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Posted by Ishani Ganguli March 29, 2013 12:15 PM
Yesterday, I cared for one patient with chest pain, another with burning pain on urination, and a third with sharp belly pain. Two of the three came to see me in my primary care clinic, the third in the intensive care unit (via the emergency department (ED)). Who went where? You'd be surprised.
In her most recent post, Pauline Chen writes about the unfairness of penalizing patients for visiting the ED for non-urgent problems - after all, it is often difficult for doctors, let alone patients, to define them as such until after they have passed. She cites a recent study of nearly 35,000 ED visits finding that the symptoms that brought patients in for what were ultimately primary care-treatable conditions were indistinguishable from the symptoms that brought in the sicker patients.
This is an important lesson for policymakers, but certainly not reason to throw our hands in the air and ask patients to come to the ED any time they feel less than perfect. While symptom category alone is an unreliable predictor of how sick someone is, there are plenty of other factors that help patients and doctors decide the appropriate health care venue. In my example above, the patient with urinary symptoms was also quite elderly and had dropping blood pressures. Not surprisingly (with this added information), she was the one who required intensive care. There is also the patient’s other medical issues, whether he’s had the same symptom before and what the cause was that time, and whether his symptoms include lightheadedness or fever.
We need to do a better job educating patients on these decisions while making primary and urgent care more accessible and patient-friendly. Chen refers to outreach efforts to educate patients in Washington state. In a recent post, I wrote about another, unapologetically British, campaign.
I’d love to hear your thoughts on this topic. Have you ever been unsure about where to seek care for a medical issue? How did you decide? What might have helped you make that decision more easily?
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