A trip to the ER!

Mom loves to go to the emergency room. It’s quite the drama and she is the center of it all. She calls 911. They dispatch a large red fire engine to her house. The paramedics examine her and then call an ambulance to take her to the University Medical Center. They wheel her into an examination room. She describes her symptoms. A parade of doctors, nurses and assistants talk to her, examine her, consult with specialists, order diagnostic tests and imaging studies, ponder the results, figure out a diagnosis and decide upon a treatment.

The drama has a happy ending. If her condition is not serious they discharge her with whatever medical equipment and prescriptions she needs. If her condition is serious, they admit her to the hospital, where the drama is repeated on a bigger stage, but with the same leading lady – Mom!

The ER satisfies her needs

I used to think that the emergency room should be avoided unless you fear that you will die or be permanently crippled if you don’t go. Or unless you are unconscious and the authorities call an ambulance to take you there. But after several trips to the ER with Mom, I realize that Mom is wise to go there. When I look at the ER from a systems engineering perspective, I see that it is well designed to meet the needs of its most important users: the sick and the injured. Mom.

She needs a ride to the ER

She certainly can’t drive herself and she may need medical attention on the way to the hospital. One call to 911 is all it takes to arrange a ride to the ER.

She needs medical attention now

People can get sick or injured anytime. The ER is always open, no appointment required. You just go when you need to.

When you arrive, a specialist in emergency medicine will quickly assess your condition. If your condition is not immediately life-threatening and the emergency room is busy, you may have to wait for an hour or two or three to be treated. But even so you know that if you take a sudden turn for the worse, you will get help immediately. And it seems fair that people who are in more urgent need of care get help first, even if they arrived after you.

She needs an accurate diagnosis and effective treatment

She knows how she feels – sick, but also worried, anxious and scared. She doesn’t know what is causing her to feel so bad. She certainly doesn’t know what treatment she needs. At the ER, a doctor trained in emergency medicine supervises a team of specialists to diagnose her condition. The medical equipment and supplies they need are all at hand. They can order lab work and imaging and have the results in less than an hour. Once they make a diagnosis, treatment begins immediately.

She doesn’t need to be hassled for money

After the doctors have examined her and we are waiting for test results, we get a discreet call from someone in the accounting department. They verify her insurance information and then leave. Mom has excellent insurance (Medicare plus Tricare – my father is a WWII veteran), but even when I have taken uninsured friends to the ER, they don’t shake us down for money.

By law, the ER must provide emergency care for all who need it. This frees the ER to focus on the medical needs of the patient rather than the financial needs of the institution. This also removes one cause of anxiety for the patient.

She needs someone to be with her

Like everyone else in the ER, she is sick and anxious. People who are sick and anxious have a hard time focusing on what they are being asked and told. And of course some people arrive at the ER delirious or unconscious. Aside from providing emotional support, a friend or relative can provide information to help the medical team. Companions can ask questions to fully understand the diagnosis and treatment. They can then explain the diagnosis and treatment to the patient in terms that the patient can understand.

As soon as I find out that Mom has gone to the emergency room, I drop everything and go there to be with her. The medical team is very good at including me in all their discussions. They patiently explain everything to me and answer all of my questions. Good thing, too. I always have to explain things later to Mom.

Don’t ask her to do anything on a computer!

Mom’s mastery of computer technology is limited to reading emails from my brother on her cell phone. She has no idea how to use the internet. Her hand-eye coordination isn’t good enough to type information into a tablet, let alone a cell phone. Mom’s computer skills are typical for everyone over 80. It is unreasonable to ask her, or anyone else over 80, to fill out online forms. In the ER, they don’t.

Is the ER the best option?

What if Mom has a condition that is worrisome and doesn’t seem to be getting better, but isn’t immediately life threatening. Should she go to the ER, should she go to an urgent care clinic, or should she go to her doctor?

Systems engineers use a technique called a Trade Study to decide what solution is best. Here is a very simple trade study to evaluate the choices for a very old person with an undiagnosed and worrisome health condition that isn’t getting better.

Conclusion

Mom is right! If you have a worrisome medical condition that isn’t getting better, the ER is the place to go.

Afterword: Why do doctors score so low?

It is difficult for them to collaborate with other doctors

We can’t expect any doctor to know everything about every medical condition. Complex or unusual conditions require collaboration. But the system of primary care physicians and specialists as currently structured creates many obstacles to collaboration.

• Doctors don’t have time for collaboration. They have their own patients to take care of. They have to spend time on the phone negotiating treatment decisions with insurance companies. They have to spend time on the computer entering information into their electronic medical records system.
• Doctors are difficult to get a hold of. If you call a doctor, the doctor will almost certainly be busy and you will probably also be busy when the doctor calls back.
• Information about the patient is stored in many places. For example, most of Mom’s information is stored in one of three different electronic medical records (EMR) systems. Some of it is stored in the offices of various specialists she has seen over the years. Doctors don’t have easy access to information stored in EMR systems other than the ones they use, let alone information stored in a specialist’s office.

All too often a doctor is unaware of what other doctors have found out about a patient. The unfortunate consequences of this ignorance include delayed or incorrect diagnoses and duplicate tests.

It takes a long time to get an appointment with them

You have to wait a day or two to see your doctor. You often have to wait weeks to see a specialist. If you have to see several specialists, this time can add up to months. In the meantime, you are not getting the treatment you need.

They require payment up front

Note that this is only an issue in the United States. All other advanced countries have figured out a way to provide healthcare to everybody regardless of their ability to pay. T. R. Reid wrote an excellent book describing how countries around the world provide healthcare titled The Healing of America: A Global Quest for Better, Cheaper and Fairer Healthcare. See the Wikipedia article The Healing of America for a good summary of the book.