I echo Ted Flemming’s sentiments with regard to the function of the ER and the need for changes; changes that are long past due. Expanding physician hours is not the only solution; it’s simply a band-aid on a gaping wound that requires multiple sutures.
Following Mr. Flemming’s assessment was a thought-provoking piece delivered by 3 ER physicians who paint a scary picture of the implosion of ER services. Is the system irrevocably broken? Perhaps not. Physicians assistants also had a say in the matter. The prognosis seems grim. Is it?
From my perspective, as armchair critic, what may contribute to health and wellness is a roster of nurse practitioners and physician assistants in every hospital across the province taking on all those patients with health/medical concerns that are clearly not emergencies. ER wait times have become life threatening. 6-12, 20 hour ER waits is is unacceptable. Full stop! Adding an extra layer of health care via nurse practitioners and physician assistants has potential to break into the flow of ER congestion as they are able to spend with the patient the time the doctor just doesn’t have. That time can be spent educating patients about what IS an emergency and what is not. Armed with knowledge reduces anxiety and may minimize the frequency of future ER visits.
Sometimes, ER traffic is comprised of frequent flyers, as I like to call them; not always those without a family doctor, but folks who think that every little thing, from a hangnail to a sniffle requires emergency medical attention. And then there are those who fear they won’t get seen in a timely manner and avoid going to the ER when they really should, waiting to the point where an ambulance is called to their home. Sadly, it’s sometimes too late. A catch-22 to be sure.
Funding to provide more physician hours has not been changed since 2004. Wait times are perilously long while physicians work diligently to break the back of the heavy load they carry. They cannot possibly do good medicine in circumstances that test their resolve to keep going. Sick patients get sicker and those who wait with them get understandably anxious. Then the pressure cooker of emotions explode. No winners.
We are a population that's aging, many in nursing homes; lots of men and women are aging in their own home but sadly, far too many find themselves aging in hallways and other spaces in hospitals because there are no nursing home beds. Equally sad is when an elderly couple has to be separated, with different nursing home placements. I’m sorry, but that’s cruel and inhumane. There’s no other way to spin it. Compassionate care must rule the plan of health services delivery.
From where I sit, we really are in full crisis mode, with too many people spending far too much time complaining about the flaws in the system instead of assessing their own contribution to that problem. Assessing what they can do in their own lives, on a daily basis, to limit their own over-use or even misuse of ER services. It’s not just about doctors, nurses and other clinicians and the care they provide. It’s about all of us.
If each community developed educational sessions on a biweekly basis, where people coul gather to get information about various concerns, I am certain that would go a long way to stemming the flow to the ER of those who are experiencing nothing more than a bit of misguided fear, anxiety or loneliness. For some, the ER has becoming a social gathering place. Look around and see how many people come in as a group, when only one is the patient to be seen. Organising informal gatherings serves another purpose. It connects the isolated to people and potential goods and services they may require to enhance continued aging in place living. It reinvigorates communities and establishes new people connections. Providers of health care would be ideally suited to hold informal lecture series to meet, greet and educate.
A movement within communities to develop programs of service and learning would become the sutures to the wounds of isolation and loneliness experienced particularly by the most vulnerable — the elderly. Doctors would do well to ask more probing questions about lifestyle and how days are spent by those seniors who live alone. Signs of trouble would be evident with deficiencies in nutrition, lack of quality of sleep, worry about what’s to become of them when their circumstance changes. So many questions. Groups of like minded individuals within the community sharing those concerns and talking about them can ease the burden and concurrently improve physical and emotional health of the often disenfranchised.
Points to ponder.
Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with her geriatric Australian silky terrier and a rambunctious Maltese. She can be reached via email at carmacrockwell@xplornet.ca
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