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September 7th, 2010
05:21 PM ET

More patients turning to ER for acute care

Where would you go if you had stomach pain? What about a really bad cough? Or a fever? More and more people are heading to the emergency room instead of a general practitioner, according to a new study.

"Primary care is completely overwhelmed," says Dr. Stephen Pitts, lead author of the report: Where Americans Get Acute Care. "Patients have observed the fact that primary care physicians just don’t have time for unscheduled visits, and sometimes the emergency room is the only option."

The report, released Tuesday in the journal Health Affairs, analyzed more than 380,000 medical records between 2001 and 2004, and compared where people went to be treated for everything from chest pains to sinus problems.

For patients who received acute care treatment – care for sudden condition, not generally considered to be life-threatening, but that do require attention within a short period of time – less than half were treated by their own primary care physician, and emergency department visits accounted for 28 percent of the visits.

"It's quite common to call your doctor only to learn they can't fit you in for a week," says Pitts, who works in the Department of Emergency Medicine at Emory University. "Unlike at your general doctor, the emergency room works under federal law that all patients have to be seen," he says. Many of the emergency room visits for acute care cited in this report happened after hours, when primary care physicians were not in the office, and on weekends.

Dr. Angela Gardner, president of the American College of Emergency Physicians, says even acute problems can become potentially serious, so getting timely care is crucial. ACEP has helpful guidelines for determining when to go to the emergency department on its website.  But Gardner also says that most people seeking emergency care do actually need to be there, and the problem is not the patient.

"If a reasonable person would consider something an emergency, they need to go to an emergency department. You often don't know it was not urgent until after you've been checked out," Gardner says.

Both Pitts and Gardner say health care reform legislation can play a large part in alleviating the burden on the nation's emergency rooms. A poll of more than 1,800 of emergency physicians finds 73 percent are concerned about overcrowding, and other reports show increased emergency department activity paired with limited funding is impacting both patient care and the ability of some ERs to remain in business.

The authors of the Health Affairs report say a promising feature of the health reform law includes initiatives to increase the number of federally qualified community health centers, thus offering more available locations for people with acute care health problems.

"This study paints a picture of our healthcare system and points out that we just don't have the capacity to manage people who have acute care complaints," Pitts says.


soundoff (39 Responses)
  1. lf

    I had to use the ER recently for just such a circumstance. My ankle began swelling for no known reason on a Friday afternoon, and my primary doctor could not see me. They go home at noon on Fridays! They told me that if I thought it was bad enough, I should go to the ER. I did, and they ran various tests and put me on heavy-duty antibiotics (thank goodness there is a 24-hour pharmacy available); the swelling had been getting worse by the hour. If I had had to wait until Monday to see my primary doctor, I'm sure the condition would have worsened signicantly. The antibiotics did their job, and I was pleased with the care I received at the ER, but would have preferred to have been able to see my primary doctor or had an acute/urgent care center available (there are none in our area). I haven't received the bill yet, so I don't know how much of the ER visit will end up having been covered by my insurance.

    September 7, 2010 at 17:52 | Report abuse | Reply
    • Common Misconception

      That is a perfectly reasonable reason to go to the ER.

      September 8, 2010 at 09:38 | Report abuse |
  2. kate

    Probably because people aren't taking responsibility for their own health. People don't want to prevent problems, but they want that problem gone right away once it shows up. Just so you know prevention is the best way to beat any health issue. If people took care of themselves then there wouldn't be as big of waits to see your doctor. Learn to take care of yourself, check out this site to start out http://www.diet-myths.com

    September 7, 2010 at 18:22 | Report abuse | Reply
    • SeanNJ

      Nonsense. If everyone made use of their PCP's for preventative measures as suggested, doctor's offices would be MORE overwhelmed, not less.

      September 8, 2010 at 10:31 | Report abuse |
    • Michelle

      So the ear infection that my friend had, which came on suddenly and was so severe that she couldn't walk straight... what was she supposed to do? When she got to the ER, they said her eardrum was ready to rupture.

      And what about people who would LIKE to see a regular doctor about an ongoing problem, but because they have no insurance, doctors refuse to see them?

      Come on, you don't know people's circumstances.

