As I See It (Dr. Z’s column) PROGRESS?

By Thomas C. Zguris, M.D., MBA, FACEP

President and CEO

Progress is defined as “the process of improving something over time.” Over the last century, mankind has certainly made staggering progress in just about every aspect of our lives. But lately, the lines between actual progress and change for the sake of making or saving money seem blurred. Remember, it is not really progress if the sole purpose is money.

Consider water. Throughout time, mankind has struggled to maintain a source of drinkable water. This often meant carrying it long distances. Today, in developed countries, water is available virtually everywhere with the simple twist of a faucet handle. What do we do in response? We bottle the water, carry it with us and discard the plastic bottle when finished. Progress?

Consider coffee. Historically coffee was one of the most inexpensive pleasures of mankind. It literally cost pennies per cup. What did we do? We elevated it to a status worthy of $3-$4 per cup. Then, we put it in little plastic disposable pods which cost $.40 per cup versus $.09 if brewed in a pot. Of course these pods find their way into the same landfills as the water bottles. Progress?

These are just two examples that represent changes in many products that have not made them better. Rather, they have just made someone very rich while damaging our environment. Consider healthcare. We have a network of emergency departments across the country staffed by exceptionally well-trained physicians and nurses and equipped with state of the art technology. Yet, because of high costs, we are looking for alternatives to this model. Alternatives such as “Minute Clinics” and telemedicine solutions are popping up everywhere. Is this progress?

Some argue that the cost of an ED visit is too high. They are wrong. The cost of seeing one more earache or one more sprained ankle is marginal because everything required for that visit is already there. The lights are on, the doctor and nurse are already on duty and the otoscope or X-ray machine are sitting idle. There is little to no additional cost to take care of these patients. So where is the problem? It’s not the cost, but the charges when compared to alternatives. In 1996, a former colleague of mine, Robert M. Williams, M.D., DrPH, wote an article in the New England Journal of Medicine entitled “The Costs of Visits to Emergency Departments”. This article predated alternatives like telemedicine or clinics based in retail pharmacies. Yet the article made the same point. Actual savings from using alternatives to the ED may not be as significant as widely believed.

So, for those of us on the leading edge of Emergency Medicine today, do we accept and even embrace alternatives to the ED? Or do we adjust our delivery model to offer the same excellent care that we already provide but at a more competitive price? The answer probably lies somewhere in between and will inevitably require collaboration with hospitals. Ultimately, the consumer will decide—and patients seem to prefer full-service EDs, as opposed to stand-alone clinics. In this case, perhaps progress is not just in improving something, but especially in protecting something that is already great.