ER and Emergency Services

melloworca6 said:Personally, I'm actually hoping they eventually implement co-pays at the ER. At least if things are truly urgent, you wouldn't be stuck waiting forever just because some idiot can't tell the difference between a crisis and a minor inconvenience, or simply doesn't care enough to prioritize properly.

dark capitalist 🤣

I’d personally vote to stop using Medicare to fund treatment for addicts. They made their own choices and took those risks; if they want to get clean, they can figure out how to pay for it themselves.

Angela Wright said:What if someone overindulges on greasy burgers, gets hit with a kidney stone, starts vomiting, the stone moves to the bile duct, ruptures, and bile leaks everywhere? I'm exaggerating here... look, things aren't just black and white. People simply aren't capable. Yesterday on some Facebook group, I was baffled by this woman who had already given birth prematurely, contracted beta-hemolytic infections, started bleeding around twelve o'clock, and now she's asking if it's an emergency or not—studying her pads, using rags, analyzing the amount, color, and texture... hello? In the end, she left because we kicked her out, and it turned out she wasn't actually fertile... but what else was there to do?!
There’s a triage nurse. If it isn't an emergency, they'll give you a kick in the ass all the way to the local clinic. You shouldn't play doctor, and that goes both ways.

I’d say most people aren't idiots and can tell if something is urgent or not (I'm betting the pain from a kidney stone feels different than your usual stomach crap or vomiting). Another thing is that some people are just bored with their lives, so this is probably just their version of socializing. Then you have those who take the easy route because why follow general practice when you can get everything done at the ER, and then there are the ones who go fishing for doctors like that. 😁

I don't know, maybe I'm just cranky because I know people who got screwed because they were sent home from the ER. They were sent home specifically because every idiot shows up demanding tests, and then you end up with collateral damage when someone who actually needed hospitalization gets sent home instead. 😢

People just head straight to the ER because they know the whole "primary care doctor -> referral -> specialist appointment -> diagnostic testing" merry-go-round isn't going to solve a single thing for a year—no matter how serious, acute, or life-altering the issue actually is 🤷

If that entire chain actually worked the way it's supposed to, way fewer people would be flooding the emergency rooms. But it doesn't work... and there are a million different reasons why 🤷

melloworca6 said:Angela Wright—it isn't that they lack the ability, rather it is simply a matter of indifference. They just don't want to deal with the hassle of waiting at a primary care clinic only to end up wandering through various specialist offices like everyone else—instead, they head straight to the ER, where everything is handled at once, and they walk out with their test results in hand immediately.

A biopic—of sorts. 😵
Back when I was still a college student—riding the subway, actually—I overheard an older lady giving some advice to her friend. "Listen, dear," she said, "just head over to Jack—tell them your chest hurts... they’ll take care of everything right then and there. And while you're at it, mention that stinging sensation when you go to the bathroom, so you can get a urine test done at the same time." 🤦

Angela Wright said:There is a triage nurse on duty—if the situation isn't an emergency, they will essentially kick you out of the ER before you even reach the doctor—and one really shouldn't try to play doctor, regardless of the circumstances.

In theory, it sounds wonderful—but in practice, reality tells a different story.

The triage nurse at my facility rarely turns anyone away—in fact, we don't turn anyone away here—because our House rule dictates that every patient must be evaluated by a doctor. Consequently, we end up seeing people who were bitten by a mosquito two days ago; if that swelling hasn't subsided after forty-eight hours of frantic scratching, they are sent straight to the ER.

You should probably try being polite to someone like that—especially after a failed resuscitation attempt on your previous patient... and then you have this one guy with a mosquito complaining about a two-hour wait. To his explanation regarding how you just lost someone you were trying to save? Just give him a cold, blunt response—telling him that his grievance is entirely irrelevant to the situation at hand.

Well... everything just went south—straight to Guatemala.

Angela Wright said:I would personally prefer to see an end to covering addiction treatment through Medicare—it’s a matter of personal responsibility, really. If they chose that path, then they should be the ones to bear the cost of getting clean.

It is the same pattern with alcoholics who end up developing cirrhosis—just as it is with those who develop diabetes by consciously choosing to pack on the pounds. It's much like smokers who face lung cancer despite being fully aware of the risks.
The list continues—much like an endless line at a DMV office.

