I Was Trying to Reorganize ...

@Michel Martin, your mail server might have a backup of those e-mails. One thing you might remember from convergence of Bush's first term is that even deleted messages don't disappear.

If you feed NPR's IT department enough pizza, they could probably undelete your messages.

Sent by Matthew C. Scallon | 12:05 PM ET | 06-27-2008

Ms. Martin,
This is the resend of the message that was lost in the email disaster. That must have been painful.
Best, Preston

______________________________________________

I still enjoy listening to your show as often as possible.
I thought you had a very interesting segment today on the long waits in the ER for psychiatric patients. Unfortunately, you missed the main issue involved, because the author failed to highlight it for you, and the mother of the patients was not aware of it. The report itself lists the first "free-form" reason for delays as "Unwilling psychiatrist to evaluate patient between 1 pm and 10 am, despite being on-call." There are other issues, of course, but the lack of a specialist to assume care of the patient will lead to a long delay every time. The survey results noted that "62 percent indicated there are no psychiatric services involved with patient care while patients are being boarded in the emergency department prior to admission or transfer." This means that no psychiatrist or other psychiatric clnician evaluated the patient during that time.

The lack of psychiatric specialty coverage in ER's is an example of a much larger problem of finding specialists to cover ER's all over the US. A pretty good article on this issue in the Washington Post in Dec. 2007 is here:
http://www.washingtonpost.com/wp-dyn/content/article/2007/12/20/AR2007122002322_pf.html
Pay close attention to the comments after the article, where a number of physicians weigh in.

This is a problem relating to neurologists (like me), neurosurgeons, psychiatrists, and many other specialists. It is a symptom of the lack of alignment of interests of physicians and hospitals in the current medical system. The physician has many disincentives to care for ER patients, including poor reimbursement for providing inconvenient service, malpractice risk, lack of other physicians to help in complex multi-specialty problems, etc. The hospitals have had such problems with some specialties that they have started paying the physicians a fee for coverage, above and beyond any billings, but this only applies to certain critical specialties that bring in lucrative patients to the hospital, such as cardiologists, OB's, etc.

There is much more to tell about this story. It would be interesting for you to interview psychiatrists in the community about this issue to obtain their perspective on why it is so hard to get ER coverage. Your ER doctor guest and his organization are probably being careful not to ruffle the feathers of the specialty community too severely, for fear of aggravating the problem with obtaining specialty support. The ER physicians' organization alludes to the need for more money to somehow improve the situation. You correctly asked for some specifics about how this would help, and the spokesman was unforthcoming. This is because the solution is one that is difficult politically and financially within the hospital. The issue will only get better if hospitals begin to substantially compensate physicians for specialty care in the ER, above and beyond the patient's insurance (or more often, the lack thereof). Unfortunately, the system is now made up of hospitals and physicians who are forced to see themselves as economic actors, who make cold, careful calculations about what they will do, and what risks they will take. This is what modern American medicine has come to.

Sent by Preston C. Calvert, M.D. | 4:46 PM ET | 06-27-2008

Although the interminable wait in the ER mental health unit during this past Christmas season was an awful experience for my daughter and myself, a few things happened that eased the pain and frustration. Believe it or not, witnessing a manic person at their "hap-hap-happiest", even when it is your daughter; and your feelings are shifting from sheer terror to being caught up in the manic moment, can prove to be unbelievable humorous as it did that night.

We sat next to a young man, my daughter's age, who was going through a hellish withdrawl from heroin. He went from rocking his body back and forth while sitting in a chair, with his head crushed between his two hands, to standing and kicking his legs out to try to relieve the deep, deep pain that he was experiencing in his body. I asked him if I could help him in anyway and he graciously said: no, but thanks.
He then explained his predicament to me, and I in turn told him what my daughter was experiencing. Well, she came over and I introduced them to each other and within seconds they were chatting away. I asked the man if he felt that she might upset him with her mile-a-minute rambling, but he suprised me by saying that he was so very happy to have someone to talk to. They talked for about 15 minutes, killing time while waiting for someone to see them. By the time his turn came up, she had him promising to look her up so she could help him enroll in the college that she attends. It has a nationally known program for students in recovery from drugs and alcohol, she informed him.

I was able to smile at least, and we wished him well before he finally shut the door behind himself and a hospital staff member.

Finally, hours after our visit to the front desk where the worker photocopied our insurance card, my daughter was seen by several people, given a prescription and a directive for follow up treatment, and sent on her "Merry December" way.

Months later, I ran across a request posted on a medical website for persons with mental illness, or family members, to particpate in a survey regarding their experiences in a hospital emergency room while that person was going through a crisis. I did offer a few suggestions for making the experience more tolerable and less stressful: having a patient advocate on the floor to help explain procedures and to answer any other questions; regular visits from the chaplains to the mental health area; and more staff working during those times when people tend to experience more crises: holidays, long cold dark stretches of days, etc.

I write this, of course, with a view from the other side of the glass examining room. I hope the medical community, and insurance companies will listen to the needs of the people who suffer from mental illnesses. The care that we need is immediate at times; and there is no other place other than a hospital for us to go to when sanity decides to travel to places unknown and far away.

It does take a special kind of doctor to decide to take on the care of such suffering people. Remember, those of you in the field, that the people you help are in dire need of speedy, expert, and respectful care when being seen for acute emergencies. Ask the patients themselves for ideas in how to better serve them. Often, it isn't a one time visit for us. We become experienced in how to deal with the system.

And, you probably know better then me, that dealing with us can sometimes be a somewhat pleasant and rewarding experience at time, and possibly even fun!

Sent by Teresa L Minneapolis | 10:52 PM ET | 06-27-2008

Thanks to those who wrote to us about the issue of long wait times in emergency rooms and how those waits times especially affect those with mental illnesses..this is a very important topic and one that seems hidden under the radar. it strikes me from reading these posts that the solutions are within sight but not, for some reason, within reach. what can be done about this?

Sent by Michel Martin, host TMM | 11:51 PM ET | 07-07-2008