Those of us who work in emergency medicine have all had these patients. They present with a complaint that started two years ago and for whatever reason now deem it an issue that needs immediate attention in the ER. I had a patient like this recently who not only had the issue for two years, but also had a primary care provider. Not only did the patient have a PCP, they saw their PCP a week before coming to the ER. Their provider also referred the patient for some outpatient studies. The studies were reasonable even though they would unlikely get to the root cause of the patient’s symptoms.
Despite being reasonable, the patient decided to not follow through with the referrals and instead decided to come to the ER demanding the studies be done there because the patient “needed to know today.” I politely went through my normal boundary setting dialogue about how the patient should be getting her outpatient studies done as referred by her PCP and how coming to the ER in lieu of that is an inappropriate use of the ER but it fell on deaf ears as usual.
Now none of this is new. We see patients with chronic symptoms all the time as well as patients who have doctors. But to read many of the articles you find out there, whether it be on a news site, Facebook or a blog, I have yet to see articles pointing out the issue of middle class, insured patients with primary care providers misusing the ER.
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