The Myth of the Free ER


Instead of writing my blog last week, I found myself in a local ER. I’m there sometimes to see a patient being admitted or occasionally with a family member, but not usually for myself. The last time, in fact, was 24 years ago in medical school when I broke my neck in a car crash. Since then, I’ve managed to steer clear, until last week.

Tuesday started like any ordinary day. I ate some old-fashioned oatmeal with a sliced banana, a handful of almonds and a few cherries. About 30 to 45 minutes later, I suddenly had some abdominal pain I attributed to gas. I’m not prone to it, with my high-fiber diet, but that’s what it felt like. I went to work and tried to ignore it as it steadily worsened and began to radiate into my right shoulder, but shortly after lunch when I could no longer stand up straight and nausea set in, I decided with some embarrassment to tell my partners I needed to go home—because of gas! My husband came to pick me up but took me to the ER instead of home.

In triage, the nurse asked me to rate the pain, on a scale of 1 to 10, with 10 being the worst. I’ve asked a lot of patients that same question, but for some reason I was completely baffled by it. It hurt enough that I couldn’t really think. I didn’t want to have to explain that, because talking made it worse, so I just guessed a number—6. Which meant we had to sit a long time in the waiting room! There aren’t any couches in waiting rooms to lie down on. Since I couldn’t sit upright, I draped myself over my husband’s knees and hid my face so I didn’t have to fake-smile (if you’re a Southern girl, you know what I’m talking about).

After awhile, maybe an hour, I started wondering if I should send my husband back to give them an updated number—7? 8? But what if it was just gas, and I wound up in front of someone with something real? I couldn’t figure it out, so I kept quiet.

Finally, a room, followed by questions, an exam, labs, ultrasound, morphine, nausea medicine and CT scan. And lots of hot blankets, because I was shivering so hard my teeth chattered. Nothing conclusive—labs showed my pancreas seemed mildly ticked off, meaning possibly gallstones, but my esteemed gallbladder playfully hid from the ultrasound (one must speak respectfully of gallbladders). No diagnosis, but not much more pain either, so I was sent home. When I got up to dress, the pain started to return. I asked the nurse just to bring me some ibuprofen for the road—by that time I realized nothing had burst open inside of me and I was probably not dying. I felt silly later, having forgotten ER ibuprofen is pricey.

A couple of days later, with milder but recurring pain, I saw my own doctor. I made my case for a duodenal ulcer instead of gallstones, partly based on the lack of cutting involved and partly on the better melodrama potential in an ulcer. After all, I could say “this new EMR system is giving me an ulcer”, but no one would believe it had given me gallstones. I only have 4 of the 5 F’s—fair, female, over forty, and fertile. Besides, it’s becoming downright quaint to keep one’s gallbladder anymore, which appeals to my nonconformist nature. Both organs can refer pain to the right shoulder, and both can annoy the pancreas. And the only spot that hurts when poked is exactly over my duodenum.

So we shall see. My doctor agreed to let me try out ulcer, with a backup plan. No more ibuprofen. I have said a blessing over the little bottle of Protonix. So far it doesn’t hurt much anymore except at about 2 am. If God has a sense of humor, She would definitely let me have something cured by a proton pump inhibitor, after all the ranting I’ve done about the overuse of same.

I wish I could say that I paid more attention to everyone else in the waiting room that day. All I know is that there were a LOT of people waiting, mostly without complaining. I imagine some of them didn’t have insurance, or at least not good coverage. I have pretty good insurance and still had to pay $70 before leaving— the famous “wallet biopsy.” One of the common conservative responses to un-insurance is to say “oh, but they can get free care at the ER.” This is untrue on so many levels.

The ER isn’t free—uninsured patients will be billed, and if they can’t pay, wages can be garnished, cars taken, credit ruined. Whatever money the hospital can’t recoup will get passed on to the rest of us in higher charges or reduced services. It also isn’t definitive care, nor is it intended to be. I did not leave the ER with a diagnosis and didn’t expect one—all the ER needed to do was be reasonably sure I wouldn’t die or be permanently maimed if they sent me home. A real diagnosis can take weeks sometimes. I didn’t get any preventive care there, and they didn’t check my thyroid to be sure I was on the right dose of hormone replacement. They didn’t offer me a flu shot. They didn’t ask if I was eating my vegetables or getting regular exercise and sleep. We didn’t chat about my family history or my philosophical diagnosis preferences, and I wasn’t in chatting mode anyway.

I can only get those parts of my medical care with my regular doctor. We can’t solve un-insurance with ER’s, even if we had more of them and even if they were actually free. We need more primary care doctors—internists, family medicine doctors and pediatricians—and we need everyone here to have that care covered reliably. I couldn’t give an accurate pain level last week, but I can tell you my level of fed-up-ness with our current healthcare financing system—11 out of 10. Let’s fix this mess—Medicare for All.



Filed under Bad solutions for the uninsured

2 responses to “The Myth of the Free ER

  1. Alice Chenault

    Wonderful piece, right on target. Get well soon.

  2. Barbara Power

    Other than going to work, I don’t get out much. This is part preference and part cost–I cannot afford more than one tank of gasoline per week. When I do venture into more urban areas I’ve noted the growing number of huge billboards with health care “invitations” to various hospitals which claim special expertise. The marketing is sort of obvious: one prong of the message is to “boomers” who are now needing cardiac care, breast CA care, prostate CA care, etc. The other prong of these strategic messages is to the children of boomers who are now pregnant. Giant messages on billboards proclaim the expert OB departments and luxurious Birthing Pavilions, and, should you need it, a level 1 NICU. In the bigger cities, there are billboards aimed at parents of children who have cancer, with messages like “We’re here to help you and your child.”
    My only wish/fantasy is that ALL these huge marketing messages would add “We’re here to help…if you have insurance,” as this is the true state of affairs and it is such a lie to say otherwise. It is not a small lie … it lures unknowing & vulnerable citizens into hospitals, especially via the ED when chest pain occurs, and they actually believe that ALL are welcome—that these EDs and hospitals are “need-blind” and won’t later take everything they own to pay that bill.
    No matter how the picture is portrayed: who pays; who goes bankrupt; which practitioners STAY in practice; the lack of primary care; the enormous cuts in funding at state and national levels–the US medical care system is heading toward a meltdown unless we enact single payer.

    Pippa, i think you may be right with your self-dx — and hope this problem and its discomfort are soon resolved. Certainly, I can easily be convinced that EHR will cause ulcers!

    in solidarity, from the north country

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