If it’s not an emergency, don’t go to an ‘Emergency’ room

If you’ve even been involved in a traffic jam on a motorway and wondered what the hold-up was, only to find that when you get to the release point, all that was holding up traffic was the drivers in front of you ‘rubber-necking’ an accident on the other side of the road, then you understand the current crisis in emergency rooms.

Our emergency rooms are staffed by world-class doctors and nurses, and speaking as a recent patient of one of those emergency rooms, I can attest to the fact that not alone are these people extremely talented, but they are also dedicated beyond the call of duty.

I was in there because I was suffering from acute abdominal pain following recent surgery and, as that sounds, it was quite serious. But I also had the chance to hear about the patients beside me and their complaints. One young man, for example, wanted a scan as he had had ‘a kick in the head’. Not recently. Not a few minutes ago. Last week. He thought he’d have a scan. The emergency room is no place for such a person.

And there were many others. I arrived at the emergency department at 3pm, so it was before the drunks had gotten themselves into ’emergency’ condition. But they dutifully began to arrive as the evening set in, some more regular visitors than others, who were advised “you could start this program with your GP tomorrow, but, of course, I can’t force you to go…”

There was the elderly woman with dementia who cursed her family viciously and loudly and screamed racial epithets at every non-white member of staff. There was the rape victim who had been brutalised and traumatised and who would never be the same again. There was the immigrant woman moaning in pain because of a misunderstanding about her heart condition, which led her to believe she couldn’t take painkillers.

You could make a valid argument that none of those people should have been there. Our emergency rooms shouldn’t be serving as ‘drunk-tanks’ – even if it is Christmas.

Rape victims should have a more private place to receive treatment and counselling. People with dementia should be in appropriate facilities. And certainly, people with minor ailments or concerns should be going to their GPs, especially at 3pm.

But none of these things happen because of underfunding in the rest of the health service, which has compelled our emergency departments to become the default point-of-care for various reasons.

If you visited your GP with concerns about a head injury, he or she would send you for a scan, for which you would have to pay. If you chose not to pay, you would be on a waiting list. If it was a serious injury, you’d probably be dead or seriously injured before you got a scan, and if it wasn’t, and you had survived that long, it would probably be unnecessary.

So you pop down to your emergency room and tell them you’re dizzy and maybe they’ll consider you an ’emergency’.

But in these winter months, there is an accident happening on the other side of the motorway. Each year, there are another 20,000 people over 65, and they all have a tendency to have more real health emergencies than people who are 40 years younger. Each year, the task of emergency departments gets bigger, which means that the dam overflows.

The root cause of the annual crises in emergency departments is the general underfunding of the health service, and the desire to introduce popular measures such as ‘free care for the under sixes’, rather than comprehensive policies where they are needed.

Hospitals are expensive, and not always needed for every complaint. General practitioners are relatively cheap. But there is no way to refer people out of emergency departments, who shouldn’t be there, to cheaper and more appropriate services such as general practice. It is a one-way street, hopelessly clogged when busy.

Equally, an under-funded health service with not enough hospital beds cannot accommodate any sizeable increase in emergency admissions. However, some of this talk is exaggerated. In most cases, people with serious illness do get admitted to hospital and do get a bed. (In my case, I was admitted to A&E in less than 30 minutes and into a regular hospital bed within 12 hours, as a public patient).

And then, one has to factor in HSE management, without vilifying them for their intentions. They have a limited budget. They don’t have the permission or authority to make the radical changes necessary, so they have to limit bed numbers – otherwise their budget is just a joke.

The demographics, the limited budget and the unlimited demands of patients all create pressure on emergency rooms. It just takes winter and a few more falls by older people, a few more ’12 pubs of Christmas’ and the system collapses like a burst Christmas balloon.

It’s a one-way highway to hell, with no one able to, or with the authority to, direct the traffic. And we wonder why we have gridlock.

This piece originally appeared in The Sunday Independent here.

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