I
think that having local doctors running local emergency rooms is a
good idea. Problems occur when a local hospital contracts with a
large group of doctors that are not invested in the community and
that work in multiple larger hospitals.
Out
of necessity those doctors are trained to do things the same way in
every hospital's ER. They have no understanding or caring that what
works well in a large, big city Hospital does not work well in a
smaller community hospital.
In
a large hospital, the ER doctor often serves as a glorified triage
nurse, merely stabilizing patients and deciding whether they need to
be admitted. They often don't address every significant medical
problem, putting the patient at risk for an adverse outcome.
At
large hospitals, attending doctors are available in the hospital at
all times and patients are evaluated by them in the ER prior to
admission . In a small hospital, a doctor may not see the patient for
several hours after admission and depends on the ER doctor being
skilled and competent enough to keep the patient stable until
reevaluated.
Relationships
with other local doctors are important to establish trust and
confidence . A primary care doctor needs to know that a patient being
admitted from the ER is going to have all important health care
issues addressed at the time of admission and that all those issues
have been discussed.
It
is also important for ER doctors to know the strengths and
limitations of the local health care system. Small towns do not have
the same resources as larger cities. Not every patient is best served
by being sent out of town for tests, procedures or referrals.
Small
communities are best served by local institutions which are best run
by local people. This is true of government, banks and healthcare,
especially where the ER is concerned.
