We are fortunate to have a guest blog by Dr. Donald Kamens, MD, FACEP, FAAEM. Hope you enjoy!
Suppose you had a broken car and had two fundamental choices to fix it.
1. You could take it to the repair shop down the street. You've known the mechanic for a long time; and you like him. He's generally thought to do good work, too, though sometimes his office staff doesn't get things done in time. The problem you have with choice 1 is finding out what is wrong with the car may take some time. He'll likely add some oil or give you some other remedy, and tell you to drive it and see how it runs. But then, if things still aren't working out, he may even look under the hood. Depending on what he sees there, he may either run a few tests or tell you everything looks good, and you should give it a few more weeks. After a few weeks or a few tests that are marginal, he will then tell you to see his friend, the engine specialist, to see what he has to say. It takes three more weeks to get an opening in the specialist's schedule, and that one charges you $700 for parts and labor. The total cost was about $1,400 between all the parts, materials, and labor. To say nothing of the time costs when you were not working.
Then we have choice 2- This is the modern garage. Not only is the place full with every high-tech instrument known, but the mechanic and his crew listen to Car Talk. You know that if you go in there, it will cost you more than your visit to your choice 1 mechanic. But you also know your car will get a thorough work over. Before you leave, you may have 10 fuel tests, 2 auto scans, and an electro-car-o-gram. However, in a few hours, you will know what's up. Really, you don't have the time to run all over the place, when you can get it all done with a one shop stop. So you choose option 2. They find what's wrong in a hour. You are done. The bill is...$1,400. Wait...wasn't that the same amount you spent chasing the mechanic in plan 1?? No one ever said that comparing a single visit to option 2 was the same as comparing the many visits option 1 would require.
And this folks, is why the ED ought to be the center of the US health care system. It is already in place. It knows how to function. It is effective. A few tweaks...and it would be the envy of the world.
Go tell Washington. BUT...you might have to walk!!
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