Could we please, in the name of all that is good and holy, stop telling people to avoid the ER during the holidays?
Better yet, let’s make it our New Year’s resolution to stop blaming patients for the structural flaws and managerial failures of the health system.
Let’s dispense, once and for all, with the patronizing reflex of telling sick people to put off their sickness care until it’s a little more convenient for “the system.”
The most grating example of this is telling people to avoid the emergency department, as so many hospitals and health regions are wont to do as soon as the holidays roll around.
The reason the coughing, wheezing, limping, chest-clutching hordes are lined up a mile deep in hospital waiting rooms is precisely because there are no alternatives.
It’s the time of year when the flu is spreading like wildfire; when Canadian weather is more likely to produce slips, falls, and broken bones; when holiday stress is at its peak and can exacerbate symptoms of people living with chronic illnesses such as heart failure. All of which means more sick people.
Retailers adjust to December’s influx of business by extending their hours and adding staff. Health-care institutions do the opposite: As demand grows, they reduce access and services.
The vast majority of primary-care practices close or reduce their hours. Specialized clinics generally shut down during the holidays. Hospitals go to great lengths to send as many people home as possible so they can close beds.
So what’s left? The emergency room.
It’s a classic example of the business axiom: Every system is perfectly designed to get the results it gets.
We have built a system – or, more precisely, a disjointed non-system – that has no front door. So by default, people head to the ER. And because so many other doors are shut around the holidays, the stampede to the ER becomes even more pronounced.
Instead of Christmas lights, we might as well decorate our hospitals with flashing neon signs over the ER that reads “O come, all ye ache-full.”
Most hospitals add staff during the holidays, which is necessary but will never be sufficient.
Bigger ERs alone are never going to solve ER woes – just as more highways are not going to resolve traffic congestion.
In fact, the traffic analogy is a good one. People drive their cars, despite the frustration and expense of sitting in traffic, because they don’t like the alternatives – namely, public transit, which is too often uncomfortable, unreliable and costly.
The same is true of emergency departments. Nobody goes to sit on a rickety chair in a room full of sick people for four hours for fun. (Oh, who are we kidding? It’s more like 8, 12 or 24 hours, and maybe 40 or 60 hours if you’re sick enough to be on a gurney and in need of admission. One study showed that, during flu season, one in 10 patients will wait more than 40 hours.)
Yet, Canadians still head to the ER because, as head-explodingly frustrating the waits are, it is still the lesser evil.
Studies, time and time again, have shown the three overarching reasons why people use the ER. One is a lack of access to primary care. Millions of Canadians don’t have a family doctor, and very few have a practitioner who provides same-day or after-hours care. The second is perceived urgency; there might be a few people who head to the ER with a hangnail, but most people are worried that they have something serious. The third is confidence; all the resources and facilities a patient needs are in the ER. If you need an X-ray or a blood test, what’s the point of going to a doctor? And why call the Telehealth line when, 110 per cent of the time, they will tell you to go to the ER?
These are completely rational and sensible reasons.
People trust the care in ERs, and we should be bolstering that trust – not undermining it.
Our health system is beset by what academics call “inefficient processes of care.” Far too few Canadians have adequate primary care, hospitals are perennially overcapacity, home care is underresourced and long-term care beds are severely lacking. All of these issues need to be addressed if we want to ease overcrowding in emergency departments.
Telling sick people to “find alternatives” to the ER is not going to solve our overcrowding woes. Frankly, it’s as insulting as it is unethical.