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"What will it take to solve the ER crisis?" your cover story asks [Dec. 3]. One answer to overcrowding is to redirect patients with simpler medical needs to ambulatory and urgent care centers.
Up to half the patients who present to EDs could be treated safely and adequately at clinic-type facilities. A full-service ambulatory care center capable of caring for 100 patients a day can be up and running in less than six months. There, patients with less acute conditions can be seen more quickly than at an ED. The cost of treatment may be several hundred dollars less because of lower overhead and professional fees and absence of facility charges.
Given the complexity of the business and politics of modern medicine, the causes of our ED crisis will not be resolved quickly. But for now, a realistic response to "overflowing EDs and the ambulances turned away" is the integration of ambulatory care centers into our emergency health care system.
Franz Ritucci, MD
American Academy of Ambulatory Care
I don't know what it will take to solve the "ER" crisis, but I do know that emergency physicians stopped using the pejorative term ER about 30 years ago, when the specialty of emergency medicine was founded. The American College of Emergency Physicians condemns this antiquated term as emblematic of the time when emergency care was rendered by reluctant part-timers from other specialties who had no interest in EM as a career. Emergency physicians work in the ED (emergency department). Please use proper terminology, not that employed by second-rate television shows.
Dennis C. Whitehead, MD
Iron Mountain, MI
Editor's Note: Our apologies to Dr. Whitehead and all emergency physicians. We'll change our style guide immediately!
If Emile Zola were alive today, he would have a new targetus!
He would denounce physicians and their patients for submitting to the insurance industry's labels of "provider" and "consumer."
He would decry the conflict of interest that we physicians now tolerate, amazed that we did not recognize that irresponsible cost reductions would ravage quality of care.
He would indict political leaders for cloaking their intent to protect managed care under disingenuous proposals for addressing health care problems.
He would accuse our nation for refusing to affirm that health care is a right for all, not a privilege for those fortunate enough to afford it.
A century ago, Zola proved that the pen is mightier than the sword. Today we need someone to prove that the pen is mightier than the wallet. Perhaps in these complex times, that person will have to be twins.
Albert J. Paul, MD
Elkins Park, PA
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Liz O'Brien. Letters to the Editors.