Hospital emergency departments are under siege, doctors are exhausted and patients are demanding. They are also often sent from the clinic to SOR, which increases the queues. In such conditions, there is a fight for human life, and it is not difficult to make a mistake.
Patients from family clinics are sent to emergency departments. According to emergency physicians, only a quarter of people admitted by HEDs qualify for hospital treatment. And according to the regulations, SORs should provide help to people in a state of sudden threat to life or health.
– Patients from clinics with symptoms such as cough or runny nose come here. There are even a dozen of them a day – tells Onet the doctor. med. Alicja Piekara – We still have people who were sent for insertion of a gastric tube, removal of stitches or plaster. Every doctor and nurse in the clinic should have such skills – he adds.
We asked Krystyna Barbara Kozłowska – patient ombudsman – why there are cases of unjustified referral of patients to emergency departments. The answer reads that «one of such reasons may be the avoidance of the costs of carrying out diagnostic tests, (…) the other may be related to the diagnosis, (…) because, for example, the symptoms are not unambiguous. The third possible reason is the lack of information from GPs about night and holiday medical assistance. »
The Ombudsman emphasizes that the family doctor may send a patient to the emergency department only “in emergencies, if he sees health reasons – after a personal examination of the patient – taking into account that hospital emergency departments and emergency rooms are places where emergency health services are provided. health risks ».
The emergency doctors say the same.
– Family doctors want, among others reduce the cost of treatment – tells us the drug. med. Jan Magiera – But such situations should not happen, because each clinic has a basic pool of money from the National Health Fund, which must be spent on performing the required tests – he adds.
We checked the financing of medical centers. In the ordinances of the National Health Fund regarding the clinic, we read that financing is provided as a lump sum, and for each registered patient, the health care center is assigned a given annual amount. Therefore, it can use it to perform basic diagnostic tests, such as blood tests or X-rays. Hospital emergency departments are also financed with a lump sum – the National Health Fund pays the monthly daily amount generated by each patient registered in the HED, with “various components taken into account”.
Some also want to shift responsibility to the SOR – says Magiera. – It happens that doctors in outpatient clinics look for confirmation of their diagnoses at HEDs. Yes, just in case, adds Maria Włodkowska, spokesman for the University Hospital in Krakow.
Such “shifting of responsibilities” is highly controversial. Why are family doctors, who also graduated from medicine, are afraid to make a diagnosis and blame their colleagues from EDs? At this question, the emergency physicians shrug their shoulders.
The clinics deny it
What do the clinics say? They categorically deny the accusations of emergency doctors. One of the doctors in the Krakow POZ was honestly surprised that the referral of patients was taking place at all. – Personally, I have not encountered such behavior. I have worked at the Emergency Room and have never seen a patient sent back groundlessly by a family doctor – he says anonymously in an interview with Onet. – We do not refer patients to HEDs, if there are no clear indications for it – adds the drug. med. Michał Winiarski from the clinic in Starachowice.
However, many clinics refused to comment on us, and none provided an official position. In two POZs, the interlocutor hung up the phone.
Sending patients to the HED is also based on purely human motives of family doctors. – When we know that a given patient with an orthopedic problem will wait several months for an appointment with a specialist, we prefer to send him / her to the HED. They will get help much faster there – an anonymous internist tells us.
According to the Act of On December 5, 1996 on the profession of a doctor, a family doctor may refer a patient to the HED only after using all means and methods at his disposal to examine him. So if the patient was sent back because the clinic wants to save money, e.g. on x-rays, the doctor breaks the regulations. This is confirmed by Kozłowska, the patient ombudsman.
“If a physician providing health services under primary health care sends a patient to the HED, realizing that his health does not qualify him for assistance there, the physician may violate the patient’s right”.
The head of the HED at the University Hospital in Krakow, Dr. Aleksandra Załustowicz, MD, claims that it happens that doctors send patients on purpose.
– We learn from patients that they are instructed by family doctors what symptoms they should give in order to have a specific examination performed – he says in an interview with Onet – We could send the patient back to the clinic, but we do not want to make a ping-pong ball out of him. It is our duty to help a needy person – he adds.
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Lack of knowledge among patients and a vicious circle
It turns out, however, that patients referred by family doctors are only a small part of those who should not be in the emergency department. Many people go there, treating the HED as an outpatient clinic, not knowing (or pretending not to know) that they should seek another form of help.
– I came here because something fell under my eyelid – Onet tells Onet, waiting in the queue for SOR. – In the morning the eye was swollen and it hurts all the time when blinking. A student from Lodz told us that he came to the SOR because his elbow hurts – the day before he fell over on his motorbike.
