What Happened to the "Urgent" in Urgent Care?
A recent trip to the urgent care center left me shocked and dismayed. Finding the time to meander over to my HMO's walk in clinic was easy. What I encountered next was the alarming part. I was not one of those in dire need of care, while only mildly bothered by a sinus infection. Still, I was uncomfortable enough to seek medical attention.
Upon entering the clinic I paid my $25 co-pay, a normal (but seemingly high) fee since I was already paying a "king's ransom" each month just to belong to this HMO. It was a quiet Sunday afternoon and there were no more than three of four people in the waiting room. I waited for about thirty minutes when I was greeted by a pleasant nurse who had called my name. She asked me to sit down before she delivered the bad news. I was told that there was a two and a half hour wait from this point on and if I wished she could make an appointment for me to come back later in the afternoon.
My jaw dropped and my usually calm demeanor was abruptly overtaken by outrage and disgust. I snapped at the nurse and told her that this was not acceptable. I thought that I am not even guaranteed services, even though I pay each month out of my own pocket to belong to this HMO medical club. The monthly out of pocket expenses only give me access to being in the medical club, but no assurance that I will ever be able to actually use the medical services. It seems like the same case that one must pay a large fee to belong to a private country club but that money does not guarantee you a tee time on the golf course. I stormed out of the clinic and found another way to heal my sinus infection.
Through this ordeal I was left with a very ugly taste in my mouth. The question I have come to ask is, "What happened to the "urgent" in urgent care and the "emergency" in emergency room services?" With the onset of "Obamacare" and Americans spending over two trillion dollars each year on health care, you would think that we could be doing better than this. Unfortunately, that is not the case.
Our urgent care and emergency care systems seem to be broken. How often have you stumbled into an emergency room or urgent care center with your own riveting pain and suffering and only been told to wait, sometimes for minutes and sometimes for hours. There are people who have died waiting in emergency waiting rooms.
Waiting areas are often filled with sick people who are coughing and sneezing, holding on tightly to their broken arms or their dislocated fingers. A person with a nail accidentally shot through the foot with a nail gun might receive the same wait time as someone with pneumonia. This occurs for the lucky ones. You are guaranteed an even longer wait time if you have to go to a public hospital because you do not have insurance.
Urgent care centers and emergency rooms are taught to "triage" their patients. This is a French term meaning "to sort." Everyone who comes in is triaged as to the severity of their injuries and then told to sit down and wait. Someone clutching at their heart in pain (a possible heart attack) or someone who is unable to breathe (asthma attack) often are admitted right away as possibly having an immediate life-threatening situation. Those who are brought in through the back door by ambulance are usually ushered right in to a treatment room and do not have to wait either, no matter how mild or severe their condition. The rest of us will have to endure hours of wait time, often in excruciating pain, wondering if we are going to die this day.
People stagger into an urgent care center or emergency room because they are in need of help. The help they are looking for is "urgent," not the next day or hours from now. When we are in pain we are not looking for a solution next week. We want an answer now.
This crisis in lack of urgency is really all about money. Hospitals and large HMO's do not make much money in their emergency care services. In fact, this is where many hospitals lose money. Surgery centers, maternity wards and cancer treatment centers are where much of their profits are made. Hospitals are reluctant to fully staff an emergency room or an urgent care center because of the payroll that they have to pay out. This would mean more financial loss for them. Most large medical systems might just prefer not to have to operate an urgent care or emergency room altogether but are mandated in many cases to do so. The rest of us end up paying the price for privatized medicine that puts profits before people.
It would be quite alarming if the rest of society operated like our emergency medical system. Imagine showing up to the airport and every time you were to board an airplane you automatically had a two or three hour delay. Currently the airline industry has an on time departure record of eighty-one percent. What if that dropped to only 5%? Imagine every time you went in to a bank to make a deposit you were told that it would be a two hour wait. How long would you wait for in the bank? Imagine if you were to drive up to a fast food restaurant and were told that it would be an hour or more before you received your food?
Other services in our lives that seem important have managed to work things out. Imagine if the 9-1-1 operating system worked like our current emergency room and urgent care centers. You would call the emergency operator and would be told that there were 400 people in front of you and they would get to you as soon as possible. When you tried to tell them that your house was burning down and you needed the fire department immediately they would tell you to do the best you could at putting out the house fire and they would send someone when they could. You tried to tell them that this was an emergency but they just responded that they had 400 people ahead of you, all with emergencies, and you just needed to wait your turn.
Imagine what it would be like to call the emergency dispatcher when you were startled by a thief trying to break into your home. Your cries and screams for help went on deaf ears as the operator told you that you were on the list and they could not guarantee how long it would take to get the police out to you. It could take minutes or it could take hours. You were told to hold off the robbers the best you could until help could get to you.