      September 9, 2010 at 09:34 | Report abuse |
  3. Mike

    Illness in our family seems to always strike on a Friday afternoon and the doctors can't see us until at least a week. We've always had to go to the ER at about $250 a pop. It's great to have the antibiotics when you need them and to actually get well. It seems like a physician who chose to take Mon-Tue off instead of the weekends could make a killing and charge a bit more than a normal Mon-Fri doctor (but less than the ER). Or how about a nationwide chain of clinics that did this. Where are the entrepreneurs?

    In general though I see the problem in our nation with rising healthcare. I don't know how it was dealt with in the past, but I end up paying about the same after my insurance reimburses me for both the ER visit or the weekday visit. Seems like the insurance companies will catch on that they're being forced to pay more for the same level of healthcare because the doctors they recommend all have the same Weekends-Off schedule.

    September 7, 2010 at 20:18 | Report abuse | Reply
  4. lane

    This article fails to disclose the ways some individuals abuse the access to ER services since they know due to federal requirements, they will be seen regardless of payment. I work as an ER nurse and every day, people who have very minor symptoms come to the ER instead of their primary physician office who likely does not take their Medicaid insurance or requires them to actually PAY for their visit. They feel entitled to "free care" and refuse to pay any of their bill which only leads to higher costs for those who do have private insurance and actually pay for their healthcare. Along with this, their are those individuals who are addicted to pain medications who abuse the ER healthcare systems seeking their drug of choice. Healthcare reform measures will only increase ER overcrowding and abusive use of our current healthcare resouces. When there is no accountablity for having to pay any of your bill because the government is picking up your tab, people will come to the ER for every minor complaint.

    September 7, 2010 at 23:44 | Report abuse | Reply
    • rob

      As a health care worker in the D.C. area, I'm aware that the emergency rooms and urgent care centers here have been overwhelmed by people who are here illegally seeking treatment for minor complaints, at the expense of taxpayers. I think everyone should have access to immediate care for life-threatening conditions, but it's frustrating to realize that our citizens can't receive treatment because of others who are cheating the system. Meanwhile, there are several free clinics around which only serve the illegal alien population. I can only imagine the uproar if we established a policy that proof of legal residency is required before any treatment for non-life-threatening conditions is provided.

      September 8, 2010 at 10:06 | Report abuse |
    • Trish

      You've just described one of the problems with the Canadian health care system. As medical treatment here is "free" (paid through your taxes), people will frequently go to the ER to see a doctor for the most minor of concerns. This is because when we call the doctor to get an appointment, we're told that they can see us in about four months. Our walk-in clinics are first-come, first-serve however they will frequently cap the number of patients they see in a day and extended hours are only until 6pm. It's not uncommon to show up at 11:30 and be told to return tomorrow.

      One good point about the system here is that illegals do not get "free" medical treatment. If you show up at the hospital you are asked for your medicare card or your credit card.

      September 8, 2010 at 10:24 | Report abuse |
  5. another-op

    When transported to the local emergency room after a near fatal car accident, they found out I had no insurance. Within 45 minutes i was discharged with a shattered skull. No money , no help.
    The general practicionare knows nothing yet passes judgement based on how much money you have for them. With costs so high it takes the average worker a week to earn the cost of a doctor or emergency room visit.
    Keep in mind, it's not the doctor causing the problem, but the nurses who don't care and would rather do like the doctor and go play golf instead of helping those in need. They murder citizens due to money, yet they have the time and money to half way around the world to help people with no money?

    September 8, 2010 at 08:44 | Report abuse | Reply
    • bullhockey

      You may have a right to sue the hospital for gross negligence depending on the circumstances. You also have the right as a patient to ask for a second opinion before you are discharged. You can also ask to be transported to another hospital that can or will treat the issue if it is medically necessary..... just letting you know...the last may not be a right but is usually a courtesy.

      September 8, 2010 at 18:51 | Report abuse |
    • Willette

      The problem is certainly NOT the nurses. You have no idea what ER nurses do and have to put up with. You obviously don't realize that nurses cannot medicate you, rush your treatment, or even let you eat or drink something without a doctor's order. How dare you make an accusation like that when you are ignorant about the profession?

      September 9, 2010 at 09:13 | Report abuse |
    • Rachel

      IF you were in a "near fatal car accident" there is no way you would have been D/C'd in unstable condition. Usually, trauma doctors and ER doctors do not pay attention to a patient's pay status.

