Inappropriate patients

Letters

CJEM 1999;1(1):20

To the editor:

Although it is true that our society is “over-Medicared” (e.g., walk-in-clinics), perhaps the problem is not inappropriate ED use but, rather, lack of patient knowledge. If patients are asked what their perception of their medical problem is, and what their understanding of the real, possible, and most frightening consequences might be, then one might come up with answers that are closer to the truth.

We surveyed our ED patients for a month and found that those with minor problems came to the ED because of convenience, because of concern that they might have a “serious” problem, or because of perceived acuity. These are not bad people misusing our treasured yet crumbling health care system; they are just uninformed. Education is a powerful tool, and doctors, nurses, media and educators can help us solve this.

David Mann, MD
Powell River, BC

To the editor:

The question of inappropriate emergency visits is a sensitive one; it forces us to examine a couple of key points. First and foremost is the issue of resource allocation. It is hard to suppress the feeling of frustration when we perceive the needless use of both emergency personnel and limited physical space. Both are in rather short supply, and we are all looking for ways to decompress our emergency wards. Limiting patient encounters that could otherwise be dealt with in another setting would be a useful step toward achieving this goal.

Second is the issue of patient rights. According to the Canada Health Act, every Canadian citizen has a universal right to health care — health care that is not restricted to certain hours or specific locations. It is not appropriate for emergency personnel to decide what a patient’s threshold for seeking medical advice should be. These acts are driven by anxieties and health concerns that are unique to every patient. They should be respected and not scrutinized or minimized.

That’s not to say that all stubbed toes require costly ED registration and emergent attention. I simply feel that the present format of emergency triage is inadequate when faced with this type of patient. I believe it is our responsibility to provide a viable alternative for patients who arrive with non-emergent complaints. Many centres in the United States have walk-in clinics within the ED itself. The clinic is essentially a separate entity run by a nurse practitioner who may then refer a patient on for emergency evaluation. Registration costs are much lower than those incurred with ED visits, and personnel are kept to a minimum. This, along with ongoing patient education, could serve as a more efficient way to deliver emergency care.

Kirk Hollohan, MD
Vancouver, BC