Addicts are essentially patients—much like the others I’ve mentioned—with one distinction: addicts destroyed themselves through illegal substances, whereas the latter group chose to ruin their health with legal ones. It's a bit of a paradox—their condition is ultimately the result of what amounts to a conscious act of self-destruction.
Whether a substance is considered legal or illegal—that is often just a matter of societal definition—which, in my view, is where the hypocrisy lies regarding who is granted certain rights and who is denied them.

melloworca6 said:Honestly, Angela Wright, it’s not that they aren't capable, it's just that they don't care. They don't want to deal with the hassle of waiting at their primary care physician or walking through the standard diagnostic process like everyone else, so they head straight to the ER to get everything done at once—tests and results included. Honestly, they should just start charging them for that nonsense so they stop bothering people. One trip for something trivial would be enough to teach them a lesson.
...Not to mention how those types are the first to complain when they or someone they know actually has to wait somewhere (including months for scans or check-ups), even though they're the ones creating unnecessary crowds in places they don't belong.

Based on my conversations with doctors and hearing how things work behind the scenes, I feel like if I were in their shoes, I’d start charging for half of that myself. We have a healthcare system, yet when you truly need something, you either wait like an idiot or pay out of pocket for private care specifically because of people like this. I spent three months trying to schedule a follow-up with my immunologist because I couldn't find an open slot. During my appointment, she actually told me that nearly 50 percent of her patients that day shouldn't have been there; they were sent to her unnecessarily by their primary care doctors who just pass patients off wherever they want. Meanwhile, people like me, who genuinely need specialized care, end up waiting months for a simple check-up.

I completely agree with you!
When I was in the ER at Jack (dealing with side effects from chemo), there was a guy sitting next to me loudly complaining about having a slight cold. He went to the ER because he didn't want to bother his regular doctor and wanted everything handled immediately... well, I have zero respect for that behavior!

In a certain suburb, they seem to have this "principle" where certain patients (usually immigrants) are admitted through the ER so they don't have to wait for specialties like rheumatology; they just write down that they have high blood pressure... while the rest of us wait like fools for months, even though we could have just followed the standard route. Maybe it's not an official policy, but I know someone who shared a room with me who was admitted that way...

Angela Wright said:I would rather stop covering addiction treatment through Medicare. They took the risk themselves; they should handle their own recovery.

My dear husband would probably still want it covered by Medicare once... but I am totally on board with both of you!
It's one thing to deal with something like cancer, but it's another to have the healthcare system coddle someone because they made poor life choices.
My husband is a psychotherapist, and I can tell you firsthand that they are truly overwhelmed by intense empathy... yet there isn't a hospice facility (I won't mention that tiny 3-bed setup...) or psychologists available at oncology clinics! But for addicts and alcoholics? There's always resources for them.

He developed cancer because of his own risky lifestyle choices... khm... and I haven't seen any news about him getting some off-label treatment covered by Medicare just because his oncologist thinks he needs it. Let’s be real: there are review boards, hospital budget constraints, and pure pragmatism at play—if we're being honest with ourselves, isn't that how it works? They weigh whether it's actually worth spending the money on him versus hospice, mental health support, or getting a second opinion. Or you get those excuses like, "We don't have it right now, but maybe tomorrow; the nurse went home and took the pharmacy keys with her."
Meanwhile, every single addict gets their methadone delivered right on schedule, accompanied by all the coddling, hand-holding, and sympathy you can imagine.
Fine then, let's just give everyone everything and stop being so bitter when they kick us to the curb because they're too busy mourning the fact that the last resuscitation attempt failed... honestly, people are unbelievable. 🤷

melloworca6 said:I’m honestly hoping for the day they start billing people who show up at the ER without a legitimate reason (like that whole mess where they said they were going to fix things, but who knows where it got stuck).

But how would anyone even decide in the moment if someone actually has a "legitimate reason"?

People come in with nonsense and clog everything up. Then someone with an actual emergency has to wait because some genius decides Saturday night is the perfect time to mention they've been peeing blood for five days or running a fever for a week...

At the ER, you wait based on... urgency. 😁

If peeing blood is more serious than what you've got, then yeah, you wait while they handle that patient first. If a wheeze when you cough is less critical than your situation, you won't be waiting long. I don't see the issue.

To sum it up, Peter: people can be absolute pigs.
There will always be those who exploit the system knowing full well what they’re doing, and then there are the ones who just don't know better, lack the guts to make a call, or simply decide they belong in the ER. Triage exists, but why it's implemented in some places and ignored in others? That's a question for the folks running the emergency rooms.
I still maintain that it’s better to overreact and deal with the fallout later than to face someone yelling, "Where the hell were you?" when things go south... besides, there will always be idiots and conflicts. Anyone who chooses a career working with people just has to accept that reality.

