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Jewish World Review Jan. 20, 2006 / 20 Teves, 5766 Emergency medicine armageddon By Drs. Michael A. Glueck & Robert J. Cihak http://www.JewishWorldReview.com | And so it comes to pass. Everything we have yelled and screamed and warned about for the last 5-10 years has come to a critical mass. We're not gloating about this, however. We, as patients, are worried to death. The massive medical purple pustule is ripe, coming to a head and about to burst. According to Jeff Minerd, MedPage Today, January 11, 2006, "[The] U.S. Emergency Medicine System [Is] Near [the] Breaking Point." And no wonder. From our ["The Medicine Men"] point of view the last few decades have witnessed a decline in the delivery of quality of healthcare for many reasons: Increased government control of medicine with too many unreasonable unfunded mandates that overload the system Increased beaurocratic red tape and hundreds of thousands of pages of regulations Increased corporate and stockholder control of medical care, medicines and physicians Increased litigation and monetary awards enriching the trial lawyers but of little value to medical care other than increased lawsuit-preventive defensive measures such as expensive lab and radiographic tests Jailing of physicians for prescribing legal prescription pain medications to some, like you, of the 50 million Americans in pain Privacy regulations (HIPAA) that do little to help patients, hinder helpful (and gratis) hallway consultations, and, ironically, allow government officials to peek into your medical charts at will Longer and harder medical and specialty training, more exams in and post-medical school, more hours of continuing education, more specialty and subspecialty examinations and now extensive recertification examinations. A good idea ­ except that with corporations and HMOs allowing 7-10 minutes per patient visit, much of this training is superfluous. So while education and training is up, care is down. Failure to put any controls on illegal immigration and the emergency benefits we give them ­ thank you, gutless congressional and state representatives, for this. There are many more, but we have reached our limits of indigestion. Returning to the January 11, 2006, article, which notes, "The emergency medicine system in the United States, already under stress, could fail if severely tested by a new natural disaster or terrorist attack, according to a report from the American College of Emergency Physicians." The report also notes but is not limited to those issues mentioned here: The state-by-state evaluation awarded poor or near-failing marks in emergency medicine to 41 states and a grade of C- to the country at large. California, Massachusetts, Connecticut and the District of Columbia led the nation, with overall grades of B. Rating worst in the nation with grades of D+ or D were Alabama, Arizona, Arkansas, Idaho, Indiana, New Mexico, Oklahoma, South Dakota, Utah, Virginia, Washington and Wyoming. The number of people coming to emergency departments continues to increase, with nearly 114 million patient visits in 2003, the highest number ever, the report said. At the same time, the overall capacity of the nation's emergency systems has decreased, with hundreds of emergency departments closing in the past 10 years. The growing ranks of the uninsured ­ who often turn to emergency rooms for their medical care ­ are also putting a strain on the system, according to the report. "Soaring amounts of uncompensated care means fewer resources for everyone." At the same time, all health insurance payers, including private insurance companies, Medicare and Medicaid, are paying less for services, and state governments are cutting health budgets. Another stress on the emergency medicine system is the high cost of medical liability insurance, which has led some specialty doctors to leave medicine or to be less willing to be on call for emergency situations. The task force analyzed data from sources including the American Medical Association, the American Nurses Association, the Henry J. Kaiser Family Foundation and the U.S. Department of Health and Human Services. "Americans assume they will receive lifesaving emergency care when and where they need it, but increasingly this isn't the case," said Frederick C. Blum, M.D., president of the college. Source reference: American College of Emergency Physicians. National Report Card on the State of Emergency Medicine. January 10, 2006. Available at www.acep.org. To which we add: It is time to wake up, America! Without excellent emergency care, all medical and health care will suffer in a sequence of devastating dominos. As we discussed last month in our article "High Cost of Medical Care for Illegal Immigrants," one solution is to change the rules giving free health care to those who come here illegally. Most Americans are no longer willing to accept the dishonest deal with the serpent made between our far left (for easy votes) and far right (for cheaper labor). In closing let's ask: What might happen "when entitlement fails"? Imagine not just a single-shot, 9/11-type disaster, but a rolling medical emergency where some locales have plenty of time to know they're not going to get what they expect or need. What would that say about us as a people? Editor's Note:: Michael Arnold Glueck, M.D., wrote this week's punditry Every weekday JewishWorldReview.com publishes what many in in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here. Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here. Archives © 2006,

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