“Growing up, I understood the financial difficulty of my family and how it put us in the position of trying to ‘fight through’ ailments instead of seeking treatment we could not afford.”
Evidence has revealed that many people avoid calling an ambulance in the setting of a medical emergency. Research published in this journal indeed demonstrated that at a major hospital in this country, patients with an acute ST-elevation myocardial infarction, that went straight from the ER to the cath lab, arrived by private vehicle some 60% of the time.1 The paper also discussed the finding that patients whose preferred spoken language was Spanish were far more likely to arrive by private vehicle than to present by EMS to the hospital. A similar finding was shared with these authors about patients presenting with stroke.2 This difference in mode of arrival is far more than the major medical issue that it presents, but also presents a cultural issue that must be addressed.
Denial of symptoms of a condition prevents the management of the possible critical severity of that condition in problems ranging from heart attack to stroke. It is understandable that patients might say, “Won’t I be okay if I just stay home?” They may say, in acknowledging that a problem is there, “If I just relax, the symptoms will go away.” Or, going further in recognizing that a serious problem may be occurring, “maybe I can call my doctor tomorrow if I still feel bad.”
The senior author of this submission writes, “My mother, being a housekeeper, valued our health to the highest degree. But with the high price of healthcare, it made it increasingly discouraging for us to seek help during emergencies. It would often lead our family to bear the cost of paying “later on” rather than “now.” “Dying is expensive,” “We don’t need to call an ambulance, we can drive,” “What do those paramedics know anyway?” are remarks I have heard from friends, neighbors and extended family.”
He goes on, “with the high costs involved with emergency care, many families have been hesitant due to the challenges of having to pay off hospital bills. It’s as if one stressor is being traded for another. During my graduate program at Case Western, I had severe chest pain one day that led me to seek emergency care. I was treated and got better, but then I saw I owed thousands of dollars for medical treatment. Growing up, I understood the financial difficulty of my family and how it put us in the position of trying to ‘fight through’ ailments instead of seeking treatment we could not afford.”
The authors conclude that for an EMS system to be successful in participating with the community in lowering the adverse effects of medical emergencies, they must identify the burdens that are placed on patients through accessing the emergency healthcare system, including the cost of this access. Further research is needed that will reveal alternative methods of addressing these costs across the breadth of our population.
Only then will our patients have the open and free access to care that is needed.
References
2. Personal Communication: North Texas regional stroke physician.
