Emergency Medicine as a profession is rapidly becoming untenable. There is now simply no way to justify sending anyone home because apparently nobody has any follow up. I got a nasty letter from our peer review committee the other day about a patient I had seen who complained that I hadn’t admitted him. Without going into the details, when I saw him in the Emergency Department for his two years of Pain That No One Could Diagnose a review of our records showed that his medical Odyssey included negative MRIs, negative CT scans, Negative lab studies, negative Studies I Had Never Heard Of, and many visits to a small platoon of specialists who could not diagnose him. On top of that he had a completely unremarkable exam when I saw him and totally normal vital signs. What’s an Emergency Doctor to do?

I’ve also caught some flak for having my abscess and laceration patients return to the Emergency Department for follow up. Apparently the preferred practice is to have them follow up with the so called “Private Physician” or better yet, the local charity hospital where wait times for the clinics can run to months. While I’m sure many of my self pay patients could easily afford forty bucks to be seen at an urgent care for a wound recheck, many of them wont and they’ll either come back to the Emergency Department anyway or let a complication fester to the point where I’ll just go ahead and admit them. I do my best and try to err on the side of caution but not every simple abscess that looked like it could be drained in the Emergency Department gets better. I’d just like to see them again to make sure everything is alright. Why a routine wound check is not included in the bill is beyond me.

Not to mention the growing number of patients I am seeing with a Chief Complaint of, “My Doctor Said I Needed an MRI.”

This is the growing problem…maybe we can call it Mission Creep. It seems we are becoming the de facto primary care physicians and specialty clinic for a growing number of patients who are incapable, unwilling, or unable to handle even routine medical follow up.

This, too, will not end well.