Quora Query: Why do you believe that people who abuse the healthcare system in the US should be enabled, through not telling them, in no uncertain terms, that their non-emergency issues are just that…non-emergencies?

There are several fine answers to this query – see, particularly, the one by former Nurse Mara Obelcz on Quora. And just as there are several answers to your question, there are several – many – reasons that people come to the emergency department (ED) at various hours of the day and night instead of visiting a Primary Physician (PMD).

Firstly, as one who was Medical Director and Division Chief of Emergency Medicine at UF from 1995 to 1999, it is as clear as day that we often didn’t know that a problem wasn’t an emergency until we had worked it up and determined the cause, or ruled out a serious cause. For example, a headache is just a headache, until it isn’t. Until it is a brain tumor, an intracerebral bleed, a subarachnoid hemorrhage, an infection…..well, you get the picture. So how would I tell the person who has a non-life threatening headache, after we figured this out, not to come back unless they had an “emergency”?

Secondly, we are living in the deepest period of income inequality since either the 1890s or 1920s – depends upon whom you read – which has significant implications for how people access health care. Such profound income inequality – the consequence of years of neoliberalism and the destruction of good union jobs in our country – means that many of us work several jobs just to make ends meet. So, many working people in inadequately paying jobs are uninsured or underinsured – the number is about 83 million if you combine both of these, a quarter of our population – the result being that they don’t have a PMD. If they become ill, the ED is where they go; where would you have them go? How would you have us turn these people away, whatever might be their illness?

Thirdly, again as a consequence of the neoliberal policies of both wings (Republican and Democratic) of our Capitalist Party, we have no transportation system in much of the country. What is a mother or father – without a car and working between 1 and 3 jobs daily – to do when they or their child becomes ill? They borrow someone’s auto whenever it is available, and go to the ED. Again, may I ask? What would you have them do?

While I don’t want to make this answer too personal, much of my work in medicine has been in the operating suites and the intensive care units of large academic institutions. The job I’ve done is infinitely easier than that of the ED or Primary Care physician; and I can say this because I have ALSO done primary care and emergency medicine. My respect for these front-line physicians is almost limitless.

Most of us, at some point of weakness and perhaps fatigue, wonder why the person with “nothing but a cold” comes into the ED at 0300 hours. Upon reflection, in one form or another, these three explanations come up, and we remember why we are physicians and nurses: To serve our people.

Thank you for the query.

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He serves as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders). While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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