ColbyCosh.com

According to an ER doctor on CBC Radio's Cross Country Checkup this weekend, you can ensure that you're treated almost immediately in a Canadian ER if you walk in naked. Demonstrating bodily functions is also helpful, although it will usually result in 4-point restraints as well. This approach isn't generally recommended, but there you go...

The first one's a bit tricky to do in the winter in most of Canada, especially if you have to walk (or take public transit) to the ER in the first place...

And the only ones who use the ER in America, except in case of a true emergency, are the UNINSURED.

Shortest wait-time I've ever had in an ER was the most recent visit, at just under two hours (it was an unusually late night, according to the staff there).  Then I was escorted into a consult area, where I waited approx. one hour longer to see an attending.  She was nice enough, and seemed quite competent.

I *do* use the ER as a "clinic," but only when the regular medicentres are closed.  I have my own family physician (more and more of a rarity in Calgary), but let's face it, he ain't available for about, oh, eighteen hours a day, five days a week, and not on weekends, either.

*Ahem*

That should read "...unusually *light* night..." above.  Sheesh.

I think wait times are the principle bane of our health system, but the last time I personally needed an emergency room -- several years ago now -- in one of the busiest hospitals in Montreal, I had about a 10-minute wait.

I think there are massive regional differences. In Manitoba - Brandon and Winnipeg both - I was treated in less than 20 minutes at emergency rooms. In Toronto, I've never seen an ER doctor in less than 6 hours. Most Torontonians I've discussed it with seem to feel anything less than 12 hours is amazing good luck. On the other hand, I suspect GPs here do a better job of making ER visits unnecessary. My family doctor will take walk-ins who need stitches immediately, and I never even heard of a doctor doing that outside of an ER when I lived in Manitoba.

I have to admit I've never presented at an ER with a life-threatening injury--it's mostly been cuts and GI issues, i.e., the sort of thing that a rational centrally-planned system will in fact place low in the queue, but only on the assumption that pain should be ignored in the triage process. (I've heard rumours about this "family physician" thing but it surely belongs with "house calls" as a jokey relic of the past.) The last time I had to visit the ER, I was stuck with a 2½-hour wait and then given IV fentanyl. It's certainly a good way of thwarting drug-seeking behaviour if you don't count the suffering as a cost to the patient.

The data from the 2005 U.S. National Hospital Ambulatory Medical Care Survey were just published http://cdc.gov/nchs/data/ad/ad386.pdf, and apparently the average wait nationwide to see an ER physician was 56.3 minutes. It's certainly possible to spend 6+ hours in a U.S. ER waiting room if you choose the wrong place on the wrong night, but probably not if you're presenting with a blue baby or a textbook heart attack.

Colby, I'm not sure what you presented to the ER for, but I'm not surprised you had a wait before getting pain meds. ER staff see so much drug-seeking behavior that they tend to get a little jaded. If you're still around after a couple of hours and you haven't wandered outside for a smoke, tried to make a date with the patient next to you, or asked if the nurse can fetch you a sandwich, they're happier to take you seriously.

Hell, why dispense pain medication at all? Nothing but trouble, isn't it?

I don't know about average wait times at US emergency rooms, but I do know that it can take up to half an hour to even be seen by the triage person. A friend of mine was told by her doctor to go to the ER for IV antibiotics to treat an infected dog bite. I waited with her for 3+ hours (in part to keep her from leaving in disgust!) until her husband could come to keep her company; it took her another hour after that to be seen. She was apparently a priority 2, because she'd seen her doctor. (I'm not sure why doctor-prescribed IV antibiotics had to be done at the ER, but that's another rant.)

Colby, it's trouble if you're staffing an ER with a reputation for dispensing the good stuff too easily. The frequent fliers are extraordinarily time consuming and expensive.

I'm not saying it's right -- just that it's common. Every couple of years my husband has a kidney stone. The pain is hideous. He has insurance, he has no history of drug abuse, he does not otherwise fit the drug-seeking profile. We always go to the same hospital, where he has a chart, where his previous scans are on file, where he's previously been admitted for the same condition. But he still doesn't get opiates until the new scan comes back.

