Writing a blog is the only affectation I know where sarcasm passes for intelligence.  Sometimes I find it helpful to leave a trail of breadcrumbs to help you see where the story may be headed; today I have decided to leave a trail of croissants.  That said, here we go.

Packing for my trip today I was interrupted by the obscure phrase, “Those socks are arrogant. There is a reason why most men wear plain, dark socks.”

“I don’t want to look like most men,” I said as I tossed them into my suitcase.

“If you wear that pair, you won’t look like any men.”

“Besides, socks cannot be arrogant,” I replied, ignoring her sarcasm, “any more than they can be disappointed. Socks can be cotton and Italian, as these are, and they can be colorful for the same reason, but they cannot be arrogant. Show me someone who has a bad thing to say about my socks and I’ll show you someone challenged by color.”

Every time we get into one of these conversations I feel like I am trapped in a veritable Tennessee Williams play, or like I am having a battle of words with Sigourney Weaver in Alien minus her automatic weapon.

“You know what I mean,” she said. For those of you who have your own sock monitor, you should be able to infer who she is. “Wearing those socks makes you come across as arrogant. The type of person who would wear those socks is the type of person who would walk into a Seven-Eleven and kill everyone because the Slurpee machine wasn’t working.” Sigourney get your gun. Wasn’t that a musical?

“I have a mind of my own.”

“I know,” my Sock Monitor replied. “It’s how you use it that keeps me up nights.”

“The socks make me a nattily dressed, confident and sartorial gentleman.” I felt like I was trying to explain cholesterol to a Big Mac. Maybe I needed to spend some time in a reeducation camp.

“Yeah, whatever you think they make you, do not wear them to your meeting tomorrow unless you want to be remembered as the guy with the leprechaun feet.”

I looked at her with the trepidation of a student teacher in a geography class trying to point out Burma on a dated map, and I decided to call this a draw before Ms. Weaver went for her weapon.

The IDN’s website displayed the waiting times for its five hospital emergency departments. Two of hospitals displayed wait times of “+60 minutes.”

Now I am not sure why I think the way I do about things. Maybe it means I don’t play well with others. Or, perhaps it reflects the fact that my thinking is so far off from being main-stream that my little billabong dried up a long time ago.

So, let’s look at the idea of posting wait times for a hospital’s emergency department. I imagine hospitals post them because someone suggested that doing so would improve customer experience. My question is, Cui Bono—who benefits?

Emergency: a serious, unexpected, and often dangerous situation requiring immediate attention. The definition, to my way of reading it, is unambiguous. Dangerous situation requiring immediate attention. Need we define immediate? Suppose you have one of those situations.  Which of these do you do?

1. Dial 911
2. Drive yourself to the hospital
3. Log in to the hospital’s website to check the wait times at the emergency department, and then drive yourself to a hospital.
4. Phone a friend and ask him to come over to watch the Eagles game with you.

Let’s take a minute to review your options.

If you dial 911, you do not have to trouble yourself with wait times because the ambulance driver will decide which hospital will treat you.  The EMT will not ask you about your insurance, and the driver will not consult you about your preference based on current wait times. In fact, you may not even be taken to one of the hospitals in your payer network.

If you drive yourself to the hospital, and your situation is really a dangerous situation requiring immediate attention, do you go to the closest hospital regardless of whatever the wait time may be? Or, do you start messing around with higher maths. Please play along.

Our Lady of Rapid Service is seventeen miles away and has a posted wait time of ten minutes. The hospital of We’ll Get To You When We Can is five miles away and has a wait time of forty-two minutes.

The real question becomes, “Which hospital has the lowest gross time before I can be seen?” (The lowest wait time does not guarantee that you will be seen sooner. Gross time equals the sum of drive time plus parking time plus wait time.) To answer this correctly requires that you include numerous other factors; traffic, road repairs, weather, time of day, curvature of the earth, and so forth. It also requires a bit of clairvoyance on your part.  The posted wait times are the current estimated wait times, not the estimated future wait times. The posted wait time would be helpful if you were at the hospital now, as in right now. But the wait time may be different by the time you arrive.

So chances are good that if you have the time to look up and evaluate wait times, and have time to select a provider based on those wait times, and have the additional time required to drive yourself to said hospital, the one thing you do not have is…say it with me… A dangerous situation requiring immediate attention. The concept of wait time flies in the face of the concept of immediacy. In other words, someone with all of this extra time on their hands probably does not have an emergency. 

Which, as it turns out, is what a lot of people who go to the emergency department do not have—an emergency. In which case those people should not be going to the emergency department, and if they do, perhaps they should be made to wait. Getting rid of those who do not have emergencies, or just making the non-emergency group of people wait in their own little queue, will make the wait times for those who have real emergencies so low that the hospital will not need to post wait times.

Which not only solves the problem, it makes the option of watching the Eagles game make a lot more sense.

Back the question I raised at the outset, Cui Bono from posting wait times?  The only answer I can come up with is that the people who benefit the most are the ones who do not have an emergency. An example might be the person who called their doctor on a Friday afternoon because they ran out of their prescription and they were told that they would have to wait until Monday for a new script.  This person calculates the drive-time/wait-time math and picks the hospital that will get them home with the least amount of interruption to the Eagles game.

Bonus round. Now, for extra credit, how would having a triage nurse available at the hospital’s call center impact ED wait times? It would bring them down because many of the people whose needs were basic, those people who did not have an actual emergency, but who needed a new script or medical advice, could be served by speaking with the nurse. This would bring down wait times, reduce costs, improve patient experience, and allow more people to watch the game or do whatever it is they would have done had they not been waiting in the emergency department.