      September 9, 2010 at 13:43 | Report abuse |
  6. ER-Dream

    It is sad that people can't get prper, timely treatment other than an ER/Ugrent Care. My primary is kind of a joke, (as most are in my area), only open 8:30-4:30 M-TH, 1/2 day Friday, rarely have someone ANSWER the phone. For the ammount of money I have to pay, there should be a doc at the office 24/7! If it's after 5 on a Friday, and you are sick/in pain, there is really no other choice. Also, I am sick of seeing every medical discussion include pain medication abuse. It is NOT the overblown issue the media is making it out to be! (BTW, if deny the illegals free care and deport them, you would be amazed at how empty the ER's would become)

    September 8, 2010 at 09:04 | Report abuse | Reply
    • Common Misconception

      And how would we differentiate illegals from any other patient? Some people simply don’t have their ID or insurance on them. Should we exclude anyone who can’t prove insurance and citizenship from critical care? EMTALA exists for a reason, hospitals shouldn’t be allowed to just dump patients. The problem is the American people need to make a value judgment about health care – we can’t have it both private and freely available.

      September 8, 2010 at 09:50 | Report abuse |
    • rob

      @Common Misconception: Verify proof of legal residency in the same way that proof of insurance is required for continued hospital care. That's not difficult. Everyone with a life-threatening condition would stil receive immediate care.

      With the current situation, everyone who claims to not speak English receives full treatment, while citizens who acknowledge they don't have insurance are turned away.

      All U.S. citizens are fluent in English, and everyone here on a visa is already required to carry documentation at all times.

      September 8, 2010 at 10:15 | Report abuse |
  7. AJ

    This is exactly why "Stat Care" Clinics are popping up in strip malls near you. They are there to take care of people after hours and on the weekends. I also work in the emergency department and it is difficult to take care of critically ill/dying patients when you have a patient with a toothache (that they've had for a month) demanding pillows/blankets/lunch etc... There is no common decency left anymore. It's extremely frustrating for those of us who work in those areas to see people who could wait until the morning or visit a stat care clinic. I understand emergency situations, but non-urgent complaints clog up the ER and take away valuable attention to more severe situations.

    September 8, 2010 at 09:15 | Report abuse | Reply
  8. J

    There was a time when you could go to an urgent care for treatment after hours instead of an ER, but now insurance companies won't pay if you do that. So instead of going to an urgent care you are forced to go to an ER where costs are higher. Weren't urgent cares created to take the stress off of hospital ER's?

    September 8, 2010 at 09:21 | Report abuse | Reply
    • Common Misconception

      It really depends on the location and reasoning. If the urgent care center isn’t part of your company’s network, then yes I can see why you would be sent to the ER instead. There is also liability concerns, and many insurance companies will err on the side of caution by sending you to an ER rather than an acute care center.

      September 8, 2010 at 09:45 | Report abuse |
    • Me

      J, if your insurance is normal, you will probably find that it is cheaper (not to mention about 10 times faster) to go to an urget care place even if you have to pay for it completely yourself.

      I have "excellent" insurance and I still have to pay AT LEAST $150 for an ER visit. You can get a lot of services at an urgent care place for $150, even if your insurance doesn't pay anything.

      September 8, 2010 at 13:06 | Report abuse |
  9. Dennis (Investigator/Negotiator) at MedicalBillDog

    Patients everywhere–myself included–need training on when and how to use emergency services. I sprained my ankle a couple of years back. It was late in the evening, and I was in a lot of pain. Thinking it might be a break, we went to the emergency room. Later, my PCP said I should have waited until morning and called her, that my sprain wasn't an emergency. I still wonder, though, if it had been broken would it, then, have been an emergency? If so, how am I supposed to know whether it's broken without an x-ray? Is this a Catch-22 situation, or am I just a wimp who should not bother the ER with my silly broken bones?

    September 8, 2010 at 09:27 | Report abuse | Reply
    • Common Misconception

      I agree with you. I don’t believe your case was unreasonable – I’m an EMT and I get sprains all the time, but realistically there is no way to know outside of an X-ray, but you can usually tell just from the pain level. For most people, a sprain is the worst pain they’ve ever experienced, so they can’t adequately judge. I’d recommend just thinking of it this way, if you can put weight on it without excruciating pain, it’s probably not broken. If it just hurts to walk on it, it’s probably just a sprain.

