In our previous series, “Surviving the ER”, we discussed what to expect from your visit, and some of what we expect from you, the patient. The questions, the triage, the waiting, the environment, the actual encounter with the doctor, the do’s and don’ts, and, finally, the bills you will receive to pay for all of it. The response we’ve had suggests the information was helpful and well received. You’re welcome.
What we didn’t discuss at any great length were some of the reasons things work the way they do. Why, for instance, are you kept waiting for what seems like forever on a Saturday evening to get a simple laceration repaired or a twisted ankle attended? If we are the consummate professionals I said we are, shouldn’t we understand that Saturday evening is going to be busy and that some extra help might be a good idea?
Or you might wonder why we gasped in horror when you came to us with your 3-month old with congenital heart disease and now a fever; or when you totaled your car, said ‘no, thanks’, to the paramedics on scene, then hitched a ride to our place from a friend; or walked in with crushing chest pain; or came to us saying you were 9 months pregnant, hadn’t had the time to see an obstetrician yet, and were feeling what might be contractions.
Or maybe it’s just the bills that have you a bit mystified. There’s the one from the hospital, of course. But what about the others? Doctors you are certain never laid eyes on you, nor yours on them, are now demanding payment for things you aren’t sure ever happened. How, you ask, can one visit to one emergency room with one urgent problem generate more than one bill?
All these questions are valid and all deserve an answer. In the following installments we will do our best to explain what can aptly be called “The System”. Though some of the answers may leave you less than satisfied, and some will surely raise more questions, we hope what insight we are able to provide will give you a better sense of how the business and practice, policy and politics of healthcare delivery interact, what the future holds, and, maybe, what can be done to change things for the better.