Patient came into the ER yesterday. Chief complaint was bilateral heel pain. I saw the chart – based on the chief the complaint, I ordered bilateral heel xrays. They showed bilateral small heel spurs. I brought the patient back to my bed to be a quick in and out. I started getting the history from the patient.
"What brings you into the ER? Tell me the story."
"My heels hurts."
"Ok, how long have your heels hurts?"
"About 4 months." (no expression on the patient’s face)
"4 months??? So what changed today that made you come into the ER?"
– The patient just stares at me like why would you ask that question. So I rephrased the question.
"Why after 4 months is this an emergency today?"
"Well, I got laid off 1 1/2 months ago and since I did not have a job to go to I thought I would just come in and get it checked out."
"This is the same old pain you have been having – no change?"
"Yep" the patient says with a grin.
I finish the exam. Yep, heel spurs.
"I will give you some pain medications to go home with, but you will need to follow up with podiatry to get further care."
"What?!?! That is all you are going to do for me? You mean I have to now get an appointment somewhere else."
"Yes. That is all I CAN do for you."
The patient got up and left unhappy. Nothing like having free healthcare so that people can come into the ER like it is just a 24 hour walk-in clinic. As more people get insurance under the new legislation and no change in number of primary care providers, this will happen more and more. This will take up more man hours in the ER and thus delay care for patients who really need to be in the ER. I can’t wait.