It's been a long week. Friday morning I completed 3 weeks of working 7pm-7am in the ER, Sunday - Thursday. Overall it was testing and frustrating. Based on my personal experiences, I think 50% of the patients I saw were substance abusers. That's fine, but only 10% of them were looking for help in achieving sobriety! Also frustrating is the practice of psychiatric boarding. North Carolina, like many states, does not have enough beds for psychiatric patients. This causes our patients to often wait in the ER, waiting for a bed to open up. To make matters worse, hospitals are allowed to cherry pick patients - screening out those with substance abuse, aggression, and definitely screening out those without insurance. Inpatient psychiatry does not make a lot of money - our patients are often poor with Medicaid or no insurance and the stays are long. However, it's all about the investment - unstabilized patients are high utlizers of the ER and health care systems. Also, many don't have proper housing, food or outpatient follow-up. The USA is all about capitalism, make your own money, if you don't have it it's your fault. Unfortunately no matter who's fault it is, not supporting those in need up front is just going to cost you money in the back end and I would argue it's a lot more! It can be frustrating working in the ER smacking band-aids on my patient's problems when really they need so much more.
In Washington state, it's been declared unlawful to board patient's in the ER. The explanation being if a patient needs inpatient help then they should be admitted asap. Not sitting in the ER for days. It is a very interesting ruling and I'm looking forward to seeing the effects on mental health care in Washington and across the nation.
On a brighter note, I went to the US Figure Skating National Champtionships in Greensboro yesterday! Uploading pictures today and I will post them here tomorrow! :-)