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A study released today in the online journal Health Affairs demonstrates that the time it takes for a patient to see an emergency physician has increased significantly between 1997 and 2004 (Waits To See An Emergency Department Physician: U.S. Trends And Predictors, 1997-2004). The authors, who looked specifically at adults waiting to be evaluated for acute myocardial infarction (AMI), noted some of the greatest increases were for blacks, Hispanics, and women:

Whites waited a median of twenty-four minutes, while blacks waited a median of thirty-one minutes and Hispanics, thirty-three minutes. Females waited slightly longer than males, a median of twenty-six minutes versus twenty-five minutes.

Below the cut: a few random observations from one doc's POV.

The authors determined that these racial differences had little to do with race and everything to do with urban vs. nonurban hospitals: "For patients ultimately diagnosed with AMI, the only significant interaction term was urban versus nonurban, with city patients' wait times increasing 11.6 percent faster per year." Thus, our urban hospitals are more broken than our nonurban hospitals. Of course, this may still be a symptom of racial bias in the public policies leading to these broken urban hospitals.

I heard about the study this morning, in Joanne Silberner's report on NPR. It's a good piece, and brief. I encourage you to listen to it. I was heartened by Dr. Art Kellerman's comment that Americans are focusing on the long wait times for elective surgery in the UK or Canadian systems, when they SHOULD be focused on wait times for true emergencies, like AMI. That's when wait times matter most. There, I gather, we don't fare as well as the folks in the UK or Canada (although Dr. Kellerman doesn't cite evidence). I'd like to martial the data for you, but it's late, I've spent the day seeing patients in my office, and I'm exhausted. I'm an ENT, not an ER physician, but we get tired, too.

One thing about Joanne Silberner's report really caught my ear. At the end, Dr. Kellerman apparently felt the need to drive the crisis home: "If you can't get a single heart attack patient to care in time, how are you going to handle hundreds or even thousands of victims of a terrorist strike?"

At this point, I did a "Whaaaaat?"

How the hell did terrorism enter into this discussion? Is terrorism the ultimate attention-getter? Is it the sine qua non for relevance? Or is it the 21st Century's equivalent of Godwin's Law?

Didn't Dr. Kellerman think the basic message was clear? People are waiting longer to be seen for a possible heart attack. You could die because of our broken system. (Yes, yes, survival data might have given this study greater impact. As it stands, we can only guess. But it's common sense, I think, that longer wait times will eventually bite us all in the ass.)

But no. He had to invoke the specter of a humongous terrorist attack.

I would love to see the odds ratio: chance of dying from a heart attack vs. chance of dying from a terrorist strike.

Sorry this diary is all over the map -- but I found it an interesting NPR piece, and an interesting study, and wanted to bring it to your attention. Thanks!

Originally posted to Balls and Walnuts on Tue Jan 15, 2008 at 09:29 PM PST.

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