The ED physician should not expect the hospital and admitting doc to work for free because the system sucks when the patients don’t meet admitting criteria. I like the line in the WSJ article “she told me she needed to be admitted to the hospital”. That’s great he has the patients decide on whether they need admitted or not, it probably saves him a lot of decision-making.

I think Nurse K above has the right idea – I can’t remember ever saying no to any doc that has asked me to work somebody into my schedule.

Someone with a primary MD, someone who is a VIP, someone who has a relative of an MD will have an advocate to get the evaluation done with an efficiency of time. One of the things this patient received was some reassurance that someone cared about her. The logic that a matter of days or weeks makes little difference in the prognosis in a case like this is of no significant psychological comfort to the patient who is told that they likely have cancer.

Right now we have many forces which push people toward EDs — limited office hours, not enough primary care doctors, doctors who use EDs as evening and weekend coverage. Someone might create some kind of “intensive outpatient” admission for these patients, but until they do, the current system fills a gap.