Welcome to the Jungle!

For most hospitals, the portal of entry has become the Emergency Room. Sticklers like to call it the Emergency Department, but that sounds too long. ER has such cache after the long running TV drama, that the term just sticks.

Why is the ER so important? Part of it is access. The ER is a victim of its own success in simple messaging. "We’re here. The lights are on. We’re always open. We can’t turn you away (there’s a law called EMTALA that says ERs have to treat and ‘stabilize’ you, even if you have no insurance. Come when you can. Enter at your own peril. Hurry up and wait." (OK, I added those last two).

ERs certainly are convenient. At least in the way that they’re always open and you know where they are. Ambulances take you right to them. How easy is it to get an appointment with YOUR doctor when you want to?

The problem is that people are using the ER for everything now. “I don’t feel well.” “I have a cold.” “My throat hurts.” “Me, it’s my back.”

ER docs are trained to treat emergencies. They know how to stop bleeding, how to shock chests, how to put tubes in your throat to hook you up to a breathing machine if the need should arise. They didn’t choose their field to wave their hands at your cold.

Apparently, when ERs first came about, your personal doctor might meet you there and handle the assessment. The ER doc would just hold the phone until your doctor could come. No one would dare overstep your own doctor’s wishes.

But soon doctors realized that they could see more patients by staying in the office. This gave more and more ground to the ER docs. The ER docs would do their own assessment and decide if you’re sick enough or not to be admitted to the hospital. Thus, the ER became the portal of entry.

If you come to my office and you’re sick, or I don’t know what’s going on, I can now send you to the ER. The ER is set up to do quick lab tests and xrays, even CT scans and MRIs if necessary. Everything in my world moves more slowly. You have to get from one place to the next. In the ER, they do it for you or come right to you—the blood tests, place the IV, even bring a portable xray machine to your gurney (your not-so-comfy ER bed) if you need one.

The ER bundles you. If you need a specialist of some kind to see you, they call that specialist in. It can all happen so fast. Can, I said.

The down side of this clever system is that so many individuals choose to receive care there, that the system breaks down. People wind up waiting for hours. An old man literally died waiting in one Chicago ER. And they don’t show you that on Chicago Hope.

It’s not really hopeful if you have to wait so long that you die.

NEXT: Why do you really have to wait so long in the ER?