There Are 32 Patients Ahead Of You - Please Wait

Newspapers have discovered that some hospital-discharged patients do not have follow-up from the physician or physicians who saw them during hospitalization. Though the articles imply indignation and surprise, apparently the issue isn't important enough to ask about its causes and effects.

Once upon a time hospital emergency departments were served by on-call private practice physicians who provided needed emergency services while generating new practice clientele and revenue. Then hospital administrators discovered that hiring teams of contracted emergency department and acute trauma specialists not only augmented their hospitals' cash flows and helped them to meet federal and state requirements for patient stabilization before discharge or transfer, but also provided political clout among the medical staff through contractual control of physicians. While hospitals drew comfort from their public service and profit from their billing of insurers, Medicaid and Medicare, many of the physicians who provided in-hospital services were not happy because they received minimal payment for care of very sick people who did match their fee or practice profiles. These physicians had agreed to care for these people in the hospital, but were not required to add them to their office practices - and they didn't.

Meanwhile, many of these patients had no continuing relationship with any physician, or had only a practice or clinic which would see them only during daytime hours. Individual choice, language issues, alcoholism, drug use, cultural, financial, insurance coverage and daytime home responsibilities may have limited their access to medical services from someone who would accept the responsibility to care for them post-hospitalization.

And so on discharge, the physician would dutifully advise the patient to return to her previous physician or instruct the patient how to access the county medical society or other clinic or referral program to get ongoing care, or ask social services to arrange for post-hospital care, but the physician and the patient knew that the next time the patient was sick he would come to the ER where the entire charade would play out again. This wasteful system which shifts revenues to some providers, costs to taxpayers and underfunded responsibilities to others will be changed only by systemic reform of our health system.

So the next time you are #32 on the list of people to be seen in the hospital ER, remember that our social policy has created that waiting list. And try not to die from that heart attack, passing as indigestion, before they get to you.