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# Adam Davis 2011-05-26 07:18
Dr. Bukata,

You are entitled to your opinion yet you are rapidly losing the enormous respect I and many others have for you with your continued support of big government and quasi-governmen tal organizations.

Your recent trend advocating for arbitrary rules by bureaucrats is becoming tiresome. Your protests are little more than appealing to a mafia don to "solve my problem or to enforce my preference". You should be ashamed of yourself. You have made enormous contributions to emergency medicine for so many decades, yet in the twilight of your career, these are for what you will be remembered. Sir, have you no honor?

The latest example is your solution to ED waiting times. To suggest "the Joint Commission crack down because hospital administrators fear them" is a Faustian bargain. You fail to realize these enormous wait times are driven by the unintended consequences of prior demands for crackdowns after tragedies. These generally do nothing to fix the problem yet give more control to government bureaucrats that further interfere yet add no value. How quickly you forget Joint Commission mandating pharmacist approval of all medication orders in the ED or their interference with procedural sedation?

One of the most egregious examples of interference, however, is EMTALA passed by Congress. The subsequent distortions in the physician-patie nt relationship are self-evident. EMTALA after nearly three decades has become an unmitigated disaster. We see every manner of absurd, non-urgent-conv enience visits across the spectrum to the true emergent cases that we are trained to handle. Reform EMTALA and this problem that you demand the Joint Commission "do something about" goes away.

There is no doubt the case you described is a tragedy but your emotional, knee-jerk reaction demanding Joint Commission action will only lead to more interference and ultimately the further destruction of not only our specialty but the house of medicine.

Regards.
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# MDMicelle 2011-05-26 11:25
The RRC cited my program and at least 17 other programs (I surveyed the CORD listserve) for ED throughput exceeding 4 hours for d/c'd patients or 8 hours for admitted patients. Don't know if this will "encourage" my hospital to enable us to make improvements though.
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# MDCharles Kochert 2011-05-26 21:51
I agree with Mr Davis. If Joint Comission wants to help "solve" this problem, they should be asking, "What can we do to keep frivolous cases out of the ED so that EDs can focus on true, or at least potential, medical emergencies?" Non-urgent cases make up a tremendous amount of my workload, and often these people tell me that the reason they came to the emergency department is that they do not have any insurance or money and cannot afford to be seen anywhere else. Yes, the bills exorbitant for those who actually pay, but it is only because we allow so many "freeloaders" to be seen for minor conditions and then cost shift. Government intervention, if it is to be used at all, should be used to address this theft of services. EMTALA was never intended to cover an ingrown toenail that has beebread present for several months, but now that CMS is tying hospital reimbursement to patient satisfaction scores, hospital administrators are even more reluctant to offend these people who are stealing resources from their hospitals and timely care from their fellow patients. In the end, even government interventions with appropriate intentions always have disastrous outcomes (see Medicare, Social Security, Medicaid, etc).
Rick, I believevthat you are a very intelligent and experienced physician, but your solution to the problem of excessive wait times attacks the problem from the completely wrong end of the spectrum.
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# MDBecca 2011-05-27 23:38
Yes sir, we are doing our patients an injustice. They should not wait for five hours to be seen. Horrible ER doctors. I think they should stop sitting around and actually work. Every time I walk into an ER all I see is them sitting down for lunch, relaxing in the staff lounge, or writing on facebook. REALLY? Most shifts I dont eat, use the restroom, or sit for more then a minute to complete a task. Yet I ccant get patients admitted, cant get consultants to come in, cant get labs to return, cant get one-on-one nursing care for each person. And of note: That $500 that "we" get. How much of that do "we" see? I agree with above. You are appraoching this from the wrong direction. For someone who usually has a respectable opinion, I believe sir you just lost.
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# re:...paul 2011-05-28 02:38
if you are interested in losing further respect for Dr Bukata i encourage you to listen to the May edition of "bouncebacks" on emrap.

something to the effect of always siding with the plaintiff on malpractice lawsuits. abolutely disgraceful coming from our profession's "leadership."
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# HDoc 2011-06-23 08:53
You probably also agree with Massachesetts "fixing" their hospital's on Divert problem by simply demanding hospitals no longer go on divert.
If ER's were a ship, it would be the Titanic.
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