Because of a typographical error, a story in yesterday's editions on emergency rooms incorrectly stated that about 5 per cent of patients cared for in Greater Southeast Hospital's emergency room could be cared for in a doctor's office. The correct figure is 50 per cent.
About two months ago, when Sandra Sherrod's son, Ricky, came down with a sore throat, she packed him into the car and took him to the emergency room at Georgetown University Hospital.
Mrs. Sherrod drove from far Southeast Washington to Georgetown, but she has become accustomed to making the trip whenever she has faced medical problems in the last 22 years.
Like a great many other persons in the Washington area and across teh country. Mrs. Sherrod does not have a family doctor. She does not have a pediatrician to care for the children. Instead, she goes to the emergency room at Georgetown.
The modern emergency room represents an awesome collection of technology and human talent, trained to render service for various situations in which minutes may be the difference between life and death.
Emergency rooms are staffed and equipped to handle acute problems, but in the last 25 years, they have become the place where sick persons bring problems they once took to their family physician.
Depending upon the definition used, from 25 to 50 per cent of visits to emergency rooms locally and nationally involve medical problems that could be handled as well, if not better, in a private physician's office.
Between 1954 and 1970, according to a Columbia University study, the number of visits to emergency rooms grew from 9.4 million to 43 million. "Emergency rooms," the study said, "now account for one-third of all hospital ambulatory visits, compared with only 20 per cent in 1954."
It is an expensive way for patients to get medical treatment. "Aside from the fact that we're open 24 hours a day, seven days a week," George Washington University Hospital emergency room director Robert Jackson said, "we have a large capital cost, large personnel cost. We are set up to handle the most acute problem that presents itself at the door. That's what we're set up for and what we have to be ready for."
As a result, a patient entering George Washington's emergency room pays a basic fee of $45, with tests and other procedures extra. "Obviously, the more it costs, the more we have to charge," Jackson said.
According to the Washington area Blue Cross, the average charge for an emergency room visit in the area is $25 to $30, with another $15 to $25 charged for the physician.
Health planners, seeking ways to get people out of hospitals in order to reduce costs, are distressed to find that increasingly large numbers of people are showing up for treatment of problems that could be handled just as well and at less cost in a private physician's office.
Although the price is high, Mrs. Sherrod and most other emergency room patients do not pay it, at least not directly. Mrs. Sherrod's medical bills are paid by Medicaid, a federal local program of medical assistance for low-income persons.The figure varies at each hospital, but 80 per cent of emergency room bills are paid by some form of private or governmental health insurance.
As a result, the cost of treating emergency room patients is borne by the medical system - by taxpayers, insurance policyholders and employers who pay premiums. Ocassionally, the patient pays.
Private health insurance policies usually are not intended to pay for emergency room care unless the patient's problem is actually "acute."
As Dr. Milton Corn, head of Georgetown University's emergency room, noted, however, "There's a very widespread custom of labeling conditions acute (by Georgetown's emergency room staff) simply so the patient can file a claim and be able to collect. This is simply sympathy on the part of the emergency room staff for the patient . . . That's not a hospital policy."
Cost does not entirely explain the increased use of emergency rooms as substitute for the family physician.
Another factor is the relative decline in the number of family physicians, locally and nationally. According to the National Health Council, the number of family physicians nationally has declined from 94 per 100,000 persons in 1931 to 55 per 100,000 in 1974.
In the metropolitan area, according to the Metropolitan Washington Council of Governments, the number of physicians in general practice declined from 541 in 1970 to 479 in 1975. Meanwhile, the area population grew by about 200,000 persons.
The number of general practitioners in the metropolitan area has declined from 18.6 per 100,000 persons in 1970 to about 16 per 100,000 in 1975. Thus, the metropolitan Washington area, already far below the national average in the ratio of general practitioners to its population, experienced an absolute and relative decline.
The numbers are somewhat misleading since a great many area internists - who are counted as specialists in the COG study - serve as family physicians. The figures do illustrate the problem persons here and across the country confront as they try to find a family physicians who can see them promptly when they are sick.
Not surprisingly, use of emergency rooms as substitutes for the family doctor appears to increase as the concentration of physicians declines in an area. A study of area hospitals in 1975 found that about 26 per cent of patients treated in Georgetown's emergency room were "non-urgent." The study found that 35 per cent of indigent patients, as opposed to 25 per cent of all other patients, had "non-urgent" problems.
At Greater Southeast Community Hospital, about 5 per cent of patients who come to the emergency room could be cared for in a doctor's office, according to Dr. Patricia Russell, director of Greater Southeast's emergency room. The problem, according to Russell, is that the area around Greater Southeast has one of the lowest concentrations of physicians of any area in the region. Persons coming to the Greater Southeast emergency room are asked three separate times if they have a personal physician, Russell said. "Well over half the patients say do not have a physician," she said.
To confront the problem, Greater Southeast has at least three physicians on duty in the emergency room from 10 a.m. until midnight. Since about one-third of patients coming into Greater Southeast's emergency rooms are under 16 years of age, Russell said, one of the physicians on duty 14 hours a day is a pediatrician.
In addition to the shortage of family physicians, Russell cited reasons why people visit emergency rooms, "Somehow the concept has gotten into people's minds that if they need a physician between 8 and 5, Monday to Friday, they'll call him, but outside of those times, no matter what arrangements the physician makes, they'll go to the emergency room," she said.
A survey done for Blue Cross by the Roper Reports supports Russell's conclusion. Persons surveyed were asked whether they would take a problem to their family doctor or to the emergency room on weekdays and on the weekend.
Sixty per cent of those surveyed said they would call their doctor on a weekday if they had a severe stomach or abdominal pain, and 31 per cent said they would go to an emergency room. On weekends, however, 51 per cent said they would call a doctor, and 38 per cent said they would go to an emergency room.
Part of the reliance on emergency rooms can be explained by the failure of a mobile population to find a family physician after moving into a new community. "I think one of the most difficult things in moving into a new area is finding a physician," Russell said. "I hear this in Montgomery County as much as any place else."
Each of the local medical societies provides a service to recommend names of at least three doctors to callers requesting it.
When a doctor is called on short notice, there is no guarantee he will see a patient. "They're on call for known patients," Corn said "If you are not known to them, they're not inclined to deal with you."
Going to the emergency room also is easier than seeing a physician especially when cost is not a factor. Of 200 patients visiting the Greater Southeast emergency room March 20 - a normal day - all but eight had some form of coverage to pay for the visit.
The standard complaint of persons who take their non-emergency medical problems to the emergency room is that they are kept waiting too long.Attempts to deal with the problem can be self-defeating.A Blue Cross study in Michigan described the problem and what happened when a solution was tried:
"Delays in seeing patients lengthen. Complaints are more frequent; hospital staff often respond to the increased load by becoming less sympathetic with patients with minor illnesses; true emergencies are less easily identified, and prompt care for them may be jeopardized.
"As some efforts are made to improve conditions, another chain develops. If staff is added, waiting time reduced, translators brought in and minor discomforts of patient convenience relieved, the word gets about. The emergency room again becomes a desirable and speedy and convenient way to get medical attention, queues again lengthen, and the whole process starts in again," the study said.