Surgeon in my dreams commented:
I have migraine headaches and asked my doctor just last month during a visit what should I do if I have another like the one I had just gotten over. I mean I was hurting so bad I just knew I was about to die and welcomed it. I was throwing up with barely any time to come up for air in between.[sigh] This is so emblematic of much that is wrong with health care (especially primary care) in this country. No criticism to you, SIMD, you and many many other patients do what they are told and "just go to the ER." And we are there to see you, because we have to be. But the point is that people like you shouldn't come to the ER. I should be clear on this point -- there are times when, say, a headache or abdominal pain do warrant an ER visit. New onset symptoms which are not well understood do require an emergent evaluation. But for chronic conditions which have been appropriately diagnosed, we are all better off if you are treated by your personal doctor. And let's be honest: doctor's offices do have IVs, medicines, fluids, etc., and if they do not it is a matter of choice on the part of the office practitioner.
I asked him if I come to his office would he give me something or just what should I do. He TOLD me to to go the ER. He said he did not keep anything strong in his office so it would do me no good to go there.
I am not trying to criticize my office-based colleagues. I suspect many of them would love to provide comprehensive care, from routine and preventative visits to more urgent, acute problem-based care. Flea gets insanely pissed off anytime someone is diverted away from his care. He may be an outlier, but I suspect he is representative of many clinic docs' desires. Most clinic docs will not or cannot manage to provide these services because primary care compensation is so low that their financial viability is dependent on through-put, and the reimbursement given under ambulatory care codes is woefully inadequate compared to disruption to the office flow and the time investment required to provide the care. Change the site, though, to the ER and I can collect three or four times the amount (far more including facility fees) for the exact same service. Even with the recent RVU updates, the system remains broken, and one of the consequence is the shuffling off of much primary care to the ER.
Symtym covered this pretty well last month. A couple of key points that bear emphasizing:
- Emergency Medicine has been a willing victim of its own success.
- Emergency Medicine has been all too willing to cover for the deficiencies in the availability of primary care (in terms of numbers and time).
- Emergency Medicine is not an essential service, but a convenient service.
- "Just go to the ER" is not a national health policy.
To respond more usefully to you , SIMD, we must acknowledge that we go to war with the health system we have, not the one we would wish (to paraphrase the departed but not lamented Sec Rumsfeld). Let's also acknowledge that the ER is expensive, overcrowded, inconvenient, and the care there is in many cases suboptimal. So what else can you do? If I had migraine headaches, and on an occasional basis they became uncontrollable, and if I had a PCP who knew and trusted me, I would ask for the following "Emergency Kit":
- Two tablets of orally-disintegrating Zofran
- Five tablets of 10 mg Toradol
- Four tablets of 2mg Dilaudid