Emergency room patients increasingly leave California hospitals against medical advice, and experts say crowded ERs are likely to blame.
About 352,000 California ER visits in 2017 ended when patients left after seeing a doctor but before their medical care was complete. That's up by 57%, or 128,000 incidents, from 2012, according to data from the Office of Statewide Health Planning and Development.
Another 322,000 would-be patients left the emergency room without seeing a doctor, up from 315,000 such episodes in 2012.
Several hospital administrators said overcrowding is a likely culprit for the trend. California emergency room trips grew by almost 20%, or 2.4 million, from 2012 to 2017.
Moreover, ER wait times also increased for many during that time period: In 2017, the median ER wait time for patients before admission as inpatients to California hospitals was 336 minutes — or more than 5½ hours. That is up 15 minutes from 2012, according to the federal Centers for Medicare & Medicaid Services. The median wait time for those discharged without admission to the hospital dropped 12 minutes over that period, but still clocked in at more than 2½ hours in 2017.
California wait times remain higher than the national average. In 2017, the median length of a stay in the ER before inpatient admission nationwide was 80 minutes shorter than the median stay in California. Four states — Maryland, New York, New Jersey and Delaware — had even longer median wait times.
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https://khn.org/news/as-er-wait-times-grow-more-patients-leave-against-medical-advice/
Monday, September 9, 2019
Walking on Eggshells in Medical Schools - The New York Times
I trained to be a doctor in the bad old days — not the worst old days, but the bad old days. Humiliation was part of the deal, sometimes deliberately inflicted by certain grandstanding, sadistic attending physicians, sometimes more casually, because everyone could see that you didn't know something you should have known.
Now we are aware of the consequences of harassment and unconscious bias, and we are trying to give medical students room to learn and grow — but many medical students and residents continue to experience harassment and discrimination and bullying. At the same time, some faculty members worry that they cannot discuss difficult subjects, or give negative feedback of any kind, for fear of upsetting students. In other words, though the training environment now looks much gentler to those of us who trained in the bad old days, we still don't seem to be consistently getting it right.
In August, a commentary in JAMA Pediatrics addressed the intrinsic complication that medical training inevitably makes people uncomfortable: "Walking on Eggshells With Trainees in the Clinical Learning Environment — Avoiding the Eggshells Is Not the Answer." You can't avoid the eggshells, they argue, because medicine is going to bring you up against difficult situations and tricky conversations, and also because part of the responsibility of those who train doctors is to tell them when they're messing up.
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https://www.nytimes.com/2019/09/09/well/family/walking-on-eggshells-in-medical-schools.html
Now we are aware of the consequences of harassment and unconscious bias, and we are trying to give medical students room to learn and grow — but many medical students and residents continue to experience harassment and discrimination and bullying. At the same time, some faculty members worry that they cannot discuss difficult subjects, or give negative feedback of any kind, for fear of upsetting students. In other words, though the training environment now looks much gentler to those of us who trained in the bad old days, we still don't seem to be consistently getting it right.
In August, a commentary in JAMA Pediatrics addressed the intrinsic complication that medical training inevitably makes people uncomfortable: "Walking on Eggshells With Trainees in the Clinical Learning Environment — Avoiding the Eggshells Is Not the Answer." You can't avoid the eggshells, they argue, because medicine is going to bring you up against difficult situations and tricky conversations, and also because part of the responsibility of those who train doctors is to tell them when they're messing up.
More ...
https://www.nytimes.com/2019/09/09/well/family/walking-on-eggshells-in-medical-schools.html
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