More doctors and nurses could be called in, but why do that? Its not as though an Emergency Room is a restaurant, where people can get up and leave. But even in an Emergency Room patients sometimes do decide to get up and leave - even though it may be decidedly dangerous to do so. The morale of the staff deteriorates; good and caring doctors become zombies simply hoping to make it home and somehow put what they’ve experienced and seen out of their minds.
Hospital administrators sometimes show up for a moment -- to do what administrators do. They instruct harried physicians to admit anyone they can. Other administrators run to hospital floors to press other doctors and nurses to discharge anyone they can -- so the ER can admit more new patients to -- keep the money machine rolling.
Beyond the, penny-wise, pound-foolish, tactic of hospitals not adding doctors or nurses to an ER that may be being besieged by twice or even three times the normal amount of patients, administrators often decline to interest themselves in listening to complaints or to concerns from their own personnel.
Interviews with a variety of doctors and nurses reveals the same thing: Nurses, because they have a union, are able to present grievances to administrations, but too often, they just get turned down; doctors who have no union, and knowing that if they complain they will be smeared by bottom-line-obsessed administrators, just swallow-it and try, sometimes against all odds, to do their jobs.
In a malpractice suit, a doctor was sued for allegedly harming a patient through lack of attention. The malpractice attorney asked why the patient hadn’t been seen often enough. Apparently the doctor’s response, explaining that the ER was dangerously overcrowded and understaffed, was met by the inevitable question from the plaintiff’s attorney; "Did you document in your note that the ER was overcrowded and understaffed, or did you complain that the ER was overcrowded or understaffed." And again, because doctors are instructed never to document anything that may make a hospital look liable, the answer had to be, “No.”
While it is the doctors and nurses who seem to be on the receiving end of much of the blame for poor Emergency Room care, it is not at all uncommon that it is the administrators, the ones who sit in their glamorous offices and count the beans, who are responsible.
Imagine any other business, like a restaurant, for example, being run the way most emergency rooms are run. Imagine twice the usual numbers of patrons showing up, and some being forced to wait outside for hours, while others are escorted to tables occupied by complete strangers. In order to try to maximize profits, the size of the staff is not modified to adapt to the need – time after time.
My guess is that the restaurant would go broke, unless they were the only one in town -- and in that case, I'd bet a lot of people would just stay home and make their own dinners. But in the real world, as with any rational business, the owners would hire more staff, build a bigger space, and prosper.
In the world of Emergency Rooms, however, reality is turned on its head. Here, because there are times when the ER is not full, and times when it is exploding with three times the normal load of patients, no extra staff are hired, no more space is provided, and because patrons have little alternative, they wait, and wait, and wait, inside and outside the ER. Having interviewed and observed many patients and doctors over the years, I;ve seen first hand what goes on when too many patients encounter too few doctors -- it becomes the most chaotic and among the most dangerous parts of our healthcare system.
One way to fix this mess is to create the only incentive a hospital and its administrators will appreciate- make it very costly to hospitals who leave patients in their ER for a prolonged period of time and create guidelines that require all ERs to have a minimum ration of doctors to patients ( much like child care centers have ).
If it costs the hospital money, when they leave patients in the ED for long periods of time, then they will find a way to fix this mess. Hospitals could open up clinics or urgent care centers ( or cooperate with urgent care centers in their neighborhood) near the hospital that can see non-emergent cases, EDs can actually divert patients to other hospitals when their hospital is too full to adequately treat patients, administrators can call in more doctors when some threshold is reached where a patient to doctor ratio is just too high to safely care for patients .
As I finish writing this I feel hopeless . With the Anthony Weiners and Charlie Rangels in Congress I cannot imagine that any part of our broken health-not-care system will be fixed.
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