Inside Medicine: People need better options on weekends

Published: Thursday, Jan. 17, 2013 - 12:00 am | Page 3D

Roger's stomach began to hurt a few minutes after 5 p.m. on a Friday. He called his doctor's office, but all he got was the familiar recording telling him to call 911 or go to the emergency department if he had a medical emergency.

Otherwise, he was instructed to call back Monday after 8 a.m.

The problem was, Roger didn't know if he had a medical emergency. He stopped to ask himself, "Is a medical emergency determined by the severity of the pain or the cause of the pain?"

He took some aspirin and tried to go to sleep. Saturday morning, after a generally sleepless night, he called the office of his wife's doctor, which had a similar recording. His wife insisted they head to the emergency department at a nearby hospital. When they arrived a nurse asked him some questions and ushered them to the waiting area, where they were told the wait would be six to eight hours.

One goal of the Affordable Care Act is to improve our access to primary care. But, why is it that doctors keep bankers hours?

Many people find it difficult to go to the doctor during the work day and would prefer an evening or weekend appointment.

Yet, few U.S. physicians offer after-hours care on nights and weekends, compared to, say, 95 percent who offer after-hours care in the United Kingdom and the Netherlands. It is even difficult to find an American doctor to talk with after hours.

Well over half of all emergency department visits occur between 5 p.m. and 8 a.m. or on weekends. It turns out that many problems that bring people to the emergency room are normally managed by primary care providers, including Roger's stomach pain.

It is not surprising that a recent study published in the journal Health Affairs reports that emergency room use is significantly lower when people have access to after-hours services with their primary care provider.

The same study also reports that people with access to after-hours care report higher levels of satisfaction with their care.

According to a UC Davis study of more than 30,000 people, those who have regular access to their primary doctors including extended office hours, have lower health care costs. Not only are they less likely to go to an emergency room, they also are less likely to require hospitalization than patients who are unable to contact their doctor after hours.

It turns out it wasn't just fewer emergency visits and hospitalizations. Because their doctors knew them, they were able to order fewer expensive drugs, blood tests, X-rays and other procedures commonly ordered in the emergency room.

Roger left the emergency room before he was seen. When he called his doctor Monday morning it required some assertiveness to get them to fit him in the next day.

Clearly, things need to change and doctors just may have to change their work hours and their mind set.

This might be yet one of many positive changes in our health care system triggered by the implementation of the Affordable Care Act.

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