Years ago I was working with New York City as an EMT out of Queens General Hospital. I remember being in shock after picking up an otherwise non-ill appearing man who gave a complaint that I currently cannot recall. We took him in a city ambulance to the local hospital. The part that shocked me was that he never entered the hospital. He thanked us and proceeded to go across the street to do his shopping. He never was sick and never intended to enter the ED doors. We served as free transportation for him. He expressed no qualms regarding his actions. The only conclusion I can draw today was that, in his eyes, it cost him nothing. He was able to get away with it. He had a complete disconnect not only from the ethical issues of what he did, but the costs being eaten by the city government for the taxi ride.
The same issues apply daily in the care I provide in the Emergency Department. There are multiples of patients who use the ED as primary care who are donning the latest Iphones, wearing expensive leather jackets, downed in expensive Aeropostel and Uggs clothing. They are at a lost when I ask them who provides their primary care. “I just go to the hospital!” Attempts to explain to these people the importance of routine primary care by an appropriately trained individual falls on deaf ears. They will openly admit that the use of clinics and primary care facilities will cost them money. They have nothing in the game. Hence, using one of the most expensive forms of medical care, which often isn’t the best care, continues to be used and abused.
I recently questioned an administrator regarding the potential logic of opening up various clinics. Perhaps a pediatric clinic on Tuesdays staffed with board certified pediatricians, Wednesday an adult primary care clinic staffed by Internists, and so on. It seemed like a perfect solution to me to guarantee good follow up with individuals most appropriately trained to assure convalescence and preventive care. “We looked into this, and financially it isn’t viable.” In other words, my translation of this statement is that the hospitals can collect more state money for emergent care for non emergent patients than they would receive if they set up and established local clinic care. Follow the dollar signs. The current government bureaucracy continues to do a disservice to the very individuals they are supposed to protect.
Emergency care being a safety net and providing primary care is something that will never end. However, I wonder how much general abuse would stop if the general public had to send in their taxes monthly rather than not realize that they are disappearing from their paychecks until April 15th. In other words, each month a payment would have to be sent in no differently than a payment to a cell phone carrier. The statement of “let the government do it” would be reconnected to the concept that the government is us. Abuse local services? – Your taxes go up. Your monthly payment to the local government-taxing agent goes up. Don’t pay? Sorry – your garbage will no longer be collected. Don’t pay? Sorry, your mail service stops.
Will this ever happen. Of course not. Still, free taxi rides are destroying the system.