Thursday, January 12, 2006
Decisions by one patient ripple out to affect other patients

By Dr. Anthony Policastro
Nanticoke Memorial Hospital,
Medical director

There are multiple situations in which the actions of one patient affect the medical care of other patients. This may not always be obvious. However, the situations are common. The most common example is showing up late for a doctor's appointment. When a patient is late for an appointment, it has a ripple effect. Patients following that patient will be seen later than their scheduled appointment. Patients who arrived early may have to wait for the scheduled patient to be seen. Being on time is a considerate thing to do. A second example is related to the use of ambulance transport to the emergency department. Dialing 911 when it is necessary can be life saving. However, some people call 911 because they have no other means of transport. Some of them dial 911 because they think if they arrive by ambulance they will be seen sooner. Regardless of the reason, this could result in problems for other patients. An ambulance might be tied up with a less serious problem so that the crew cannot respond to a more serious one. Patients who do not arrive by ambulance may have to wait longer while those coming by ambulance are evaluated. Interestingly, a new Medicare requirement about this went into effect on Jan. 1. Medicare will pay for ambulance rides to the hospital if they are true emergencies. That will usually be defined by the patient being admitted to the hospital from the emergency department. However, Medicare will now only pay for a total of three non-emergency transports. After that the patients will have to start paying the ambulance bill themselves. Medicare would not have put this rule into place if it did not think that some people were calling ambulances unnecessarily.

A related issue is the patient who decides to go to the emergency department because it is convenient to do so. That patient may not want to have to schedule an appointment with a primary care physician because it might be inconvenient. Fortunately, these people make up a small percentage of emergency department patients. I conducted a study on this when I was in the Air Force. It looks like it is about 5 percent of patients. However, in a busy emergency department, even one unnecessary visit out of every 20 patients prolongs the wait for all the other patients. Except for true emergencies, emergency department visits should be preceded by a call to the primary care physician to see if a timely appointment is available. One other type of inconvenience is related to the current problems with hospital overcrowding. Sometimes hospitals do not have enough empty beds. Sometimes hospitals have enough beds but not enough nurses to take care of any more patients. In either case, patients have to wait to be admitted. It is not unusual for a patients who are being discharged to indicate that they cannot go until they have a ride home. While it is true that they need a ride, it is also necessary that the driver come to the hospital as soon as possible. Waiting for someone to get off from work is not reasonable. Waiting for someone to run an errand first is not reasonable. There is often a patient who is acutely ill waiting to be placed in that bed. For such an ill patient to have to wait for someone else to get a ride home does not make sense. Discharged patients and their drivers need to consider the needs of those sick patients when they make their plans for leaving the hospital. Things do not happen in a vacuum. Our actions frequently affect others. We need to realize that. We need to make sure that we act accordingly. We certainly would expect others to be considerate of our medical needs. We should be considerate of theirs as well.