My friend sat dutifully by my side in the squeaky plastic chairs of the emergency department waiting room. She tried her best to subtly come up with conversation ideas to keep me talking; our misguided belief in the old wives’ tale about keeping a person with a concussion awake showed how much more we had to learn. She slyly texted to update friends on my condition and fielded their questions as I held my head in my hands. The bright lights of the room and the blare of Friends on the television in the corner were too much for my now-sensitive brain to handle.
When I was called into the triage room and my vital signs were assessed, I explained to the health care provider that four hours earlier, I had taken a bad hit at a soccer game that I was playing with my classmates and had cracked my head against the ground as I fell. He asked me a few more questions about the incident before directing me back to the waiting room to await registration. As my name was once again called, I ambled to the small registration desk, and the tired but kind worker behind the desk asked, “Will you be able to pay the $150 co-pay for your visit?” I promptly handed over my health savings card, but the frugal part of my mind yelled in frustration. Although I set aside money for emergencies, this was certainly not in the budget. I expressed my very real concerns to my friend in the waiting room in the form of a joke: “I guess I’m not going to be eating out any time for the rest of the year.”
My friend and I launched into a discussion on how difficult managing health must be for patients who lack insurance or use the emergency department and other urgent care facilities as their primary care providers; surely it would be easier and more economical to have a scheduled PCP visit than it would be to drop at least the equivalent of a week’s rent (as I had, after insurance) on a long visit to the emergency department! A 2011 North Carolina study showed that nearly 60% of emergency department visits in the tested sites were for health issues that could have been addressed in a primary care clinic. Additionally, the costs associated with a visit to the emergency department were 320 to 728% higher than those in the clinic. Perhaps the problem of high health care costs lies in limited access to primary care or a lack of education of what health issues are truly emergencies. On the other hand, how many patients, insured or not, had a genuine health concern but chose not to get care because they did not have the money? Even a patient on Medicare, a service for the elderly or those with conditions like kidney failure or ALS (amyotrophic lateral sclerosis), has to provide a copayment plus 20% of the cost of the doctor’s services in the emergency department.
I had waited several hours after my injury to decide to get help, but this was not out of monetary concerns. Rather, it had been ingrained in me that emergency rooms were crowded with patients expressing minor concerns, and I did not want to contribute to the statistic of unnecessary visits. When I finally chose to go to the emergency department, it was because I knew of all of the things that could go wrong following a physical insult to the brain; although I was almost certain that it was lying, the voice of my neurobiology professor saying “talk-and-die syndrome,” echoed in my mind.
Ultimately, my gut was correct, and I simply had a minor concussion. However, my experiences in the emergency department made me appreciate my good fortunes and question how many patients must be falling through the cracks. How lucky am I that I can access care whenever I need it without a second concern? How lucky am I that I can agree to have imaging done if only for my own peace of mind? How lucky am I to comprehend what the doctors and nurses are asking and telling me and know when I should seek care? As I move forward in my medical career, I hope to remember this day in which I was a patient, full of anxieties not limited to my simple medical concern. I hope that by the time I am a physician, access to high-quality health care won’t come down to good fortune. How lucky would that be?