Last night I was contacted by a physician in the local urgent-care.   I like him, and we made polite, but brief, conversation.  ‘So, are you guys busy?’

I gave him the status report.  ‘Well, yeah.  We have about 25 people waiting to be seen the waiting room is full and every patient room is full.  Also, we just received a gun-shot wound to the head by EMS.’

‘Wow, sounds terrible!  So, here’s what I need to send you…’

What he sent was, in fact, reasonable.  A young woman with signs and symptoms of meningitis (who was treated earlier in the day for and upper respiratory virus…with Amoxicillin, of course.)

She needed a lumbar puncture, which I performed and which was  negative.

But I had this thought.  I could probably have said, ‘an airplane crashed through the roof and half the staff are dead,’ and he might well have still said, ‘bummer, here’s what I need to send over.’

Emergency medicine has risen to such a level of importance, has become so indispensible, that no one pauses to use ED’s no matter how overwhelmed they may be.  Another patient went to the local orthopedic office, and was told to come to the ER since he couldn’t afford to pay for his surgical follow-up and pain prescription refill.  So in the midst of our chaos, we were treating surgical follow-up…for free.

I’m glad we’re useful, and that our specialty is capable of great things.  I’m happy that my department rises to any challenge and that my partners and I can sort through almost any crisis.  I consider it a blessing that I can help those who need care but can’t afford it.  (And by the way, I do not work for the hospital, but am paid for what I see.)

I worry, though, that due to EMTALA and nationwide financial pressures, due to the ability of others to shield themselves from EMTALA and engage in ‘moral diversion,’ our ED’s will continue to be crushed.

It doesn’t really matter how busy we are, how overwhelmed we are, how understaffed or underfunded, someone else will always be able to send patients our direction.

And as it stands, we’ll always have to deal with it.  But something has to change, because the safety net is ripping, slowly but surely.


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