      September 8, 2010 at 09:41 | Report abuse |
    • Jake

      If it's an obvious fracture like an open/compound one or if there is a strange deformity, then you should go to an emergency room. Otherwise, a lot of sprains are not an emergency and you should have waited to see your primary in the morning, like she said. Or talked to whoever was covering her on-call service for the night. And when it comes to xrays, xrays will not show all fractures and a doctor has well-studied exam tools that will help him/her know if you even need to have an xray.

      September 8, 2010 at 09:56 | Report abuse |
    • rob

      You were absolutely right to go to the emergency room; that's what they're there for! Even doctors can't diagnose fractures without xrays, unless there's an obvious deformity. That's why EMTs and paramedics are trained to immobilize injuries such as yours and transport patients to the hospital. If you can't bear weight on it, there's a good chance it's broken; even if you can, it still could be broken and extensive swelling or activity can increase the damage to surrounding nerves/blood vessels. I'm sorry your PCP was so rude.

      September 8, 2010 at 10:24 | Report abuse |
  10. carolae

    People also have a choice of going to the nearest Urgent Care, provided their town has one. If not, the ER would be the next choice. Sadly, people just can't pick up the phone anymore and call their doctor only to be told we can't see you for several weeks. If you are having any kind of pain, high fever, problems breathing, etc., just go to the ER. You may be there for a good many hours but at least you will be taken care of and have peace of mind. The doctors and care you get today are not what it use to be back in the 50's thru the 70's. After that, you were lucky the doctor spent 5 mins. with you!

    September 8, 2010 at 10:00 | Report abuse | Reply
  11. carolae

    I have another comment to make (just made one above). Back in late April, my husband started having these painful headaches 24/7....nothing he took would make it go away. Finally, he called the doctor and was told he would have to wait 3 weeks. So my husband went to the ER and after a number of tests, was told that they couldn't find anything and sent him home. On his way out, a nurse stopped him and told him to go over to this other hospital where he might get better care. He did and was there for 1 week. Diagnosis went from "can't find anything at the first hospital" to "Hydrocephaelus....water on the brain. The pain was coming from the fluid backup. Once that was removed, the pain went away immediately. You have to wonder what kind of doctors are working in these hospitals now. We will never go back to the first hospital and even though this one is on the other side of town and 45 mins. away, we'll go there as the care he received was top notch and the doctors spent a lot of time with him.

    September 8, 2010 at 10:05 | Report abuse | Reply
    • misbel

      Try to go to larger, university setting based hospitials and avoid the small town, small time hospitals. Even though there are residents, the care is often infinitely better in academic places. There may be great docs in urgent care, but these docs have settled for salaried positions, no continuity of care, and lesser shift pay. Ambitious docs want private practice and hospital positions. Remember to only go for urgent, nonemergent things. What are they going to do for a heart attack? Broken bone? Brain hemmorrhage? Send you to the hospital...

      September 8, 2010 at 15:58 | Report abuse |
    • Michelle

      The problem is that most docs never want to DO anything. "We can't find anything wrong," even when something obviously IS wrong. So upsetting. I'm glad your husband was okay.

      September 9, 2010 at 09:45 | Report abuse |
  12. SayWhat

    Trouble is if you go to an urgent care or ER and find out that the problem did not need immediate care your insurance is likely to refuse the claim and you're stuck with a huge bill.

    September 8, 2010 at 11:29 | Report abuse | Reply
  13. Me

    How about the problem of physicians abusing the ER?

    THREE TIMES in the past 2 month, I've had a doctor tell my wife or daughter to go to the ER when they had a problem at an inconvenient time.

    The best? When my daughter got a sore throat on Thursday night! Although we called as soon as they opened their office, they couldn't "work her in" on Friday, so told us to take her to the ER, since it would clearly be malpractice to let it go 3 days untreated. If we had done what they told us to, it would have cost someone (me and/or the insurance company) $1,000. Fortunately, we knew enough to find an urgent care clinic instead: no matter how far it is, it's better than spending 8 hours and $1,000 at the ER.

