Don't like ED diversion? OK, what's your plan?


As you've seen in this publication, the University of Chicago Medical Center has taken a great deal of criticism for instituting a program screening emergency department patients. The American College of Emergency Physicians is publicly calling for Congress to investigate the hospital's procedures, which the group says may be a violation of EMTALA.

Well, here's my question: Where was the College when hospitals in cities like Nashville, Jacksonville, FL and Atlanta instituted similar policies in recent years? Surely those patients are as deserving of protection from patient dumping as those in Chicago, no? 

Perhaps the reason is that those programs didn't get critical press coverage, as U of Chicago did in the Chicago Tribune. Or maybe U of Chicago stood out because of First Lady Michelle Obama, who had worked in community outreach. 

Regardless, the notion of ED diversion seems to have become mainstream pretty quickly--almost overnight--when a large, prestigious academic medical center got on board. And then the emergency physicians' group had to speak out, as its domain expertise was being challenged.

Yes, it's certainly good seeing emergency physicians stand up for patients. And I'm not suggesting that the group's concern over the patient screening and referral process isn't sincere. But I sense a struggle for power here, as well. I don't think they're thrilled with changing the rhythm of the ED, for reasons as old as human addictions to tradition and routine.

If the American College really wants to contribute to the dialogue, let's hear some thoughtful proposals for compassionately addressing the overflow of patients with minor illnesses in the ED. Let's talk about ways to improve primary care access. And please, share your ideas on how to pay for all of this.

In the meantime, by all means be critical of U of Chicago or any other institution you fear is engaging in inappropriate practices. But unless you acknowledge the real problems they face--and accept that the solutions could possibly change your world--you won't make much headway. - Anne

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