Freeloaders in the ER

Rae pills help blue

I recently read an article written by an ER physician.  The article was filled with disgust for healthcare in the US and how many entitled patients come into the ER with less than life or limb threatening emergencies.  He spoke about their cigarettes, their inked bodies, and their well-groomed nether regions.  The doctor complained that these people spending our tax dollars on luxuries are coming into the ER expecting free care. They apparently aren’t poor enough. Part of his concern stems from the Emergency Medical Treatment and Labor Act. In 1986 EMTALA was a way to protect those less fortunate, making it illegal to turn away patients based on their insurance, or financial status.  In 2015, this is seen by many as a burden, a way for freeloaders to get convenient medical care.

I think that it is time for practitioners to take a look at their negative attitudes projected at the poor, or uneducated, and reevaluate the issue.

So, what is the issue?  ER practitioners are upset that their time and waiting rooms are filled with non-emergent medical and social issues.  They make the assumption that it is the patient’s fault for not going to their primary care provider or even go as far as to judge the way patients are spending money.  How dare a patient come to the ER at 10 PM only needing reassurance and ibuprofen!  They have money for a smart phone but need assistance getting their prescriptions?!?  The nerve!

I have a confession to make.  I have this same attitude all too often.

There was a patient that came into my ER and after reading the nursing notes, I was appalled.  This goofball off the street came in with a “red mark” on his foot that had been there for a month.  He had not gone in to see his PCP.  I tried to put on my “compassionate” face and walked into the exam room.  He had a wart.  A wart on the bottom of his foot.  I started to get really irritated but I knew there had to be more to this story.  I asked him what was it that really concerned him about this “red mark”.  The patient started to tell me about his horrific struggle in his home country in east Africa.  The war torn area stripped people of their families, their lives, and their access to basic healthcare.  His friend recently died from an infection that started out as a “red mark” on his foot.  The patient was scared.  He likely suffered from PTSD.  I reassured him and educated him about plantar warts. He did not have a primary care doctor or insurance, which was not remedied that night.  We talked for a while and it was a reminder to me that we can never understand the whole story and it isn’t our place to make judgements about our patients.  It is our job to help them.  It is our job to listen. It is out job to educate.  Our frustrations with the healthcare system do not need to be directed at our patients who are often the victims in this mess.

This is a complicated issue and there are pressures put on us to preform well.  Patient satisfaction scores, reimbursement, politics, and hospital executives distract us from our main mission, patient care.  The blame does not lay on the patient’s shoulders.  The ER will never be like it was prior to EMTALA, thank God.  We will care for anyone that walks in the door.  The healthcare crisis can be solved when our shift is over.


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