Angela Wright said:He's facing cancer because of his own risky lifestyle—well... I haven't seen anyone get off-label drugs covered by Medicare without some pushback, since oncologists have to justify it. You know how it goes—those review boards, weighing the hospital budget, being practical (let's be honest, that's just how it works)—deciding if he's actually worth the cost. And then there's hospice, mental health support, second opinions, or the common excuse: "We don't have it right now, but maybe tomorrow once the nurse gets home and brings back the pharmacy keys."
While every addict gets their methadone right on schedule, surrounded by nothing but coddling and sympathy.
Let's just give everyone everything, then, and not act bitter when we're kicked out because they realize the last resuscitation attempt didn't work... honestly, people are unbelievable.🤷

Perhaps I misinterpreted the first sentence... I wrote that he was facing diabetes, not cancer (unless you were referring to fatty liver disease as a potential cause for HCC). 🤔
You didn't answer why one addict is viewed as less valuable than a heavy smoker who develops lung cancer, or someone who spends their whole life eating junk food and bacon only to develop type II diabetes at 150 lbs. Does that mean they don't deserve Metformin simply because their lifestyle directly caused the illness? Or does an addict not deserve treatment because their behavior led to a severe physical and mental dependency—or perhaps just because society views them as social outcasts?

On a side note, since we're discussing methadone, 20 tablets of 5 mg heptanone costs $4.00. It isn't a sum of money large enough to bankrupt the government—nor would it significantly impact the healthcare or federal budget.

As for your point about giving everyone everything... I am referring strictly to the Emergency Room.
We provide care, and we will continue to do so, until primary care becomes more proactive in managing patients (roughly 70% of "emergency" cases could be handled in a family doctor's office).
Until then—which may be never—if you don't call home, you're out of luck.

Angela Campbell84 said:But how exactly would they judge, and at what point, whether someone actually showed up with a "legitimate reason"?

The whole billing thing wasn't my idea. There was a decision made that anyone who isn't an emergency but shows up at the ER and insists on being seen gets slapped with a bill. Why that hasn't actually kicked in yet, I have no clue.

I think doctors have plenty of expertise and know-how to tell who’s legitimate and who isn't. For example, someone who spent three hours tanning and got a sunburn isn't an ER case; someone with blisters all over their body is. Someone having a seizure is an ER case; someone with a low-grade fever for a week who just decided to get every test possible done at the ER is not. Etc.
For those who aren't emergencies, if they insist on an exam, you just hand them a bill—let them eat cake. If you want the ER to treat non-emergencies, pay up. I honestly think most people would decide they can just wait and go to their primary care doctor instead.

In the ER, you wait based on... urgency. 😁

If getting bloodwork done is a more serious situation than your condition, then yeah, you’ll wait while they process that patient first. If wheezing when coughing is less serious than your issue, you won't be waiting longer for them. So I don't see the problem.

Aha. So you think one person can somehow examine and assess everyone's level of urgency? If you've got one doctor for 20 or 30 people, tell me how he's supposed to examine everyone all at once?

Are you also okay with people calling 911 for every little thing and lying about their symptoms just to get an ambulance sent out, while you're sitting there waiting for that same ambulance to pick up your mom who just had a stroke or a kid who just got hit by a car?
What's the difference between that and someone sitting in the ER waiting room getting tests done that should have been handled by their family doctor? Because of both groups, people suffer and die.

Angela Wright said:To sum it up: Peter, people are pigs.
There will always be those who abuse the system and know exactly what they're doing, but there are also those who just don't know better, or are too scared to judge, or decided their issue was an emergency. There's such a thing as triage, and why it's used in some places but not others? That’s a question for the ER director.
I still think it's better to overreact and play it safe than to deal with someone asking "where were you?" later... and there will always be idiots and wars. Everyone who chose to work with people just has to live with that.

I can't just accept that because someone close to me got screwed over by this exact thing. She went to the ER and got brushed off because they were slammed—thanks to idiots who use the emergency room for every little checkup instead of going to their primary care doctor—and she was sent home right before having a stroke.

I don't want someone I love to suffer tomorrow just because some guy is having his 150th panic attack of the month and camping out in the ER, or because he overate and has a little stomach ache, or caught a virus and decided a week later he's done with having a fever.

Same goes for if I get hit by a car; I don't want to wait 20 minutes for an ambulance because some moron called 911 and lied about her symptoms, hogging the vehicle while I'm bleeding out on the road waiting for help.

