James R. Coggins (coggins.ca) is an historian, writer, and editor based in Chilliwack, BC.Overcrowded emergency rooms. Long wait times. Sick people giving up and leaving without being seen (over a million of them every year). Emergency rooms being shut down due to a lack of doctors (hundreds of days every year). Emergency rooms at Canadian hospitals are definitely in crisis.But the bigger question is why. The problem does not start in emergency rooms. They are not the source of the problem. The reality is that most of the patients in emergency rooms should not be there.Emergency rooms have become the primary venue for medical care for many Canadians, and they were never intended to play that role. They are for emergencies.Sixty years ago, doctors’ offices worked like walk-in clinics. Doctors had regular hours, and if you had a problem, you dropped in. No appointment necessary. This especially worked well in small towns, where a couple of doctors could handle all of the patients in the community.Then government got involved. Governments demanded more administration and better record-keeping. Having a patient’s entire medical history digitally available to any doctor who sees the patient is a useful medical practice. Although I am not sure that every sore throat or case of the flu needs to be recorded.Governments also began paying the bills. Again, this was a good step because it made increasingly complex medical care available to all.But governments then found that they needed to look for ways to control costs. So, they restricted the number of patients a doctor could see in a day. As a result, patients had to make appointments. It must be admitted that at least some overworked doctors welcomed this development..Now here is the problem. With doctors increasingly moving into better-paying and more interesting specialties, there are relatively fewer general practitioners/family doctors. There are close to 6 million Canadians without a family doctor. These people have no option other than to go to the ER.What about the Canadians who do have a family doctor? The appointment system means that patients often cannot get an appointment with their family doctor for seven to ten days. This works fine, especially for older patients who need regular checkups. But illness and injuries cannot be scheduled. In ten days, the patient will be better, dead, or in the hospital. So, the patient goes to the ER.This is especially true if the illness or injury occurs in the evening or on a weekend, outside regular office hours. In these times, more patients head to the ER.To solve this problem, governments set up walk-in clinics. They worked. Too well. To control costs, governments began restricting hours and restricting the number of patients a clinic could see. Walk-in clinics were often booked up for the day shortly after they opened. Patients would troop from clinic to clinic looking for one that had openings and would often end up in the ER. Many of the walk-in clinics have now closed.Another approach governments have tried is to set up urgent care centres. The idea was that patients needing medium-range care could go to these centres rather than the ER. But, to keep these centres from being overbooked, they refused to see non-urgent patients, expecting them to go to their family doctor or a walk-in clinic. Instead, they went to the ER.It should also be mentioned that because of government restrictions on how many patients can be seen, there are also long wait times to get an appointment to see a specialist. If the problem becomes more serious while the patient is waiting, the patient often ends up in the ER..The result of all this is that for many people, ERs have become their primary venue for medical care. Rather than tackle the cumbersome work of trying to get an appointment elsewhere, they go to the ER first.Illness and injuries cannot be scheduled. Governments have tried to limit costs by restricting primary care (family doctors and walk-in clinics), but this just diverts patients to more expensive ERs. This is a case of being penny-wise and pound-foolish. Government restrictions result in poorer healthcare and higher costs in the long run.If governments would set up 24-hour walk-in clinics on the front lawn of hospitals, the vast majority of ER patients would go to the clinics rather than the ER. This would save money since clinics have less administration and lower costs than hospitals. Emergency rooms would then return to what they were intended for — to treat those suffering from real emergencies. And if a patient at the walk-in clinic needed more urgent care (even an X-ray or other test), the patient could be transported across the lawn to the ER.This approach would cost governments considerably more in the short run, but it would improve medical care and reduce costs in the long run. Clinics are cheaper to operate than hospitals, and giving patients immediate care can prevent small problems from becoming bigger problems.James R. Coggins (coggins.ca) is an historian, writer, and editor based in Chilliwack, BC.
