Asking the doctor to determine whether a patient should pay or not can be very destructive even in short-term relationships. I can guarantee that some patients will attempt to argue about their diagnosis (some already do, for different reasons). Some will purposefully beef up their symptoms to be classified “urgent” – leading to unnecessary tests and treatment. I already know of several patients who claim to have chest pain when they clearly don’t, just to get seen faster.

The biggest problem is that most non-urgent problems seem urgent to patients. To be sure, some patients come into the ED with obvious nonsense, but most of them have some sort of valid concern, even if it is not an emergency. For instance, most hot kids are non-urgent (colds, flu and similar viruses), but a very small percentage have sepsis, meningitis etc.If you discourage the non-urgents, it won’t be long before someone does not bring in a really sick kid. Money is always a dangerous barrier in medicine.

This means that the extra fee you are proposing can only be determined by the doctor retrospectively, after making a diagnosis. This would cause all sorts of strains on the doctor-patient relationship once the patients learn the new system. I expect a number of doctors to “up” their diagnosis to make it sound like an emergency. This will undoubtably cause confusion and, possibly, misdiagnosis (imagine presenting with a cold four times in a row and being labelled “bronchitis” each time – four episodes of bronchitis in a row is much more alarming than four colds and will lead to a lot of unnecessary investigation)

I can also guarantee a sudden flurry of complaints. The biggest generator of complaints was the old part charge for ED services – and that was not a retrospective fee.