There are many similar cases. Only a few people with whom we talked came to the HED rightly – in a serious health or life threatening condition. Patients simply do not know when to go to the hospital and when to go to the clinic or inpatient care. The simplest solution is then the emergency department.
There is another reason for the long lines at emergency departments. What is a seriously ill person supposed to do and the waiting period for treatment is several months or even years? He goes to the SOR, because he will receive help there “on the spot”. And the circle is complete.
– First, the patient should try to help himself – explains Magiera – take a painkiller or a flu pill and see if the symptoms disappear. You have to use common sense, because calling an ambulance by a girl who has a stomach ache during menstruation is unfounded – she adds.
The HED is also visited by patients for a prescription or discharge from work – such activities are not the responsibility of emergency physicians.
The victims are both patients and doctors
Unfortunately, doctors emphasize that the lack of knowledge among patients has the greatest impact on those who need help most urgently. – Many times there are patients who insult us and humiliate us because they wait a long time for the examination – says the drug. med. Maciej Sztuka. – They say that we are thick-skinned, but what are we supposed to be like, if there are fights in the corridors every day? – he asks.
Indeed, indiscriminate comments towards doctors are part of the hospital everyday life. The most common complaints relate to the long waiting time. Patients also loudly claim that “doctors are doing nothing” or comment when the doctor goes to the duty room with a cup of coffee.
– And this is probably the coffee that the doctor made himself in the morning, it is already cold and he will drink it until the end of the shift – says Włodkowska. – We are not robots, and often we do not have time to meet a physiological need, let alone eat a meal. The crowd of patients increases the risk of overlooking a person who really needs urgent help – adds Dr. Załustowicz.
– We understand the frustration of patients who wait several hours, but the qualification at HEDs does not result from the order in which they come – says Magiera. This is how the Triage system works – he explains.
What is Triage? This is a medical procedure that emergency physicians use to segregate patients. The most severe cases, whose life is at risk, are assigned the color red. Further, less urgent cases are orange, followed by yellow, green, and blue. The last two mean a patient who does not require quick intervention, and the waiting time can be up to 12 hours (it is clearly specified in the regulations).
Clinics, HEDs and patients are not to blame. The system is inefficient
Is there a solution to this situation? Both family and emergency physicians say that systemic changes are needed. The patient, family doctor or emergency doctor are not to blame, because almost the entire health system is inefficient. First of all, there is a lack of specialist doctors.
– It should start with the reform of primary care and specialist care to make access to doctors easier and the queues shorter – says Dr. Załustowska. – It is also necessary to educate patients when to visit the HED and when to visit the clinic – adds Piekara.
We checked where such information can be obtained. It is enough to enter the phrase “with what to the HED” in the search engine – many pages are displayed describing which diseases and injuries should be reported at the clinic and which at the HED. There is also such information on the official website of the NFZ. There are also provincial branches of the National Health Fund in Poland, which provide telephone numbers with messages to be heard on health care.
We also sent a question to the Ministry of Health as to whether any steps had been taken to resolve this situation. In response, we read:
«I would like to inform you that in the document» Policy Paper for health protection for 2014-2020. The National Strategic Framework “presents a long-term vision of the health care system development and the tools for their implementation (…). Thus, the information contained in the document sets the directions for introducing changes, e.g. in terms of the functioning of individual types of healthcare services. (…) the implementation of this solution should contribute to limiting the phenomenon of referring patients to these service providers »- we read in the official reply from Danuta Jastrzębska, Head of the Media Service Department.
When to report to the SOR
With what cases can you go to the hospital or call an ambulance? Only in emergency situations of a sudden threat to life or health, such as loss of consciousness, convulsions, sudden and sharp headaches, abdominal or chest pains, massive bleeding, electric shock, flooding, loss of consciousness, extensive wounds, burns or leg fractures, making it impossible to move. Information on this subject is provided by the National Health Fund on the official website and many health-related portals.
Hospital emergency departments do not issue prescriptions or referrals to a specialist. It is also impossible to obtain a control visit or specialist consultations, because specialist doctors do not work at HEDs, but emergency doctors.
In other cases, such as runny nose, fever or chronic pain, the patient should seek the help of a family doctor or XNUMX-hour medical care.
Doctors emphasize that they will not change the current situation on their own. They count on systemic changes, health care reforms and patient education. – We can only see more patients and hope that we will not make a mistake in all this time and fatigue. – sums up Sztuka.