What I have been trying to say is that we didn’t make any assumptions about that guy. We treated him with the same standard of care and urgency that any emergent medical condition would warrant until we had proof that he was faking it and after he grabbed a nurse’s breast so violently and so hard that the entire right side of her chest was bruised for a couple of weeks. We made no assumptions and only acted on his behaviors and proven medical condition.
The experiences you have had are horrible, but they are not universal. Unfortunately, the way the emergency medical system has been stretched to its limit lately means that the best the ER can do is to keep people from dying, and diagnose and treat the more straightforward conditions. For most of the more complicated and chronic stuff, there’s very strict laws about how much medication for what duration can be prescribed by an emergency physician, and a significant amount of the time, the best we can do is make sure you’re not actively dying and put in a referral to the specialists with a note that you should be bumped up the waiting list a bit depending on severity. Hell, even trying to admit people to the hospital isn’t a sure bet these days because the inpatient departments are allowed to enforce their staffing-to-patient ratios, so the ER gets stuck trying to take care of inpatient and even ICU patients with ER resources for up to days at a time.
My somewhat glib comment about people not being aware of what counts as an “emergency” is very literal when it comes to triage. We do our best to treat everything that comes through our doors, but if there’s not an immediate threat to life, limb, or permanent disability, there’s pretty distinct limits on what we’re able to do on a short timeline and what the hospital allows us to do for free. EMTALA stands for “Emergency Medical Treatment And Labor Act” and it dictates that anyone who turns up to an ER with an emergent medical condition that poses immediate threat to life, limb, or permanent disability will be treated and stabilized to the accepted level of care regardless of ability to pay, and a mother presenting in active labor will be provided with delivery care or appropriate timely transfer to a labor and delivery department if appropriate regardless of ability to pay. There’s very strict rules about the level of treatment to be provided and when or if transfer to another facility or provider is warranted and permitted, but past the stipulations of that law, it comes under the hospital administration’s rules and regulations about what level of care can be provided by the emergency department.
I’ve seen quite a few physicians defy the hospital rules by ordering some of the special labs and tests that the specialist would order so that the results are already available in the system for when (if) the patient gets seen by the specialist, but they can get in quite a bit of trouble for it, and if it’s not documented just right the patient’s insurance might not pay for it. That’s one of the other delightful limitations on what the ER can do…we have to toe the line on what needs to or should be done versus what the patient’s insurance will pay for, because believe it or not, we really don’t want to stick you with a bill for thousands of dollars of tests that your insurance denied coverage for.
Due to overwork, understaffing, antiquated training, and burnout, a lot of physicians’ and nurses’ bedside manner could use a fair bit of work, but in terms of the care provided, 99+ percent of the time, it really is the best we can do under the restraints created by laws, rules, resources, and insurance.
Permanently disability is exactly what happened to me and so many others when the ER refused to do anything because our pain is not taken seriously. The crux of the issue here is that you cannot ‘see’ how much pain someone is in and come to a conclusion how pressing their need for medical attention is without further investigation. I’m not asking ER staff to provide treatment beyond what they are supposed to, I’m asking ER staff to provide treatment of what they are supposed to.
The problem is that what constitutes as a medical emergency isn’t dictated by patient’s pain or symptoms, it’s dictated by the medically unsubstantiated biases and preconceptions of medical professionals because patients are presumed drug seeking to be and unreliable witnesses to their own bodies even with clear documentation of prior medical conditions.
Per the laws involved here, “permanent disability” means something like paralysis from a spinal injury, or loss of organ function due to acute critical illness like a necrotic bowel or something. Unfortunately, according to the medical and legal literature on the topic, disability from pain or chronic disease is beyond the required services of an ER. Arguments can be made for acute-on-chronic situations like splenic damage or rupture in sickle cell crisis, but those areas can get pretty fuzzy.
That’s a shame. Under disability law, permanent disability is legally defined as a loss of mental or physical function to the point of significantly reducing one’s ability to work or perform daily activities for an indefinite period.
It’s ironic that medical disability considers the loss of a limb as a permanent disability but not permanent pain and suffering, because I’d gladly trade my leg to know what it’s like not to be in pain again and to be treated like a person with a visible disability.
