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ER overcrowding

The public doesn't really care about the problem of ER overcrowding, right?

Well, maybe as a matter of public policy, Iraq and immigration have a firmer grip on the public's collective attention. But for people who have had to be a patient in an ER, and have had to wait for hours and hours to get a simple medical problem addressed, ER overcrowding is a big deal.

It's certainly a big deal for people who work in ERs. As a resident, I work in three very different ones, and I know that people often have to wait a long time before being seen -- unless they come in complaining of stabbing chest pain and have a blood pressure of 80/40. If you're not one of these lucky few, the typical ER experience is, "have a seat, I hope you brought some knitting with you to keep you entertained." My first job when they finally come back is to apologize for the long wait.

The reasons for overcrowding depend on whom you talk to. Some people say that it's because of the large and growing number of uninsured patients who can get care nowhere else. Some say, bullshit. Here's Michael Saloman, president of the California chapter of ACEP:

Crowding in the ER is actually a symptom of hospital crowding. There is a shortage of nurses and hospital beds in Modesto. Admitted patients are forced to wait on ER gurneys for hours because there is no place to put them upstairs. If all ER beds are occupied, then patients in the waiting room can't be seen. That is the reason ERs are crowded.

People, people! Let's not get hot under the collar. Just ask me, and I'll tell you that you're both right. Think about it: many of the ERs beds are occupied by admitted patients that can't go upstairs because there's no room to put them. This can effectively turn a 30-bed ER into one with ten or fewer beds. The rest of them are occupied by admitted patients, getting their q8 hour antibiotics and being forbidden to eat after midnight.

But let's be realistic: if all the people in the waiting room who need a med refill or have the flu, and who can't go see a doctor at a clinic because they don't have any insurance would get up and leave, the waiting room would be a lot emptier. Sure, these people are easily treated and released, but that doesn't mean that treating them takes no time, or that they don't need a private area where they can be seen and examined.

So what's the solution? Simple. First, build more hospital beds. Second, make sure everyone has health insurance and a nice, warm, conveniently-located clinic where they can see a doctor. Third, stop eating junk food (and don't wait for the FDA to regulate added salt in food). Fourth, get more exercise.

Like I said: simple.

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