This week, we're going to be wrestling with the difficult topic of access to care. There is a lot of attention on this issue that will only increase as the economy continues to sour. In emergency medicine, the conversation centers on diversion - or when it's appropriate to send patients to other hospitals. Please follow each of the links below to supplement your reading for next week.
Is it wrong for a university hospital to turn away a patient because he doesn't have insurance? What if it was a kid attacked by a pit bull? There's been a big splash in Chicago about a child with dog bites to the face being sent home to follow up at a different hospital. The situation has drawn criticism from the American College of Emergency Physicians, but the University of Chicago is defending its position to divert uninsured patients. This story's juiciness is enhanced by the direct connection between Michelle Obama and hospital’s Urban Health Initiative (UHI), which has as its goal to divert non-emergency patients away from EDs. It’s supposed to make the system more efficient by freeing up ED staff to treat the most urgent cases. But ACEP likens it to dumping unprofitable patients.
As the newspapers and ACEP present it, this policy clashes with one attraction for choosing a career in emergency medicine: being part of the urban health safety net. But shouldn't innovative solutions for improving access to medical care be implemented from within the ED? I didn't hear much about the UHI when I interviewed at the University of Chicago, but in a recent email to applicants, the U of C emergency medicine residency program director did say that resident training will actually not be very much different because of the University's policy. This makes a lot of sense, given that training occurs at four hospitals around the city and there are always patients in urban ED waiting rooms. As one of my friends (a student at U of C) points out, it is important to see both sides of this story. It sounds like the medical indications (not sewing up an animal bite wound because it had a high chance of infection) won out against the contextual features (it may look bad in the newspapers to send someone home with a loosely approximated animal bite wound).