this post was submitted on 20 Dec 2024
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I'm very sorry that you went through that. I know it sucks with the American healthcare $ystem, but you are always allowed to seek a second opinion and any provider that is opposed to that is a bad provider and you shouldn't see them again anyways.
One thing to keep in mind about the ER though, is that they're there to rule out anything that is going to kill you quickly, and if you didn't lose enough blood to drop your hemoglobin count (a measure of how many red blood cells you have), it is perfectly within the standard of care for them to discharge you and tell you to follow up with your primary care physician or a specialist. The ER has a lot of resources, but not enough resources to fully diagnose every possible problem. They can make sure you're not on death's doorstep, and stabilize you if you are, but beyond that, they're pretty strapped for resources and staffing which make it hard to fully work up every mystery diagnosis.
If I'm going to be charged 4000$, I want a fucking diagnosis.
Unfortunately, a solid diagnosis can be really hard to find and there are a lot of diseases and conditions that require more testing than can be completed in the ER. Part of why the ER is expensive is because the tests they do get come back almost immediately, but they very rarely order the tests that take a long time anyways. Expediency and staffing are the main contributors to the cost of emergency care.
With the example of your case, how would the ER get you the diagnosis of a food intolerance without spending weeks on an elimination diet? There are some allergies that can be tested for, but that testing involves injecting a sample of the offending agent under the skin and watching to see if it causes irritation.... but allergies and food intolerances are not the same thing and the only way to test for food intolerances is an elimination diet. For the allergy testing, the ER doesn't have the samples to do the subcutaneous injections. It's really only allergy specialists that have those available.
They sent me out without literally any clue as to what it was. My body felt like a ticking tine bomb, and I was terrified it would happen again. And it did. Several times. I had no idea it was an intolerance until nearly a year later. My weight kept yoyo-ing and I lost almost 30lbs in 2 months. I was terrified of my own body.
No medical professional told me about the elimination diet or even that it could have been food-related. I got desperate enough to try it on my own after my sister was talking some shit about "cleansing toxins" and mentioned it. I looked it up and did it on my own accord.
I get that ER is for emergencies, sure, but I left with zero answers and didn't have access to another specialist, as they're at least an hour and half drive away from my town. And VERY full. Not everyone has access to a second opinion.
This is true and the healthcare access problem is more than just cost. If you're an hour and a half away from any specialists, then the ER you went to likely doesn't have access to set up those referrals. I have worked in both metropolitan and rural medical systems, and the biggest problems in rural healthcare are almost always access-based. If a hospital/ER is not in the same medical group as a specialist, they can't put in emergency referrals to that specialist, and I have worked in rural hospitals that don't even always have imaging services available. There's an MRI on a trailer that gets brought around to the various hospitals in the group meaning that each hospital has one day a week or one day every other week where an MRI is available. The other option a small, rural ER has is to call EMS to transfer you to another hospital with more resources, but if your insurance doesn't like the reason they give, you end up on the hook for that 90 minute ambulance ride. Small community hospitals are really between a rock and a hard place when it comes to connecting patients with resources while trying to avoid unnecessary expenses.
The best advice I have for anyone in a rural area with poor healthcare access is to establish care with a family physician for primary care because, most of the time, the primary care physician is the one that actually gets to the bottom of things or coordinates the referrals for specialists. If you have a standing relationship with a physician, it's a lot easier to make an appointment and they have a baseline to work from as opposed to starting from scratch like an ER physician has to.