view | Challenges physicians face in the emergency room

To the editor:

repeatsThe examine estimates misdiagnosed thousands and thousands within the ER(Information article, Dec. 16):

As a New York emergency medication doctor who has fought on the entrance traces of the Covid-19 pandemic in a number of the nation’s hardest-hit hospitals, I used to be shocked by the way in which knowledge was offered on the Company for Healthcare Analysis and High quality. A examine on “diagnostic errors within the emergency division”.

The examine confirmed that emergency medication physicians have a powerful price of about 95 p.c of diagnostic accuracy. It is a surprisingly excessive diploma of accuracy contemplating that these diagnoses are carried out in a fast timeframe with restricted assets (lack of nursing, overcrowding), cowl each medical specialty (neonatology to neurosurgery) and are generally carried out in situations that put docs’ lives in danger. In danger (epidemics and violence within the office).

As emergency medication physicians, we agonize about each single a kind of remaining 5 p.c who go undiagnosed and proceed to push the boundaries of our younger specialty towards the objective of 100% accuracy. This drive to organize for any medical menace to humanity is how we now have created one of the vital enviable and preventive healthcare security nets on this planet.

Catarzyna Valkoska

To the editor:

Critical missed diagnoses can have severe penalties. However we should not ignore the most important and most essential downside within the American well being care system.

The dearth of sufficient main care help in our nation results in emergency rooms being overwhelmed by sufferers with minor issues, finest dealt with within the main doctor’s workplace. She or he is a specialist who is aware of you, has your medical data and has a relationship that outweighs the worth of all of the intensive providers obtainable on the hospital however will not be crucial for minor issues.

This inappropriate use of emergency departments is exacerbated by the truth that sufferers at the moment are overwhelmed, already evaluated and awaiting admission, however caught within the emergency room as a result of hospitals should not doing sufficient to extend inpatient mattress capability.

Decrease main care pay motivates well being skilled graduates to enter comparatively extra paying specialties that provide higher existence. Simply wait till your personal physician retires and you discover one other one.

Why let Medicare reimburse so little to your main care supplier’s workplace go to however a lot extra for an usually pointless emergency room go to, or a specialist’s workplace go to?

Jesse Samuels
West Hartford, Connecticut.
The author is a retired doctor, board licensed in household medication and emergency medication.

To the editor:

As an emergency medication doctor, I take difficulty with the framing of the knowledge offered. Calling a misdiagnosis “flawed” is deceptive and inflammatory.

A big portion of sufferers current to the emergency division with nonspecific or obscure signs. It is a gigantic problem that requires ability and expertise to type out which of those people have life-threatening situations and which will be safely discharged residence. This have to be finished whereas reaching value efficiencies and bypassing the useful resource constraints inherent in our healthcare system.

There’s all the time room for enchancment, however emergency physicians deserve reward for his or her spectacular ability and competence fairly than be chastised for a way laborious they work.

Andrew Williams

To the editor:

repeatsMassive hospital chain cuts fueled a staffing disaster(“Earnings on Sufferers” sequence, entrance web page, Dec. 16):

Thanks to the journalists who examined this dysfunctional hospital system and to the nurses who documented what can solely be thought-about affected person abuse for revenue.

Whereas the pandemic has opened the curtain on the situations that result in employees burnout, hospitals have laid the groundwork for this staffing disaster for many years, the article famous.

Hospitals and different care services can’t exist with out nursing, which is the most important healthcare occupation. Nevertheless, it’s not uncommon for hospitals to disregard their nursing employees and as an alternative pour their assets into excessive government salaries and advantages, huge lobbying budgets to struggle obligatory ratios that may restrict the variety of sufferers a nurse might take care of at anybody time, and earnings. Large. Nurses are used to listening to managers lament the “nursing scarcity” the very second they’re shedding nurses or freezing hiring.

Some individuals in hospital techniques complain that nobody desires to be a nurse anymore. Effectively, sure, if nurses are required to work double shifts, neglect their households, and sacrifice their bodily, psychological, and emotional well being, solely to be mocked for his or her lack of “dedication” when the system sabotages their capability to offer care.

A lot of the nurses I meet need to keep in nursing, and I’m assured that sensible, expert, and caring people will be part of them if nurses are given the respect and assets they want and deserve.

Bernice Breech
Cambridge, Massachusetts.
The author is a former journalist and co-author of From Silence to Sound: What Nurses Know and What They Ought to Convey to the Public.

To the editor:

This text demonstrates what has been recognized within the healthcare discipline for a very long time: excessive nurse-to-patient ratios result in… higher outcomes, Fewer hospital deaths and a shorter hospital keep.

In fact, nurses value cash, however these making the selections to put off nursing employees have completely no concept of ​​all of the issues nurses know or do, or the vital pondering expertise wanted to do their job.

And would any of those officers really feel protected with a nurse who’s now over a 12-hour shift and coping with a double load of protected nursing ranges?

Let’s name it what it’s: Hospital administrators and boards selected cash over life.

Joseph Tremmel
Nice Valley, New York
The author is a registered nurse.

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