Think Twice Before Visiting the Emergency Room - Do You Really Have a Life-Threatening Condition?

Have you ever thought about going to the emergency room but weren’t sure whether or not you really should? Most of us have likely been in this situation at least once in our lives - perhaps at a time when we felt so miserable and were so desperate to get better that even sitting for four hours in the emergency department waiting room seemed worth it.

Sometimes, the choice is clear, such as when patients are involved in a serious car accident, or when they show clear signs of a heart attack or stroke. At other times, the decision to go to the emergency room is less straightforward.

Anyone who is interested in emergency medicine or who may need to use an emergency room at some time should give this topic some thought. It’s an important issue for reasons other than what you might be guessing.

In the last few years, many stories circulated in popular media seem to suggest that “unfair use” of emergency rooms by uninsured patients is placing an undue burden on taxpayers, doctors, hospitals, and even insurance companies. The argument goes something like this: uninsured patients choose not to treat mundane conditions and then wait until these become severe. Then, they show up at the emergency room and doctors must treat their conditions regardless of the ability of the patient to pay for anything.

It’s often stated that this burdens the emergency department with undue costs, and that it raises healthcare costs for everyone else since insurance companies end up charging more to those who have insurance in order to make up for their lost revenue.

Are these assertions really true? Contrary to what most people believe, the cost for non-urgent visits to a typical emergency room are quite small compared to the total overall costs of running an emergency department. That means that the greater the number of non-urgent cases which present to an ER, the lower the total cost for each will be [1]. It’s also helpful to keep in mind that more minor ailments, such as treatment for a urinary tract infection or a sore throat, will not require nearly as much analysis from the attending physicians as would a major intervention like trauma surgery or treatment for pulmonary embolism (a blood clot in the lungs). So it’s not entirely true that non-urgent visits are a source of huge expenditures for emergency departments.

What some people don’t realize, however, is that there is a law called the Emergency Medical Treatment and Active Labor Act, which was passed in 2003. This law states that a physician may never discharge or refer a patient elsewhere without first providing what is called “an appropriate medical screening examination”[2]. The medical examination then determines whether the patient is truly suffering from an emergency medical condition. The law essentially says that even someone with no complaints at all could walk into an emergency department and request to be seen. The triage nurses and doctors would have no choice but to examine the patient.

What is the end result? Well, there haven’t been convincing studies on emergency room visits for non-urgent situations. As you’ll see in reference [1], results have been mixed and it’s difficult to draw too many conclusions. Common sense tells us that the more people who show up demanding care (for whatever reason, either lack of insurance, impatience, etc.), the more pressure is placed on the doctors and nurses of the emergency room. Wouldn’t we all prefer that they spend their time with those who need their expertise and experience the most?

For the sake of everyone, and most especially those who are critically wounded, near death, and who truly need emergency care, it’s best for anyone with a minor condition to wait it out. Alternatives can include an urgent care center that is open after hours, or even an immediate appointment with a family practitioner.

If you’re interested in reading more about this topic, you can consult the references below:

[1] Durand AC, Gentile S, Devictor B, Palazzolo S, Vignally P, Gerbeaux P, and Sambuc, R. ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. The American Journal of Emergency Medicine 2011; 29:333-345.

[2] Emergency Medical Treatment and Active Labor Act (EMTALA), codified as amended at 42 U.S.C. 1395dd, 1990; Heath Care Financing Administration EMTALA Regulations, 42 C.F.R. Parts 488, 489, 1003, 1994.