PROVIDENCE – She arrived breathless and pale. For weeks she thought she was having indigestion; several times a day chest pressure gripped her when she was trying to work, garden, and lately even while sitting and watching TV.

The Tums didn’t seem to be helping, and so when her boss at work asked what was wrong and then directed her to the hospital, she didn’t protest.

Quickly my emergency physician colleague at the nearby community hospital realized this wasn’t “just” indigestion. Her cardiac enzymes returned elevated, and she received an urgent cardiac catheterization at our tertiary care center.

Recognizing what is wrong
These stories aren’t unique. Most people, whether health literate or not, can’t be aware of all the symptoms and signs of life-threatening health conditions. My patient was in higher education and had a clean bill of health. She thought this couldn’t possibly be serious.

This is why my colleagues and I specialize in emergency medicine and spend three to four years – and at least 10,000 hours, often more – learning how to distinguish between the serious and not-so-serious illnesses.

Heartburn can – like in my patient – be a critical occlusion of your coronary [heart] vessels. When these vessels remain blocked – because you may have waited at home - part of your heart muscle dies and you may never fully recover, developing heart failure.

Headaches can be benign or due to aneurysms that have ruptured in the brain. A “minor rash” can be from flesh-eating bacteria and can rapidly progress causing irreversible tissue damage. Delaying surgery portends death.

What is urgent?
So, when UnitedHealthcare recently revealed a new policy that denies payment of emergency department claims that they retrospectively determined were not urgent [once a skilled emergency clinician completed a full evaluation and made a diagnosis], many of us were outraged.

Are we going to ask every layperson to become expert diagnosticians and decide for themselves if their condition was dangerous? Likely not.

The truth is that most of the time a headache is just a headache. But, even brain aneurysm pain can be improved with ibuprofen, and it takes an expert to pick the “needle out of the haystack” and say – this is the person that needs imaging and a lumbar puncture.

Of concern, the patients that are the most price sensitive – unpaid caregivers for adults, Black and Hispanic adults, people with disabilities – will be the most likely to put off care, exacerbating already poor health outcomes in these groups.

To be sure, other countries get better value for their GDP spent on health care. We have to look critically at how to reduce costs in health care.

The high cost of deferring care
Perhaps, we can start by reclaiming some of the health profits and savings UnitedHealthcare made when people deferred necessary care during the biggest public health emergency of our time.

Or, we can be more thoughtful about approving drugs with little benefit, concerning risk profiles, and outrageous price tags, such as the new dementia drug Aducanumab.

But, if you ask any clinician who has practiced in the emergency room for more than a few weeks, they will tell you patients can’t always make their own diagnosis. If they could, we wouldn’t need hospitals staffed by highly trained emergency physicians and specialists on call.

For now, thanks to public outcry, UnitedHealthcare has agreed to delay their plan to deny coverage for some ER visits, but we expect they’ll reintroduce the policy when the pandemic is over. Our goal should be to get every American high-quality care and find smart ways to bend the cost curve, without expecting patients to be doctors.

Dr. Elizabeth Goldberg, M.D., is an emergency medicine physician in Rhode Island.