Counter-Point: Frequent Users of the Emergency Department: Meeting Society’s Needs

Internal medicine physicians were once known as the " physician's physician. " These clinicians were consultants or specialists to the general practitioners of society. As medicine matured, their practices changed significantly. Now internists are one of the leading primary care specialties, while remaining specialists in their own right. When the specialty of emergency medicine (EM) was born, its intent was to care for patients with emergency medical conditions. However, as societal needs changed, so did the house of medicine, blurring the line between primary and episodic care. For better or worse, EM has changed to become the safety net for all of American healthcare. " It has long been acknowledged that ED visits are frequently the result of a failure of prevention. " 1 Others frequent the emergency department (ED) due to the lack of timely primary care. Yet, a significant portion of ED patients, primarily low-income and underserved, have no other place to go. The underinsured are having increasing difficulty finding healthcare providers willing to accept Medicaid reimbursement. To compound the problem, the fully insured are turning to the ED for a variety of reasons. Open 24 hours a day/7 days a week, EDs give access to those who can't make time during regular business hours. And in this era of instant gratification, some seek ED services for the sole reason of expediency. 4 Many patients see the ED as a one-stop shop, where a physician and diagnostic and therapeutic options are available in the same facility. Very few primary care office practices can offer the same convenience. Finally, even insured patients have significant barriers to their primary medical doctor (PMD) for urgent medical needs and can only get appointments weeks or even months later. In essence, the ED has become the preferred provider of choice for some. The EM community, although far from unanimous in proposing solutions, has at least recognized the problems associated with access to care in our current healthcare system. The Society of Academic Emergency Medicine (SAEM) developed a Public Health and Education Task Force (PHETF) to investigate the appropriateness of including primary and secondary preventive interventions in routine emergency care. Assuming sufficient resources, the PHETF found enough evidence to support alcohol screening and intervention, HIV screening and referral, hypertension screening and referral, adult pneumococcal immunizations, smoking cessation counseling, and referral of children without primary care physicians to a continuing source of care. 5 This, …