> -----Original Message-----
> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On
> Behalf Of Deborah Harrell

...

> While good primary care should be able to greatly
> reduce need for ER visits in many (perhaps even most)
> cases, there are, frex, brittle diabetics who -
> despite best medical care and best patient
> participation in their own health - will require
> emergent care.

Yeah -- our daughter, for one.  She ends up in DKA about once every other
year, which is most definitely life-threatening, as you'd know, of course.
And then there infections.  We were in the ER with her a couple of years ago
when she had been fighting a kidney infection (we thought that was all,
turned out she had food poisoning, too) and spiked a fever so high that the
nurse seriously thought the thermometer was broken.  She came back with a
second one, then the old-fashioned glass kind... then she came back with the
director of emergency medicine.  Carrie's temp was over 107.  Needless to
say, they got it down rapidly, or we wouldn't have a daughter any more.

Why don't they save money by educating people better about when to head for
the ER and when to go to a clinic?  Kaiser solves this by keeping a clinic
open most of the time and redirecting people from triage to it.

I guess there's part of me that's slightly sympathetic.  When I was a
paramedic, a couple of decades ago, it was fairly unusual for people to call
911 for a clearly non-emergent situation.  These days, it seems far more
common.  When we got rear-ended on the freeway a few years ago, I was fairly
sure that our injuries (whiplash that troubled me for years afterwards)
didn't require immediate care.  But the highway patrol officer who showed up
urged us to go by ambulance so that we wouldn't have to wait for hours at an
ER or clinic.  Walk in and wait, come by ambulance and go to the head of the
line.

Which reminds me -- we used to be superstitious about anyone who could walk
to the ambulance.  The pregnant ones always seemed to deliver; the cardiac
ones always seemed to arrest, etc.

And I'll never, ever forget one diabetic in DKA who arrested as we
transferred him into an ER bed.  After about 30 minutes, they pronounced
him.  I walked back through the waiting room and heard his wife consoling
another waiting spouse, a stranger, I assume, telling her that she'd been
through this many times before and she was sure that her husband would be
home in a day or two.  Whenever Carrie is in the hospital and I hear a "code
blue" or "paging Dr. White" or whatever they're using for a code, I worry...

This policy is like "teaching" hungry people a lesson by withholding food.

Nick

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