A PCP who misses any obvious emergency does open themselves to lawsuits, but not all emergencies present in the usual obvious ways. The point I was making is less about ED vs PCP lawsuits and more about costs, and the lawsuits do impact costs. ED care is expensive because it has to be, both because it’s an ED where the whole point is to find emergencies and stabilize patients while getting them to the care they need, and because of the very real possibility of malpractice if an ED doc does miss something. All of that, and the points Nesrie brought up about 24/7 availability of specialists, nurses, radiologists, techs, etc, add into the overall cost of an ED visit.
And magnet, things have changed a whole lot since PCPs staffed EDs in the 70s. The ED specialty had barely gotten recognized at that point. No acute ED uses PCPs now if they can avoid it - their training is not sufficient for what is expected of an ED doctor who is seeing the full spectrum of emergent care now. Some rural EDs that don’t see much trauma do still use PCPs, so it’s not completely gone, but no level 1, 2, or even 3 trauma center is likely to use a PCP now. And I’ve never seen a patient sent from the PCP with a list or orders for testing to be done, not that it can’t happen, just that I’ve never experienced that.
To further elaborate on the headache example, I would hope most PCPs would recognize the symptoms of an acute subarachnoid - thunderclap headache, brief loss of consciousness, and the worst headache of a person’s life are taught to every medical student - and send them to the ED for workup. But a more subtle presentation is possible, perhaps only some neck pain or a lateralizing symptom that only a thorough neuro exam would detect. I feel certain that a PCP would be much less likely to be sued than an ED doc who misses that, assuming that good PCP-patient relationship.
I didn’t discuss stroke or heart attacks, because of course every PCP knows the classic symptoms and will send patients to the ED if they are having them. However, an epidural abscess hiding in a sea of low back pain is easy to miss as a PCP. Nausea can be the only presenting symptom of a heart attack, especially in the elderly, and especially for females, and a posterior stroke may only have dizziness as a presenting symptom. Nausea and dizziness are very common causes to see a PCP, so I can easily see both a stroke and a heart attack being missed by a PCP in the 15 minutes they have to assess and treat a patient. And still, the PCP would be much less likely to be sued if they did.
Why do I keep saying that the PCP would be less likely to be sued than the ED doc? Because good studies have shown that the number one reason people sue their doctor is that they didn’t feel cared for. People know that doctors make mistakes, but they are far more likely to give their PCP (that they know, like, and feel good about) the benefit of the doubt than some random ED doc who likely didn’t spend the amount of time listening to them that would have made them feel cared for. It’s about feelings more than it is about poor outcomes. I consider the PCP-patient relationship as the most important part of a PCP’s job, and all bets are off if a PCP hasn’t fostered that relationship - they are doing their patients and themselves a disservice.