A decent doctor is never going to half-ass their job; I can guarantee you that.
It’s true that things aren't working, but how could they when the local family clinic is being run into the ground by seeing fifty different patients a day just to stay afloat? You’ve got a nurse stuck wrestling with jammed printers and broken equipment instead of actually doing the medical work she was trained for. And don't even get me started on the endless waiting lists for something as trivial as a blood pressure monitor—you'll be waiting three months just to get seen. By then, you've basically had to go back twenty times just to keep the appointment.
I think I'm heading to the ER. 😉

melloworca6 said:The whole thing about charging fees wasn't my idea. There was actually a policy put in place to bill anyone who shows up at the ER for non-emergencies and insists on being seen. I have no clue why they haven't started enforcing it yet.

Maybe it’s just because there aren't as many cases of people showing up at the ER for no reason? Just a guess.

You’ve gotta be out of your mind to sit in an ER waiting room for three, four, maybe even eight hours. I actually did that the other day—and I wasn't even kidding when I said it was an emergency. All just to get some bloodwork or a urine test because I couldn't face the idea of heading to a clinic first thing in the morning and waiting around for an hour for the exact same thing.

Personally, I don't see the logic in treating someone in the ER who clearly isn't an emergency, whether they've paid their bill or not.

So you think there's a magic way to triage everyone at once? If you've got one doctor covering twenty or thirty patients, tell me how they're supposed to examine them all simultaneously.

Don't bother checking them all; just triage based on what they're telling you. If someone’s whining about an earache or a sunburn, they can wait at the back of the line. You prioritize the ones rolling in semi-conscious or looking half-dead—brain issues, high fevers, that kind of stuff.

It’s the same deal with 911—they aren't rolling an ambulance out unless you genuinely can't make it to the nearest ER on your own.

I didn't just make that up; that's just how things work.

It’s pretty frustrating when people call 911 for every little thing and lie about their symptoms just to get an ambulance sent out. Meanwhile, you're sitting there waiting for that same crew to show up for your mom having a stroke, or for your kid who just got hit by a car.

Of course not.

Look, anyone who's been stuck in an ER—whether you actually needed it or just ended up there by accident—is going to think twice before going back. Nobody wants to spend hours waiting around for routine stuff if they can help it.

Accusing people of making up illnesses on the spot just doesn't make much sense.

People who call 911 just for the hell of it should face consequences. As for everyone else? They have every right to seek medical help however they see fit.

Angela Wright said:A good doctor will never half-ass their job, I guarantee you that.
The fact is, things aren't working. How could they when a family doctor is reduced to seeing 50 different patients a day while a nurse struggles with printers and paperwork instead of doing the job she was actually trained for? And don't even get me started on the waiting lists for something trivial like a blood pressure monitor where you wait three months. By then, you'll have messed up the readings twenty times over.
I think I'm going to head to the clinic down the street. 😉

A good doctor won't mess up until they're overwhelmed. Overload them with patients and even the best doctor is going to start cutting corners because there's simply no time to treat everyone properly.

I actually switched my immunologist for that exact reason. She’s an expert—arguably the best in the state—but what does it matter if she has a mountain of patients? You schedule an appointment and wait two or three months just to walk into the clinic and out again before you've even settled in. How can anyone give you quality care when the waiting room is packed and they can realistically only spend five to ten minutes with each person?

Angela Campbell84 said:Maybe it's because there aren't as many cases of 'unjustified ER visits'? Just a guess.

Listen, if those people on TV and in the news were lying when they said 70-80 percent of ER calls are unjustified, then I'm lying to you. I was stunned by how high that number was.

First, I was pissed off about why on earth they're going to charge for ER visits now. But once they started saying only 20 percent of visits are legitimate—and that the crowd showing up at the ER is just people who got a minor rash or spent two hours in the sun and got a bit of a sunburn—I lost all sympathy for them.

Because you seriously have to be crazy to wait 3, 4... 8 hours (yeah, I waited that long at the ER the other day, and it was a genuine emergency) just to get blood work or a urine test done because you can't be bothered to go in the morning and wait an hour for it.

Personally, I don't see the point in the ER treating a patient who clearly isn't an emergency, whether they pay or not.

Are you aware that there are people waiting months for tests much more serious than blood or urine? You might have to wait five months for an abdominal ultrasound or eight months for a brain MRI. Is it worth going to the ER and waiting 24 hours if it means getting it done? Because 24 hours is faster than eight months. If you go private, you'll cough up $2,000, so what's a few hours of sitting around?

And I don't like it either. It's disgusting that you have to wait forever for certain tests, but it's also because of people like this that we wait months for specific machines. We could all play dumb and act like this, but we don't.

Accusing people of making up random illnesses just doesn't make sense to me.

