      • Monkeygirl comes out of the woodwork for a blogfight. Gotta love that.

        I think it’s sad that you left the ER, Monkeygirl.

        I have a $25 front-row “co-pay” to watch WhiteCoat and MG fight. I know how to spend MY money wisely.

  3. Looking for someone to start a flame war with WhiteCoat over ER/ED.

    This debate is a lot more petty than the one referenced in the post.

    ED in this sense is like the secret handshake for medical professionals. It is how they can show they are in the club because in the real world, ED is a disease treated with a little blue pill.

  4. The ED is for emergencies.

    Sinus congestion is not an emergency. If you have to go to the doctor outside of work hours, suck it up and go to the urgent care. Even better, drop in at the Minute Clinic. You can buy a box of Sudafed while you’re there – no extra trip needed. .

    I have no fondness for the health insurance industry, but IMHO more plans should slap stupidity taxes on people to discourage such idiocy. (Yup, my plan has a high ED co-pay, even when conditions warrant. The other stupidity tax of my plan is pre-auths for CT or MRI – no pre-auth, no coverage, unless it’s an emergency.)

    Around here, you don’t even need an appointment to be seen without waiting in the ED. The Adventist hospital up the street has a “no-wait” ED – ostensibly, this was a deliberate design, but the no-wait property is said to be more effective than usual because most of their traffic comes with lights and sirens.

    • In the town of 100,000 where I grew up, there is not a single urgent care clinic. Stop using such a broad brush on health care. You do not know what you do not know.

  5. Best part of this whole thing is Scalpel called me a “Dipstick” in an email. It’s cute when he calls me his wife’s pet name for him.

  6. Pingback: Newest EMTALA Violation? « WhiteCoat’s Call Room

  7. Working the ED over the weekend.. Saturday was Flu day – 80% of patients came in with cc of flu sx and 60% of those cultured + for Influenza A and got tamiflu. The others? One r/o MI and a bunch of dentalgia and low back pain. Most of the care given is going to end up being charity. Unfortunately, it was once explained to me that you could not determine an emergency condition from triage. The determination of an emergency condition entailed developing a diagnosis. This might entail full lab workup, repeat labs, CT, MRI if appropriate and coming to a diagnosis. This is how it was explained to me, a humble ED Nurse. Funny thing is, 99.999% of the time, the triage nurse get’s it exactly right as what’s going on from an emergent vs non emergent perspective.
    Why can’t the ED be more like a dentists office? You get to the back, get seen and the ED physician leaves and a financial clerk comes back with a treatment plan – and how much it would cost to continue continue that treatment.. I can see it now. “sir/ma’am, the ED physician has determined you have severe dental carries and a possible infection. The treatment plan is to start you on antibiotics and pain control. The portion you are required to pay today would be $400.00 (or whatever). We accept cash, mc, visa, amex and checks. How would you like to pay today?” Of course, the problem with this idea is that same person does not have money to pay for his care, nor insurance, so he goes home untreated and ends up dying from an abcess that extends into his brain. His family then sues the hospital, the physician, nursing staff and the financial personel because even though it was not an emergent problem at the time, the problem was diagnosed but not treated. Did the ED personel do anything wrong? I think not. But in the end, that is why we have to continue to treat everything that walks through the door despite ability to pay or whether it’s emergent or not. They can alway’s worsten and have a significantly worst problem that could cause disability or death, even if it’s indirectly.

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