Premier Ford bemoaned a woman with a sore throat seeking emergency department (ED) care. He scolded “little Johnny” with an injured knee and a laceration seeking ED care.
By Alan Drummond, Raghu Venugopal
Ontario Premier Doug Ford made reckless statements on Oct. 25 that we as emergency physicians must correct. It is patients who decide what is a medical emergency. This ensures those with time-sensitive and unforeseen emergencies get the care that they need.
Premier Ford bemoaned a woman with a sore throat seeking emergency department (ED) care. He scolded “little Johnny” with an injured knee and a laceration seeking ED care. He dismissed someone with a headache. The Premier advised, “Go to your family physician first and he’ll determine if you’re going to the (ED).”
Firstly, 50 per cent of family physicians are not “he.”
Secondly, these statements are dangerous.
It’s callous to belittle those seeking ED care. As physicians know, the eyes don’t see what the mind doesn’t know. If you only know a sore throat is a benign virus, it’s because you didn’t go to medical school. In reality, we see serious causes of sore throat regularly, including epiglottis and deep-space infections. To diagnose these, we do a careful assessment and undertake testing when required. Many end up being a benign cause, but that’s after an evaluation – not a Monday-morning football call by a politician. A sore throat can end up in the resuscitation room with an anesthesiology STAT page to help secure the airway and the patient ending up in the ICU. This applies to children – some “sore throats” get admitted to hospital requiring multiple specialists. Medicine isn’t spit-balling.
We’ve seen headaches end up as meningitis, brain abscess, stroke, torn neck arteries and brain cancer. Others suffer migraine needing intravenous treatment, acute glaucoma needing immediate specialist involvement and inflamed scalp arteries requiring high-dose steroids to avoid blindness. It requires training to rule out the worst and decide what’s most likely. This is the reason it takes seven to nine years of training to become an ED physician.
Premier Ford said “little Johnny” should be sent to the “clinic” that takes care of “stiches” or “broken arms or broken legs.” The Premier seems confused. The management of lacerations and acute fractures is the ED where little Johnny is entirely appropriate. Perhaps it’s Premier Ford’s “20 years of my life” in the United States that leads him to not understand the Ontario reality.
After Premier Ford’s regrettable comments, the Canadian Association of Emergency Physicians (CAEP) had to state that the reason EDs are crowded is not due to “low acuity visits.” CAEP said “ED crowding is due to hospital crowding and the inability to move admitted patients to the floors.” Not little Johnny. The Ontario Medical Association then reminded Ontarians “patients should never feel discouraged from seeking help when and where they need it.”
There are 2.5 million Ontarians without a family doctor. They can’t get their insulin or seizure medications easily refilled. They can’t obtain an ED referral before seeking care. For others with a family physician, access is not easy. To mandate them to see their family doctor first is obtuse.
“Every emergency doc I talk to,” said the Premier, is “guesstimating 50 per cent of people shouldn’t be in the ED – they should be down the hallway.” This is problematic at many levels. First, the Canadian Institute for Health Information showed only 20 per cent of ED patients could be cared for by a family doctor. Next, ED patients are triaged. If they are minor cases, they are already “down the hallway” in the minor zone. And if they are serious, they are triaged to the acute zone. Chastising Ontarians for coming to the ED with seemingly minor problems is targeting victims who are blameless since they have no other choice.
We’d have to go back to Toronto Mayor Mel Lastman, who blamed patients for “abusing” EDs, to find similar ignorance from an Ontario politician. The reality is Premiers don’t decide what is an emergency and neither do doctors. We rely on the public’s good judgment.
We trust our patients to make that decision.
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Previously Published on healthydebate.ca with Creative Commons License
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