Treating the ED's poor, realistically

In today's issue of FierceHealthcare, an Iowa physician gets slammed for allegedly minimizing the health complaints of poor people in an effort to get them out of her emergency department. If the charges are true, it's an ugly situation which the hospital in question should address instantly.

After all, such behavior can have devastating results--in some ways, more devastating than if she simply sent them away. If Dr. Cline-Campbell out and out refused to see such patients for financial reasons, they might press on and demand treatment elsewhere, but if she convinces them that their health complaints are trivial, they have every reason to slink away and die without insisting on further help.

The thing is, as physicians reading this know, even those with (seemingly) warmer hearts than Dr. Cline-Campbell have to turn away some poor patients, too. The best ED physician may struggle when they're presented with a stream of patients who come to the ED without having had good primary care.

The truth is, physicians should be considering a patient's socioeconomic status, though obviously not to condemn, demean or limit that patient's treatment. The truth is that a patient's situation in life has some bearing not only on their access to care but also, sadly, the likelihood that they have common chronic diseases or engage in some risky behaviors. In any event, they're showing up in the ED, they have real needs, even if they're not as sick as they feared.

So, what about creating seminars in your hospital or medical practice on addressing the problems of medically-underserved patients arriving in your ED (and making them mandatory for hospitals with large indigent populations)? Such seminars could help hospital administrators learn from physicians about their indigent care problems, familiarize physicians and hospital staffers better with social service resources and perhaps address everyone's cultural assumptions about these patients, too. Of course, such meetings could also be used to develop or improve ED diversion programs, too.

Ultimately, of course, a sick person is a sick person--but the reality is that people are going to view patients through socioeconomic filters. Perhaps all a hospital can do, for now, is make sure that the filters are the right ones. - Anne