A very welcome development this week, after the article in "Medical Examiner" on hospitals' E.R. problems produced a monster response from readers—more than 400 top-posts. The Fray team's job is to read as many of these as possible and then try to summarize the reactions as helpfully as possible for other readers. But in this case, one of the authors of the piece—Jesse M. Pines, who co-wrote with Zachary F. Meisel—bravely read a very high number of the posts and wrote in the Fray about them for us. He identified five different sets of responses, including:
1) Complaints from angry health care providers who felt they'd been insulted. Answer—no such criticism intended.
2) Patients giving experiences of the system, good and bad.
3) Congratulatory messages from those who agreed with the article.
4) Posts from nurses who commented on the "bed-hiding" issue. Answer: "The point was not to say that anyone is lazy—you are just as overloaded as we are in the ER."
The fifth group was from providers who talked about other problems in the health care system that contribute to crowding, and our author had this to say:
While I'm glad that you used this forum to discuss these issues because all are important, the article was about the hospital practice of boarding admitted patients in the ER. And how in some communities with high Medicaid and uninsured populations where hospitals are capacity-constrained (where demand for services exceeds supply on both the ER side and inpatient side), boarding is the profit-maximizing strategy. While Zack and I thought we explained it in the article, I am sorry if this was unclear to some.
He argued his case with more details and references before concluding:
I thank you again for your interest in this important topic that affects all Americans. Because sooner or later, you and your loved ones will all need to go to the ER. This needs to be discussed in public forums by people who understand the issues and can provide suggestions to hospital administrators and policymakers who have the power to eliminate boarding through objective measurement and accountability for this crisis.
Anyone interested in the issue should read the post in full here. And Mr. Pines is most welcome to come and help us in the Fray any time. MR ... 5:30 p.m. GMT