Letter to the Editor
Thank you for publishing the story, “Studies Rebut Anthem's Retrospective ED Denials” by Gina Shaw. (EMN 2019;41:8; http://bit.ly/2uoAw5f.) She wrote a persuasive story I can share with my legislators as they consider new legislation to limit insurers such as Anthem from making retrospective denials of ED claims that they have deemed non-emergencies.
These denials are made based on the patient's final diagnosis. Of course, patients don't arrive with a diagnosis but with a chief complaint. Their diagnoses are reached after doctors have applied their skills to collect a history, perform a focused examination, and order selected tests. Laypersons do not have these skills, so they cannot be expected to know when their worrisome symptoms are not due to a life or limb threat. No sports bookie would accept bets after the outcome of a game is no longer in doubt, yet Anthem is insisting on a system that is just as illogical and outrageous.
Also, I could not agree more with the title of the viewpoint, “Emergency Medicine Doesn't Need More Residencies” by Eric Blazar, MD. (EMN 2019;41:6; http://bit.ly/2ViAA1y.) Emergency physicians are highly trained specialists with a unique set of skills that are optimally honed and reinforced in busy clinical environments. Working at a rural, low-volume ED is arguably harmful for one's long-term career development, especially for young, early-career emergency physicians.
I don't think we should have any anguish that smaller towns and hospitals are not typically served by residency-trained, board-certified emergency physicians. They don't typically have the patient volume to support the needs of a specialist with our training and skills. That is not to say that these are easy environments in which to work. They can be exceptionally challenging because they are so under-resourced compared with large-city hospitals.
Just as small-town residents must transfer to larger towns to go shopping or see a professional sporting event, they should expect to be transferred to larger cities for anything but the simplest emergency care. We need to stop anguishing that we can't place a residency-trained, board-certified emergency physician in every ED in the nation.
People who live in rural areas inherently make certain choices. One of them is not to have the latest in technology or the most highly trained physicians near them. It's a matter of efficient and just allocation of resources because our society does not have infinite resources to make clinical care environments equivalent in all areas of our vast nation.
Gary M. Gaddis, MD, PhD
St. Louis, MO