Acute Care

When Dr. Doug Iliff got an evening phone call from his oldest son in Chicago, he was familiar with the question.  The problem was the answer.  While visiting his brother, the middle son had bumped his head and needed a few stitches.  Where should they go?

“Anywhere but an emergency room’ was the best answer I could give him,” explains Dr. Iliff, who with Dr. Michael Laccheo has been co-medical director at Minor Med for 20 years.  “I didn’t know where a minor emergency center was in Chicago, and like many healthy young men, my son didn’t have a family physician to call.  So, they ended up at the nearest emergency room after all.  The bill was over $3,000.00 for a few staples, with a CT scan thrown in for good measure.”

“I suppose there was a one in ten thousand chance this healthy kid had a tumor or a blood clot inside his skull,” Iliff says.  “but why should the ER doc take that chance of a malpractice suit on a patient he doesn’t know and probably won’t ever see again?”

“This same scenario is currently playing in the television series “ER”, coincidentally set in a Chicago hospital.  One of the doctors spends time in Africa as a volunteer and upon his return becomes outraged at the waste of money by his colleagues.  He campaigns, unsuccessfully, for a return to clinical judgment rather than reflexively ordering expensive tests.”

“But every time a doctor hesitates in ordering a test, he/she is taking a tiny chance that the test will reveal something unexpected,” Iliff explains.  “A longstanding relationship with the patient makes it safer to adopt a ‘wait and see’ approach which is essential in slowing medical inflation.”

“That’s why we have a tiered system of care in Topeka:  primary care physicians, minor emergency centers like Minor Med, and hospital emergency rooms.  Patients need to work through those levels deliberately in order to get the best care for the lowest cost.”

“I was an ER doctor at Stormont for over six years,” continues Iliff.  “Those people do a great job under stressful conditions.  Packing the waiting room with mino9r illnesses and injuries just makes their jobs more difficult.  Emergency rooms are expensive because they have to be staffed 24/7 with highly trained professionals ready to treat a train wreck at a moment’s notice.  Every patient will get faster, more efficient care if they think carefully before jumping in the car and heading to the hospital.”

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