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Saturday, July 21, 2012

Distinguishing medical urgency from personal urgency

A constant thorn in my side is the constant drumbeat of our organization pushing us to get patients in to see our physicians with less and less delay. Don't get me wrong, I am an enthusiast for creating patient friendly and responsive environments. However, we live in a world of scarce resources and resources expended to get people in faster when they do not need to be seen faster has unintended consequences in terms of resources being available to serve patients who have real medical urgency.

 We confound medical urgency with personal urgency. If an Emergency department is filled with patients who have mild and self limited illnesses and this results in resources not being available for patients who have acute and life threatening injuries, everyone realizes this is an undesirable situation. EDs have triage protocols that allow them to prioritize patients.

However, in the remainder of the ambulatory world, triage tools which formalize how we separate medical urgency from personal urgency are rudimentary if they exist at all. Our triage tool is to respond to who calls first, or who screams the loudest, or who knows somebody. Our goal is for everyone to have immediate access whether they need it or not.

In the market driven world outside of health care, there is a premium which needs to be paid if urgent wants are to be fulfilled. Granted, urgent needs (and you have to define needs) should be given priority and I think giving them priority would be much easier if we were not constantly distracted trying to deal with the urgent personal wants of those who desire for immediate service comes at zero cost. Why not ask for more and immediately since there is no additional cost.

Where markets operate, people pay a premium for faster. Order a book from Amazon and you can chose the regular shipping or you can pay a premium to Fedex the package same day.  We are planning for the cremation of our ancient Labrador retriever (who at 16 years of age is living on borrowed time). If she dies at night at home, the pet crematorium will pick her up at home...for and extra $100, or I can wait and take her in the next day. If I have a toothache on a weekend, I can go to an emergency dental clinic and I will pay a premium for the convenience. Book an airline flight the same day and I will pay a premium. That would be foolish if I did not need to reach my destination urgently.

Can we define medical urgency? I am sure I can come up with definition but is it relevant who believe they have an urgent problem? What difference will it be if there is no mechanism for garnering resources to deal with urgency? If the public defines urgency and is not required to invest any of their resources to deal with their "urgent" problems, why not define all problems as urgent. I am afraid they will get no better than they are getting now. To borrow from the restaurant world, it is as thought they are expecting fast food prices and timeline at a 5-star restaurant. However, what they are likely get is 5-star restaurant prices, fast food restaurant quality, and consistently bad service.

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