I’m not just throwing accusations around. Everything I’ve mentioned on this thread comes from people I actually know personally.
Take this last guy—he's an extended family member. It hasn't even been three weeks. And no, he didn't have some gallbladder attack, and no kid didn't overindulge on burgers and cold fruit until he threw up and lost his lunch. He just wasn't happy that they couldn't find anything wrong with him after a few days, so he went back to the ER, whining about how his heart rate was too fast (which, by the way, spiked because he was running up and down the stairs just to prove it would spike). While he was at it, he badgered the staff at the ER until they gave him a referral for a cardiologist. So the big shot actually landed an emergency appointment within a couple of days, stealing a slot from someone else who’s probably waiting a month or two just to get seen. Meanwhile, every single test they ran on him at the ER showed his heart was perfectly fine.

I don't get how anyone can defend people like this. To me, these people are literally taking away our appointments and tests.

Sandra Vaughn50 said:But you totally dodged the question about why a junkie isn't viewed as being any less "deserving" than some heavy smoker who ends up with lung cancer, or someone who spends their whole life eating nothing but junk food and bacon until they hit 330 lbs and develop Type II diabetes.

So, okay, let's say—just hypothetically—that a cigarette addict and a junkie are basically just addicted to their own stupidity, right? Like, they kind of engineered their own dependency through sheer bad choices.

whereas an obese person might be dealing with a primary biological drive for food that they just can't shake, something they were actually born with.

It's just that people don't seem to get the difference.

The whole situation with addicts, alcoholics, and the rest of that crowd is a whole other conversation entirely.

It’s honestly tough to draw a line in the sand and say, "Okay, these people are solely responsible for their own mess and they should pay the full price." I mean, what do we do about parents who refuse to vaccinate their kids? Or the folks who, out of pure ignorance, eat a poisonous mushroom and end up needing an emergency liver transplant because they trashed their organs? What about the riders out there hitting the road without helmets? Or the diabetics who completely ignore their blood sugar levels and just make their health issues ten times worse? Then you've got the group constantly drinking those "alternative" concoctions that basically destroy their bodies from the inside out. Etc.

If we start listing everyone who doesn't "deserve" free healthcare or shouldn't be paying lower premiums, we could go on forever. There are endless groups like that.

melloworca6 said:I didn't invent this whole payment thing. There was already a decision made that anyone showing up at the ER for non-emergencies who insists on being seen would be billed. Why that hasn't actually kicked in yet? I have no idea.

Doctors have enough expertise and common sense to distinguish between a real emergency and someone just being dramatic. If you spent three hours tanning and ended up with a mild sunburn, you aren't an ER case. If you’ve got actual blisters covering your body, then yeah, get to the hospital. If someone's fever hits 104, they need help. But if you've had a low-grade fever for a week and decided the ER is your personal diagnostic lab, you're wasting everyone's time. It's that simple.

Since no doctor can actually tell you if a case is a true emergency without running a bunch of tests just to cover their own backs, then... The only way to handle this is to charge everyone upfront. If the diagnostics show someone actually needed emergency care, then we just process the reimbursement through Medicare later. Simple.And we shouldn't be issuing refunds to those who aren't eligible.

That would clear out the ER crowds looking for treatment over a minor stomach bug or a bee sting pretty fast. But it opens up a massive headache: how do you actually draw the line for truly critical patients? Determining who qualifies for coverage—even after they've been seen and diagnosed—becomes a mess. You’d be stuck constantly deciding what can wait until morning or the next business day and what absolutely cannot.

I assume setting those criteria would be a lot easier than this current system, where everyone just claims they feel terrible and heads straight to the ER if it's actually true.

Also, why not? Let people pay out of pocket for an exam at 2 a.m. if they want to, provided they respect the triage order and cover the full market rate. ☕

I know this isn't going to be a crowd-pleaser, but I figure freedom of speech still counts for something.

Look, if you’re broke and you suddenly suffer a stroke or your car gets totaled, you’re basically screwed.

I mean, honestly, it's hard to tell which one is more urgent: a medical crisis or someone walking in with a stomach bug.

Angela Campbell84 said:Basically, if you're broke and you suddenly have a stroke or get into a car wreck, you're screwed.

It’s hard to argue whether that's more urgent than someone showing up with a stomach bug.

I assume it would be obvious when someone is an actual emergency. No waiting lists there—you just settle the bill and get the paperwork approved to check the box.

There's no need to oversimplify this. Any rational person knows the billing system isn't going to make a critical patient wait when it's clear they need immediate help.

But hey, if you want to pretend otherwise...