    Yes, we live in one of the 10 biggest cities in the country, and they told us to go to the ER for a SORE THROAT.

    One time, my wife called the Dr's office after hours, and they called the Dr. Instead of calling her back and talking with her for 3 minutes, he refused to speak with her and told the answering service to send her to the ER. She called another Dr. and talked with him for 3 minutes, did what he said and was fine.

    Our old pediatrician would send us to the ER every time they thought our daughter maybe had possibly broken something. That's one of the reasons why they're our old pediatrician.

    From what I see, physicians abuse the ER more than patients do. I don't know whether it's laziness, stupidity, not caring, or fear of liability, or some combination.

    Stop blaming the victim.

    September 8, 2010 at 13:00 | Report abuse | Reply
  14. THX

    The best choice after Primary Care is Urgent Care, rather than the ER. They don't cost nearly as much and can handle nearly anything. Most I've seen even had an x-ray facility on-site and the ones I've been to all took my insurance. Our PCP is always too busy to see any sudden-but-non-emergency need. Unless I want to wait a week to have the kid's ear ache looked into, I've started looking to Urgent Care as a place to take my medical business.

    September 8, 2010 at 13:01 | Report abuse | Reply
  15. ChristineWithRegence

    We all have a role in helping to control health care costs. For ideas, check out http://whatstherealcost.org/info-desk.php?category=common-cents-change

    September 8, 2010 at 15:49 | Report abuse | Reply
  16. mark

    They need to raise the co pay for ER visits to $200 bucks. That would stop this nonsense. People go there for toothaches, fevers and the most stupid things. Raise the co pay and these freeloaders will go to a a regular doctor.

    September 8, 2010 at 16:10 | Report abuse | Reply
    • Michelle

      And with that raised co-pay, how many people who DON'T have the money will avoid going to the ER for real emergencies until things go critical?

      September 9, 2010 at 09:41 | Report abuse |
  17. Diana Elam

    I am an ER nurse. I spent an entire day being yelled at by people saying that they had waited too long, or asked for food when they came in for nausea and vomiting. And STD checks, toothaches, hand pain that they have had for 5 years! All while the people that need and deserve treatment have to be treated by the same doctors and nurses. I don't get paid enough to put up with the crap that people are giving me. I can only see it getting worse. There will be no doctors or nurses in the ER. Who would want to put up with that? I really doubt there are many "emergency rooms" anymore. The majority are just free clinics connected to hospitals.

    September 9, 2010 at 00:46 | Report abuse | Reply
    • Michelle

      Is that why I got treated like dirt by ER staff when I went in for severe lower-right abdominal pain? Because, clearly, I was just there to waste your time, right? Because there's nothing I'd rather do with my time then sit in an ER for five or six hours while being largely ignored, only to be finally told that it's not my appendix, but I've got a huge cyst which is "probably" causing the pain, and they're not going to do a darn thing about it.

      I'll remember your attitude next time something goes wrong. Unless I'm bleeding out, have a compound fracture, or I'm unconscious, I'll just try to fix it at home with a band-aid and aspirin.

      September 9, 2010 at 09:40 | Report abuse |
    • Diana

      That's not it at all. You had a legitimate complaint, and I have had those and know how painful they are. Unfortunately, the people that don't need to be there take the time and care away from people like you who are truly having issues. They can also delay your care, which is why you were there for so long. So I think you misunderstood. I sympathize with the people that cannot get immediate care because of the people that abuse the ER and use it as their primary care physician or clinic.

      September 9, 2010 at 11:11 | Report abuse |
  18. CorruptGov

    Let me get this straight. We're going to be "gifted" with a health care plan we are forced to purchase and fined if we don't,

    written by a committee whose chairman says he doesn't understand it, passed by a Congress that hasn't read it but exempts themselves from it,

    to be signed by a president who also smokes, with funding administered by a treasury chief who didn't pay his taxes, to be overseen by a surgeon general who is obese, and financed by a country that's broke.

    What the heck could possibly go wrong?

    September 15, 2010 at 13:23 | Report abuse | Reply
  19. Texasmade

    Ugh all of your comments gave me a headache, think Ima call 911 to take me to the ER for this headache :P

    December 12, 2011 at 04:12 | Report abuse | Reply

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