As third-year residents at my program, my colleagues and I are responsible for being the medical control base physicians for the entire city of San Francisco. We grant medication requests to EMS, make death pronouncements, decide which hospital an ambulance should be directed to, and receive reports regarding those who want to refuse care at the scene.
These past few months, I have noticed an uptick in against-medical-advice calls, as many patients get to the hospital by Uber or Lyft. Typically, these are not the patients I am most worried about. They tend to be the patient experiencing paraspinal neck pain after a low-speed motor vehicle crash or the patient with ankle pain from tripping on the sidewalk who can ambulate and probably won’t need an X-ray based on the Ottawa ankle rules. Every once in a while, someone I want to see a doctor sooner rather than later—the patient with known coronary artery disease with chest pain (no ST-elevation myocardial infarction on ECG) or a chronic obstructive pulmonary disease patient with shortness of breath—wants to call an Uber.
Was I the only one hearing about this? I informally polled my residency colleagues. A lot of us were hearing the same thing. Why would people do this? Probably money. The cost of a ride with Uber or Lyft pales in comparison to the hundreds or even thousands of dollars a patient could expect to pay for an ambulance ride. Moreover, a patient may wait weeks or months to learn the price of that ambulance ride, but with Uber or Lyft, the patient can get an estimate before even calling for the ride. With Uber or Lyft, the patient can even choose which hospital to go to.
EMS systems are so bogged down that even some cities are trying to figure out how to possibly incorporate ride-hailing programs into their EMS systems. For example, Washington, D.C., is researching the possibility of hiring triage nurses to determine if an ambulance is needed or if a taxi or Uber could take a patient to a doctor’s office. However, the program would not cover trips to the emergency department, which would require an ambulance.
While Uber and Lyft both officially encourage riders to call 911 for medical emergencies, there is no formal policy banning the transport of sick people to the hospital or emergency department. However, when was the last time your Uber driver was really paying that close attention to why you were going wherever you were headed? Drivers will not be watching to make sure a sick patient does not get sicker on the way to the emergency department.
BIO: Dr. Degesys is an EM resident at the University of California, San Francisco–San Francisco General Hospital and the Emergency Medicine Residents’ Association (EMRA) representative to the ACEP Board of Directors.