From traffic accidents to house fires, terrorist attacks to construction accidents, our 9-1-1 emergency system does a very good job and we can be proud of it. When a real emergency arises there is a good chance that help will arrive quickly. When it comes to our urgent care centers and our emergency room wait times though it is anyone's guess. We seem to have a broken down system and we seem to be willing to put up with it. What is wrong with us? We are told to hold onto our broken bones ourselves, try to subdue our painful bloody cough or attempt to curtail the bleeding on the floor from the chain saw wound in your leg.
Imagine if we continue to have a society that allows this kind of behavior. What would happen if you had to wait several hours to put gas in your car, to get into a movie or to buy groceries at the super market? How many of us would be willing to put up with that? We are already bothered when we have to wait several hours for the cable guy or the telephone repair person to show up. Why are we so apathetic to allow ourselves to have to wait for long periods of time for something far more important than the cable guy or the telephone repair person? When do we begin to get the service we deserve?
The idea of a waiting room in an emergency center or urgent care center is ridiculous in itself. Waiting rooms are transitory stations where you are too sick or injured to go back home but not sick or injured enough to get immediate help. Why can't emergency centers be fully staffed so that once you arrive you are taken in immediately to be attended to by a team of professionals?
In a perfect world emergency rooms and urgent care centers would now become over-staffed, where the staff is sitting around waiting for patients to arrive, rather than so busy and stressed out that they have to manage which patients they can see and tell others to hold on for dear life in the waiting room until they clear their schedule. Airlines always have personnel who are paid to be "on call" to show up when someone is sick. Why can't hospitals do the same? Why can't urgent care centers and emergency rooms have more staff than they need so that sick and injured patients do not have to fend for themselves in the waiting room?
It all comes down to money. In a "for profit" health care system medical establishments do not want to spend any more money than they have to, despite most health insurance companies and their stockholders making record profits each year. As long as people have accepted waiting and are not burning down the corporate offices these large medical systems just keep doing what they are doing. People are afraid to boycott their medical system for fear of it being taken away. They will put up with substandard treatment because they are afraid of losing it altogether. Once people make it through the magical door and into a treatment room to be treated they most often receive excellent care. It is the waiting time to receive that care that makes one wonder what kind of a third world health care system we might be running.
Stop calling it "emergency care" or "urgent care" if you are not going to provide immediate health care to people in need. The names might need to be renamed to be called "three hour care," "same day care" or "we will get to you when we can care." Sick and injured people are stumbling into waiting rooms where they expect urgent or emergency care. In many cases they are being treated no better by hospitals than the cable company or the telephone company treats them. "We will get to you when we can" is the norm when it comes to emergency care.
In all cases, waiting rooms need to be eliminated from urgent care centers and emergency rooms. Just having a waiting room is a recipe for disaster. Waiting rooms are like transitory lounges at airports where you are dumped to wait between flight changes. They are a "no man's land" and half-way point between the world of relief and the outside environment. Patients should be whisked right into a treatment room the second they arrive at the center. After all, if it weren't urgent or an emergency most people would have stayed home.
The other option is that all patients arriving at these centers were to clutch their chests or their throats indicating that they were having trouble breathing or enduring pain in their chest. No matter if you had a splinter in your toe or an earache, this simple procedure would guarantee that you were admitted on the spot without a wait. And if desperate, no one should walk into an emergency center. Since ambulance patients are always admitted without wait through the back door, maybe we should all call an ambulance to be taken to a center, even if it is something as benign as the flu or a pinched nerve.
The health care system is severely broken. Emergency services are just a small part of that broken system. Only when hospitals and clinics are forced to fully staff these centers will things change. Money talks. In the meantime, we will get used to waiting around for crucial services like medical aid and cable television repair personnel. Be careful where you step; there may be fresh vomit on the floor.
1. Government subsidies:
The federal government subsidizes many aspects of our lives. Why not have the federal government subsidize a fully functional emergency medical system? The government subsidizes many farmers for instance (corn, wheat, soy) etc. Why not subsidize something as important as emergency medicine?
2. Demand that all centers are fully staffed:
The government has made many demands on industry. For instance, the government has demanded that seat belts and catalytic converters be installed in all cars. This demand required more money to be spent by the auto industry. Why doesn't the government demand that all urgent care centers and emergency rooms be fully staffed so that no one will ever have to wait. Fines and penalties should be imposed on the hospital for every person having to wait.
3. Make public all medicine:
"For profit" health care only cares about profits. If you have a national public health care system you remove all of the profit and better serve the people.