I'm a little gassy. I think I'll go to the emergency room.

Image by indigoskye via Flickr

Think I'm joking? I'm not. Well, I'm not gassy, at least not right now, and I'm not thinking of going to the emergency room. Oh, God, no, not on a Saturday night when there's a big football game in town. Just leave me to die, please.

Lots of people do go to the emergency room when they're gassy, though. And when they've thrown up once. And on Sunday nights when Monday is looming? There are lots of people there with their sick (or not) kids who want work excuses for the next day.

There are also dying people. Psychotic people. Bleeding. Laboring. Infarcting. Fractured. You name it, an emergency room near you (hopefully) is taking all comers.

It's part of the American ethos, according to Dr. Edwin Leap, an ER physician. The ER is instant. It serves all. It's open all the time, better than McDonald's drive through. Dr. Leap writes:

And whether the our patients are paying or penniless, we examine them and review their X-rays and lab results. We order stress-tests, we call surgeons. We have a finite window of opportunity, so we answer questions as quickly as possible. And frankly, that’s the way Americans like it. Instant gratification is as much a part of modern American health-care as Penicillin.

I would add that it's one stop shopping, too. It's irritating to go to your primary care doctor for belly pain and find you have to wait for that appointment, then wait for some labs, a CT of your belly. Wait for an appointment with a surgeon, all the while not feeling so great. In the ER you get a doctor, labs, imaging, and maybe even a surgeon and if you're REALLY lucky an operation all in one shot. That's what we like. It's what we need. I don't have time for five appointments; I have a few hours for one.

Dr. Leap thinks that no matter how many primary care physicians we add, we'll still never keep Americans out of the costly ER. I think he has a point. It's not the way we're built. Primary care lacks 24-hour a day nearly instant access. It lacks efficiency, I mean, 99% of GPs are not going to have an MRI, CT, and lab waiting there for patients' immediate needs.

I agree with him to a point. Not everybody will use the ER in lieu of primary care, though, were they to have access. There are a lot of prudent people out there who just lack access to prudent, sensible, cheaper care. They get desperate and hit the ER. For example, a woman feels a lump in her breast. She waits, waits, waits, frets for weeks, then can't take the anxiety anymore. She tells her husband, her daughter, her friend; panic ensues. Off to the ER everybody goes. If only she had a doctor she could have called for an appointment weeks ago. Or the uninsured smoker with a cold which morphs into a pneumonia, waiting, waiting, waiting to see if it will go away on its own. It doesn't. Upon presentation to the ER by squad the patient is so sick he or she ends up hospitalized for a week.

Dr. Leap writes an interesting post. Check it out via Dr. Kevin:

Will more primary care physicians keep patients out of the ER?

He says no. I say some.