Emergency!

In Hospital, the chief of emergency medicine at Maimonides explains why ER medicine is different from other kinds: our goal, he says, is not to cure the patient, but rather to make sure that the patient doesn’t die. ER doctors take particular pride in their line of work, as well they should—as seen in the Emergency! stories, they work brutal shifts, see bizarre and terrifying cases, must triage overflowing waiting rooms, and often deal with the sickest members of society, who have waited to seek medical care at the ER because they are not insured or their insurance does not cover them adequately.

One of the ironic things about emergency medicine is that it is probably one of the specialties that generates the most “press” about medical oddities and stories that might be found in News of the Weird, but it is also one of the most financially strained specialties as well. Similarly to the articles we read about financial disincentives behind the shrinking number of primary care doctors, ER doctors also feel that they are not entirely well-compensated for the life-saving measures they must take on a daily basis. Although many doctors complain about the sheer number of patients they have to see in order to keep waiting times down, the fact of the matter is that they are compensated per patient and not for the quality of work that they do, so that if the number of patients were reduced, their financial disincentives would be even greater. They must take on more and more cases just to stay in the red. This has to change in healthcare reform efforts. In addition to ER doctors’ woes, here is a New York Times article that reveals just how much EMTs and firefighters are becoming a part of peoples’ primary care as well: http://www.nytimes.com/2009/09/04/us/04firehouse.html?scp=1&sq=EMS%20firefighters%20medical&st=cse. I find it troubling that for so many, the ER has become the last and only resort for medical attention. Getting more people better primary care access must be pushed in legislation so that ER doctors can focus on truly life-threatening cases and so that these peoples’ health doesn’t deteriorate to the point at which they need to be taken to the hospital by ambulance for preventable diseases.

Many of the people who are taken to the ER for preventable diseases are also among the poorest and most stigmatized members of society. I feel that that the inconsistencies and emotions surrounding unequal economics really comes out in Rescuing Providence. Morse repeatedly admonishes the alcoholics, gang members, and other so-called “plagues” on society for not pulling themselves up by the bootstraps. Although they are victims of an inadequate social support system, they have to pull themselves out of the gutter to make it to the street, and although I found myself agreeing with Morse, I was also uneasily reminded about discussions about moralizing health and attaching stigma in my health inequality class. When and how can we blame people for their health condition? How can we convince people to take preventive measures? If more people took preventive measures, hopefully we would see less people in the ER.