A plan to redistribute medical care from the University of Chicago’s emergency room to nearby clinics in Kenwood, Bronzeville and other neighborhoods was scuttled recently by President Zimmer, despite its potential fiscal good sense, because of outcries from outside and within the University. Now resting in a review committee, the plan has been delayed after denunciations by the American College for Emergency Physicians as well as several hundred people from the Medical School in a petition. At a recent town hall meeting with students, President Zimmer aptly characterized this debacle as having grown out of ignorance and anger. What he did not realize was that grounds of the disagreement bear the trademark of the University of Chicago, and that he and other administrators had reaped what they had sown.
What exactly lies beneath the argument between hospital administrators, President Zimmer, outside medical professionals, newspapers, and the University community is difficult to tell because most of the opinions expressed are obscured from public discussion. For example, no one as yet to my knowledge has published interviews with the doctors and students who signed the protest petition. Nonetheless, as a general member of the University community, my initial reaction of doubt and anger to the proposed change in medical care was shared by many others, and I believe my perspective speaks for their concerns. I welcome other voices, especially those who have not spoken publicly and believe this issue merits the understanding and consent of the community at large.
The basic issue from where I stand is the utter absence of a definition of “urgent” versus “non-urgent” care. Obviously a gun-shot wound is highest priority, but what about getting a few stitches for a gash or suffering from possible food poisoning? These lesser issues only require a walk-in visit, not emergency diagnosis or surgery, but will I be sent to the Kenwood clinic if I show up at the UC Hospital needing stitches? A host of touchy issues follow from this question. In fact, I don’t think they are substantive for the discussion, but they do emphasize potency of what “non-urgent” turns out to mean in practice.
In other words, the issue is that spokespeople for the University, including President Zimmer and the authors of the Urban Health Initiative website, have failed to understand that their basic terms don’t have a clear meaning for us. Their rhetorical error resulted in anger and confusion on both sides, at first because people responded too quickly to what the policy might be, and then because the administrators who designed the policy overreacted to what seemed irrational or uninformed criticism. The former mistake was probably exemplified by ACEP President Nick Jouriles, who issued an aggressive press release against the ER policy without checking the facts first, as he admits. The latter mistake can be found in President Zimmer’s public response to student criticism, which was to blame them for not doing more research: “I would hope that as U of C students, you would try to do more to avoid a superficial [understanding].”
Having examined all the available information I could find, I would argue that the UHI failed to explain itself clearly, but that what information is available indicates the policy has merit. The horrible irony is that the UHI has stumbled into the same problem it was trying to address. As a Tribune story describes, “the University of Chicago Hospitals is taking on yet another mission: educate the uninsured on how to get quality medical care without showing up in its expensive emergency room.” The point is that a lot of medical problems that need to be treated that day (such as a pulled muscle) do not necessarily need an emergency room, and moreover a number of people arriving at the ER have chronic medical conditions but no primary care physician that provides them with regular treatment or preventative advice (see the bottom of the UHI FAQ page). The result is that people, out of justifiable ignorance, go for treatment to places that have equipment specialized to other purposes and end up wasting money to no purpose.
The sad fact is that the UHI is not carrying out this educational mission on its website in a detailed, coherent way, i.e. so that someone like me who still doesn’t understand fully what conditions are appropriate to ERs could learn about good choices for care. Moreover, the University has not pursued the point of defining “non-urgent” care in the press, as evidenced by the lack of nuance in the Maroon’s story, the Tribune, and a host of other articles (here). (These newspapers have their own responsibility to investigate further and have not yet fulfilled that obligation.)
In other words, what ended up as a PR disaster and the postponement of a potentially good policy could have gone differently. Fundamentally, the error lies in assuming the worst of one’s critics. As I see it, the people criticizing the ER policy had a good reason to be worried because the policy was very ambiguous, ironically suffering from the very problem it was intended to correct. While the ACEP and others in the community sometimes asssumed the worst of the university, the university administrators needed to respond positively to these criticisms instead of assuming the fault only lay outside their doors. Although no one escapes responsibility here, ultimately it should have been up to the designers of the plan, who understood its reasons and context best, to respond positively to criticism, even when it was hasty and unthinking. That is, after all, what it would mean to be truly a leader in health care.