Regarding long waits in the ER - I think all over the world there are similar problems. In Australia we have one of the best health care systems in the world, but the ER is still a problem for us. There are some problems that are universal. Think about it - if the ER staff were able to see you immediately you walked in the door and work on you right away regardless of how trivial or non-urgent the issue is, then we would be griping about the waste of resources that has these people sitting around waiting for patients.
It all costs. The problems increase when the bean counters begin to have more say than the quality of care watchdogs.
The other issue is urgent vs important. You can front up in severe pain but if it's not about to kill you, and someone else comes in with mild pain from the early stages of a heart attack or stroke, you will get abandoned until your problem becomes urgent enough. Your problem may be important, but not urgent.
A recent memorable stint in ER for me was last winter in Canberra Hospital. My problem was not life-threatening, and it was Saturday night, late, with car crash victims being brought in needing to be stabiised. However, my problem was sufficiently urgent so that I was no 2 in the triage, because my sight needed to be evaluated - there was a real risk I was going blind and quick intervention could possibly prevent. But a few hours was probably not going to make any difference. Others with sprained ankles were stabilised then left to wait.
The system the hospital had in place was good - you got evaluated by a nurse practitioner immediately on arrival, but then got left until your position in the triage came up. Then it was in order of arrival, all other things being equal. The problems for me cane because I was an ophthalmic patient and got put in a room away from other patients, to wait, just as the staff member who put me there went off shift. We got left for about four hours with nobody checking on me to see how my problem was progressing. I had a bleeding retina and it went unattended. I later wrote to the hospital and they apologised, and said they have made changes to their procedure to ensure this does not happen again.
Since then I had to go to the ER (sent by my GP who wanted me admitted) ironically for a chest infection I caught while waiting around Canberra Hospital a fortnight earlier. The infection had become a problem and I was struggling to breathe. At the ER I was put in a room fairly quickly, and on oxygen. They considered it urgent enough to do that much. Someone took bloods, then I was left for about two hours. But I had been checked over and had oxygen there, and a nurse coming back every so often to check my status. After two hours they put up an antibiotic drip (which is what my GP had wanted; but the hospital doctor had to see me and independently decide). Then my blood tests came back with a normal white count. They felt this indicated no bacterial infection, so the antibiotics were stopped and I was discharged. They apologised for not admitting me for more oxygen and observation, said I was breathing well enough as long as I sat mostly upright and to sleep upright, but with the bad flu season, the hospital was clogged. They had done a chest X-ray to make sure my problems were not pulmonary fibrosis from the very recent radiation treatment for breast cancer.
It took time, but the place was full. A GP would have been quicker, but would have meant referral on to a specialist which takes time. All reports were done quickly and without anyone puzzling over detail. They send it all back to the GP and specialists and THEY puzzle over it later at their leisure.
Anyway, that is a fairly standard example of the Aussie ER system. We did have a local private hospital which had an ER that many would love - you walk in, get seen right away, the best of equipment right there. But it still took some time to be processed through to admission or discharge and it also came with a high price tag. We used it a few times and loved it, but they closed down their ER because it was losing money.
ERs the world over will always be a problem. Our papers currently are full of stories about hospitals apologising to women who waited for hours and hours then miscarried in the waiting room toilet, or who were discharged as well and later died on the way home. It's a bit like M*A*S*H - meatball medical treatment.
And sometimes you can get lucky, and find a genius who thrives on caffeine, adrenalin and 24 hour shifts.
husband's cousin's son is currently working in ER in Perth, WA. We hear horror stories of the long shifts he's working, often having only had a six hour gap to sleep in between (and somehow get food as well). But the kid is loving it. And they love him, it seems. But I know if I'd tried medication as a career, I would never have survived such conditions.
Nor would most of my patients!
Cousin lost a patient and was very upset - but it was a girl brought in from a car crash who, frankly, was un-saveable. But he tried. Then her brain began to swell, despite the open fractured skull and heavy sedation. He'd stopped the bleeding, crocheted her kidneys back together, but brain damage became too severe and the EEG flatlined. Then he had to go talk to her parents who were still coming to terms with their daughter having been injured in the first place.
It takes a unique kind of person to do that job.
Marg