The Question: I am in the Emergency Department and I’m very upset. I was in another Emergency Department the day before yesterday but they just sent me home so I drove two hours to get to Sunnybrook for help. The doctor in your Emergency Department is behaving as though I’ve done something wrong. He said I should have gone back to the other ED. Don’t I have the right to go to any Emergency Department I want?
The Answer: Some patients in Sunnybrook’s emergency department are just like you: they have a medical issue they want solved, be it abdominal pain, the long wait to see a specialist or the need for a second opinion. Most physicians empathize with what prompted you to come here – in some cases, difficulty accessing timely specialty care – but that is rarely an emergency.
“Patients are doing what they are legitimately allowed to do,” said Dr. Jeffrey Tyberg, Chief of the Department of Emergency Services at Sunnybrook Health Sciences Centre. “You understand why people are doing it.”
Canada has one of the worst rates of access to specialty services. A Commonwealth Fund study of 11 countries found specialist queues particularly worrisome, with 41 per cent of patients waiting two months or more. That lack of access is partly responsible for driving up emergency visits in hospitals across the country.
“The emergency department is the only place where you can walk in and say, ‘I’m here, I’ve been to four other hospitals and I want you figure out what happened to me,’” said Dr. Tyberg.
For physicians trying to manage a limited resource of health services, it represents inefficiency to the system. If a patient has already seen a specialist and received an answer, repeating a series of tests and imaging studies will rarely yield a new insight into their medical condition.
It can be frustrating for patients, who have waited many hours in emergency, after having driven long distances – Vaughan, Barrie, Woodbridge and Peterborough – in the hope of achieving a definitive diagnosis at a top teaching hospital.
Some patients come for severe head pain, other times, they come, after having seen three other neurosurgeons for back pain for which there is no surgical remedy. Even more are stuck in long queues, waiting to see a specialist.
“They can’t work, they say it’s 14 months to see the spine surgeon in Scarborough,” said Dr. Tyberg. “What’s the guy supposed to do? You understand why people do that. It’s the only door open to a lot of people.”
To in answer to your question, you do have the right to go to any emergency department you want if you think you are experiencing a medical emergency.
To go to emergency for a second opinion or specialist consultation, while understandable due to a problem with accessing care, is not necessarily going to yield that definitive diagnosis you were seeking.
“Maybe we need to manage expectations,” said Dr. Tyberg. “People think they can come for any problem at any time. Sometimes we have to say ‘This isn’t the time or the place.’”