How to solve the ER crowding dilemma

Re: “Lack of MDS worsening ER crowding” (Gazette, March 21).

Your article says a new study purportedly will confirm “the long-held belief ” that a lack of primary care is a major cause of emergency-room crowding.

It will confirm nothing of the sort, and it is tragic that the province that seemingly holds that view has some of the worst wait times for emergency care in the country.

Improving access to primary care is certainly good for patients in terms of comprehensiveness and continuity. But ER crowding is largely an issue of insufficient hospital and community bed capacity to meet the needs of an aging population.

Many provinces have come to that view, and the tired rhetoric of blaming patients for inappropriate use is largely passé.

The reality is that there are two types of waits for emergency care.

Those with comparatively non-urgent problems usually wait a long time in the waiting room but they do not consume much in the way of resources, do not deny others access to care, and when admitted to the ER treatment area are usually evaluated and treated quickly.

The other and far more important wait involves the sick and elderly who wait on emergency stretchers for hours and even days for a bed to become available. They are denied timely and appropriate care and often suffer medical complications and even death as a result. These are the patients and the waits that we really need to be concerned about.

Access to a family physician, though important, will not significantly lessen their need for hospitalization. But waiting for admission to hospital, lying basically unattended in a noisy, neon-lit hallway, will surely increase their risk of excess and unacceptable morbidity and mortality.

Alan Drummond, MD

Chair, Public Affairs Canadian Association of Emergency Physicians

Ottawa

A team of researchers from Montreal has found that “Quebecers who don’t have a regular family phys- ician are more likely to visit the emergency room just to see a doctor.” There are more than 300,000 Montrealers who do not have access to a family doctor and it is suggested that this is causing patients to flood emergency rooms to receive medical care. Physician assistants can be part of the solution and help to alleviate emergency-room crowding. PAS can be employed in primary-care settings to extend the physicians’ services, allowing the doctors to see more patients.

PAS have a high level of medical training and can perform tasks similar to that of their supervising physician. PAS have a close and dependent relationship with physicians and function with negotiated autonomy.

Perhaps now is the time to integrate PAS into the Quebec health system. Patients would be the big winners, with increased access to care, reduced wait times and quality medical care. Louis-françois Robichaud

Quebec chapter president of the Canadian Association of Physician Assistants

Montreal