Over the past several years, in addition to my work in EMS and trauma centers, I’ve picked up shifts at various freestanding EDs around town. I care for a variety of patients in those settings from illegal immigrants to affluent suburbanites. As a result, I’ve come to a stark realization that’s crippling healthcare in the United States: Americans have no idea how to consume healthcare!
We’ve all had those calls on the ambulance that want to make us pull our hair out—broken fingernail, stubbed toe and fever for 15 minutes. Physicians see the same thing in the ED. People call 9-1-1 with a complaint that’s clearly not an emergency because they have the need to get it checked out, and checked out right now!
This issue is relatively new as emergency medicine has increased its presence in our communities and in the consciousness of Americans.
The increase in access to community-based EDs and urgent care centers has created a change in the paradigm for the consumption of emergency and after-hours care. This model is very attractive for consumers because they’re close to home, there’s little-to-no wait, you don’t need an appointment, and they’re always open.
The increasing presence of these centers, as well as expansion of hospital-based EDs, is coupled with dramatically poor access to after-hours primary care in the U.S. when compared to other developed countries. Due to this shortage, many of these patients access emergency services because they can’t get in to see their primary care physician (PCP) or just don’t have the time to take off work.
Another possibility is that because of the presence of EMS and immediate-access facilities close to home, we’ve created community health anxiety.
Patients develop a symptom or an injury at home and, because they don’t have extended family in the household any longer to ask for advice and have no medical training, they have no way to determine if it’s something that needs attention.
If they decide it does need attention, they have to decide if it needs attention immediately (EMS), soon (ED) or sometime (PCP). Contributing to this anxiety are TV shows about terrible diagnoses that seem benign at the onset, and Dr. Google. For many, it creates psychological pressure to get whatever it is checked out now no matter how minor the complaint seems.
Although we’re seeing these very minor complaints in the field and in the EDs, I’m also seeing children with femur fractures, STEMIs, strokes and patients with massive pulmonary embolisms being brought in by car to the freestanding ED because the families didn’t think to call 9-1-1.
These aren’t indigent patients or immigrants who don’t understand the system, these are middle-class, college-educated folks who made the choice to put their loved ones in the car and drive rather than call 9-1-1.
Their reason is usually one of three: “The ambulance is too expensive,” “I could drive here faster,” or “I didn’t even think about an ambulance.” They simply lack the most basic medical education to make an informed decision about when and where to seek treatment.
This inability to effectively triage themselves is widespread across the community and, although at times we’re deeply annoyed by the low acuity calls and visits, we have to appreciate the importance of our role in providing that triage for the community.
We must utilize these calls and ED visits as an opportunity to educate the public in a constructive manner on how to better access care.
Refocus on Education
We must also realize in America the desperate need to include basic healthcare education at all stages of schooling. We first need a strong focus on the importance of preventive healthcare. We consume healthcare as infants and children for the purpose of prevention through checkups and immunizations. Then from secondary school age to our 30s we consume healthcare for treatment when we’re sick and develop the false conclusion that not feeling sick is the same thing as being healthy. We have trouble switching back to the prevention model that we need beginning in our 30s.
We also need to focus education on basic treatments for common emergencies. This could mean first aid and advanced first aid in middle school and high school, and emergency first responder-type courses in college as required curriculum. These programs could train students not only in the techniques to care for emergencies, but also how to assess the level of emergency that they’re facing so that they can be better lifetime consumers of healthcare.
Until we can change policy, we have to focus on short-term opportunities to educate the public through EMS. We need to develop innovative programs that not only focus on the acute emergencies but also the importance of maintenance of health. We must also renew the “Dial 9-1-1” campaigns of the ‘80s and ‘90s, which provides education on appropriate times to call so that we don’t continue to miss opportunities to help those most in need in our communities.