The only fool-proof way I've found to get into ER in less than 2 hours if you live in London, ON is to spend the first hour and 20 minutes driving to Port Huron, Michigan.

Out of interest, I googled for the data in Canada:

Average wait times to be either admitted to hospital or discharged through ER in Quebec: over 16 hours.
year 2006-2007 ending March 31 2007.
http://www.cbc.ca/canada/montreal/story/2007/06/11/qc-hospitalovercrowding.html

Ontario April 2005-April 2006: "Ontarians typically waited one to four hours in the province's emergency rooms over a recent one-year period, although wait times in some larger cities stretched past nine hours"

"Toronto had the worst times in Ontario, with half of people in and out of the ER in four hours, while 10 per cent waited more than 12 hours"

http://www.cbc.ca/canada/story/2007/01/25/er-waits.html

Some might say visiting clinics might help, but my experience is that they can be worse. I once waited 10 hours in a medical clinic. I avoid both ERs and clinics like the plague, unless I truly fear for my well-being.

Here's my favourite line from the article about ER waits in Quebec: "Some Montreal hospitals are closing their emergency rooms on a regular basis to discourage people from coming in to seek treatment."

Maybe this can help explain how Canadians spend less per capita on health than Americans, commonly cited by socialists as a reason why our system is superior.

Wait times in Toronto-area hospitals are in excess of 12 hours.

http://secure.cihi.ca/cihiweb/en/downloads/emergency_department_wait_times_e.pdf

Also in Ontario, wait times are longer if you show up at the ER in an ambulance, regardless of the severity of your condition.

http://www.health.gov.on.ca/english/public/pub/ministry_reports/emerg_dept_05/emerg_dept_05.pdf

While we're pulling anecdotal stats out of our posteriors, I manage to go to emergency in Vancouver with a possible broken ankle and get x-rayed and treated with a final outcome (crutches) inside of 30 minutes. I also recall my Dad getting an aortic valve replacement in good time too circa 2002 or so. Colby I really do like your blog but the complainers are really over-represented on health-care topics.

"Anecdotal" means "somebody else told me a [unconfirmed] story which I'm repeating."  Ain't no story, my friend — it's a report (since it was about me, and I was, obviously, actually there).

Andy, you do seem to have it backwards. It is you that has posted anecdotes. You should be pleased that you managed to beat the odds in your visits to the ER. Since you have been so lucky you find it convenient to believe that your experience is typical.

I'm glad to hear that your ideological beliefs allow you to ignore reality.

The previous posts by myself and D are studies and statistics, presenting averages and percentages for Ontario and Quebec.

What our health care system needs most is less ideology and more acknowledgement of reality. The reality is a disaster.

So you live in BC.

Just for fun, here are some statistics (no, not anecdotes, these are real statistics) about the health system in the lower mainland in BC:

"Last month, we learned just how difficult it can be to gain access to health care in the Lower Mainland when the news media reported that it might take as long as 16 hours to be admitted to hospital from the emergency room if our condition is serious enough to warrant it. We also learned that the government’s own goal is that 80 per cent of us should be admitted within 10 hours. Not as quickly as possible, not without unnecessary delay or waiting, but within 10 hours."

http://www.fraserinstitute.ca/shared/readmore1.asp?sNav=ed&id=477

Crowded emergency rooms is a prblem in the US as well, at least in Arizona.

On of the main reasons seem to be that:
http://www.azcentral.com/members/Blog/PluggedIn/4617

"More and more often, Arizona parents are taking their children to emergency rooms for symptoms that could be treated by a family doctor.

This week, the Governor's Children's Cabinet reported 7,940 visits per 100,000 children ages 1-14 in 2005 for conditions that could have been treated by a primary care physician. That is up from 6,725 visits per 100,000 children in 2004.

The problem with this is clear: Emergency rooms are costly, inefficient places to treat routine medical problems that could be better handled in a doctor's office."

(The Full report can be found here: http://azgovernor.gov/dms/upload/ArizonasResults2007.pdf )

Somewhere between anecdote and province-wide study:

http://www.canada.com/globaltv/calgary/story.html?id=8fabc034-ce20-48a3-9930-6d7f6b034cb3&k=81606

"Calgarians travel to small towns to see doctors"