Avoiding Emergencies In Georgia


Blue Cross of Georgia does not always want to pay for people’s visits to the emergency room. The question, clearly is what they pay for and what they do not. To a certain extent, there are alternatives now that folks saw rarely if at all in the past.

Alternatives like urgent care.  In the trade we call it a “doc in a box.”  Long waits are not uncommon — it is generally one doctor present at a time, with many nurses and technicians who have enough time to at least have an authentic — if brief — interpersonal relationship with the patient. Sometimes people get wheeled into such places. By definition, patients are usually ambulatory in a “walk-in clinic.” I have worked in such places that specialized in psychiatry, where you could see pretty much anything, although prescription refills were clearly dominant.

There are some things that should go only to an emergency room — like chest pain, which always means heart attack unless proven otherwise.  Or sudden loss of use of one side of a body, which is a stroke, until proven otherwise. Some calls are tougher.  A headache, for example, is frequently a sign of tension.  Even migraines that look and sound like “classic” migraines do not usually require an MRI or brain imaging, and may be appropriate for urgent care. But a throbbing headache in a woman who seemed to be becoming increasingly confused and was on a fairly significant amount of anticoagulant alarmed me enough to send her to the Emergency Room. The ER got a call from me, alerting them of the pending arrival and  with a specific description of what I was worried about.

I do think that if the ER referral does come from a physician, common courtesy dictates a referral phone call, at least. If the emergency necessitates going to the ER from somewhere else, it might — at least in theory — be possible to get a family doctor who knows you to call ahead.  But we do have to put such questions into context.  I seem unable to get alleged colleague physicians on the phone.  I now follow my husband’s suggestion to send a handwritten fax.  I honestly don’t know how such documents are received at the other end, but I do know that they get there.

As for the good people of Georgia (referred to in the above article link), I don’t know anything about the caliber of their high school (perhaps even compulsory) courses in hygiene, but I hope they are very high, if people are expected to tell if they are “real” emergencies or not. Are these situations for a telephone screener?  I don’t know anyone with enough liability to take the job.  Maybe a telephone answering computer.

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