Should you go to the ER?

Apparently, Anthem insurance is refusing to pay some ER bills for visits it deems unnecessary, such as for the young man who felt a jolt of pain in his back when lifting a heavy box. At the ER the docs diagnosed his problem as a muscle strain and sent him home. His bill was $1,722. On the whole I agree with the new policy, called the “avoidable E.R. program.” The ER contributes a substantial portion to the nation’s enormous health costs. Many trips are unnecessary. But decision-making can be tricky.

Take my sister’s visit following a serious automobile accident. She reluctantly went to the ER on the advice of people on the scene but was sorry she did (see earlier post). After five hours, she was pronounced OK and was sent home. A next-day visit to her GP would have sufficed in her case.

In contrast, there’s my friend Janice who flipped her car upside down on one of our curvy mountain roads. She was hanging upside down from her seat belt. As in my sister’s case, she was advised to go to the ER, but she declined. A good decision. She was fine.

Then there’s the time I was standing on a chair outside washing windows. The chair toppled and I came down hard onto the patio pavers, landing on my elbow and hip. I concluded that I was OK and went about my business, although soon my elbow swelled up horribly and I found it hard to walk. So I went to the ER (husband drove). The docs quickly said my elbow was fine: my bursa simply filled with liquid. An x-ray of my hip also showed nothing broken. The pain in walking was surely a strained groin muscle. Thus, my trip was unnecessary. (But I was glad I went because the hip x-rays showed I have dense bones. Nice to know.)

Doctors and consumer groups are fighting this new policy, arguing that it forces patients to diagnose their own illnesses. Well, that’s not such a bad idea. I think we’re often good at knowing whether our health incident calls for emergency treatment—if we can just trust our instincts.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.