Our county recently had a large drug-bust.  Some 37 people were arrested, for a variety of charges, from distribution to manufacturing and all the rest.

Since it was in the paper, and public knowledge, I felt it important to find out how many of them were regular ‘customers’ of the emergency department.

Of the 37 arrested, there were some 167 ED visits over the past few years since we have had EMR.

Now, what do we do with that number?  What does the customer service model say?  What do we feel about the need for insurance, or other social supports, provided by government?

Complicated question, I suppose.  But looking through the chief complaints, it seems that an inordinate number were for painful conditions.

As prescription drug abuse skyrockets, as deaths from those drugs rise dramatically, and as the economy staggers under entitlements like disability, Medicare and Medicaid, it might be reasonable, even compassionate towards all, to ask what to do with these ‘customers.’

I’m sure they were sometimes genuinely ill.  But on the whole, my suspicion is that they caused more harm, more cost, more difficulty and more disruption than the overwhelming majority of other patients.  For instance, those not arrested on drug charges.

It doesn’t take many people to cause enormous trouble and enormous waste.

37, a small percentage of our 37,000 visits each year, seems a reasonable number to cause difficulty.

37 more customers who maybe, just maybe, should lose their status as customers after all.

It’s not hard-hearted, and it’s not hateful.  It’s wise, it’s discerning and it’s going to be necessary if medicine is to continue without simply falling to pieces.

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