There are days, and they seem to come more frequently lately, that I wonder if I am really making a difference.

At times, I feel like the character Zero in the movie “Holes.” In this splendid story, the diminutive Zero found himself on a juvenile work farm, where the warden forced the kids to dig deep holes. The corrupt warden hoped to find buried treasure under the dry lake bed. For Zero and his fellow inmates, it proved to be tiring, pointless, and boring work. In the end, things turned out well for Zero, and I suppose that it will for us as well.

Still, I wonder how much farther the safety net can be stretched by pointless and uncompensated work. As the economy circles the drain, and our elected representatives micturate away the futures of our grandchildren, we see more and more nonemergencies and receive less for our trouble.

How many of you enjoy being the drunk tank for the police, the dentist, the psychiatric clearinghouse, and the social worker?

No matter how one slices it, a large number of our patients should be seen in another setting or don’t need to be seen at all. Yes, I have read the study that shows it is not these patients who contribute to the delays and boarding that plague most of the nation’s emergency departments. There comes a point, however—and I believe we are already there in many places—that the number of nonurgent patients creates enough chaos to impair our ability to care for the people who truly need emergency care.

Twenty years ago, when reimbursement was better, the occasional uninsured patient did not stress the system, because compensation from the insured patients was reasonable. As reimbursements have declined, and the financial flexibility of the system has been lost, these patients now put an enormous stress on the system. Accompanying this has been the stress placed on staff and physical capacity.

In spite of great challenges posed by these stressors of the system, emergency physicians have been masters of adapting to change. We have found ways to become more productive and use patient care spaces more efficiently. We usurped surrounding office space from the nonproducers and cajoled administrators into building new emergency departments. It seems, however, that almost as soon as the new spaces are built, they are outgrown.

Many departments nearly crumble under the weight of patients who are sick and those who are not. The University of Chicago has recently implemented a plan to reduce unnecessary visits. They have been criticized for this and accused of possibly violating EMTALA. Clearly, the folks at the University of Chicago felt they were at the breaking point and needed to make tough choices in order to provide good care to the most ill. This is not a theoretical discussion.

I’m sure many of you bristle at the above paragraphs. “We have always taken all comers, and we shouldn’t be turning anyone away,” would be the argument. I am sensitive to this part of our mission; however, we have enormous issues before us, and collectively and as individual departments, we need to examine our problems with an open mind.

In situations such as we find ourselves in now, I believe that it helps to look back at our original mission. The reason the “emergency room” existed originally was to identify, stabilize, and begin treatment for serious and life-threatening conditions. To say that our mission has evolved over the years is like saying that Congress went on a small spending spree this year. Some of this has been for the better, and some has been decidedly for the worse.

On the upside, our collective talents have exploded, and we have become a vibrant specialty that attracts some of the brightest medical students. Our specialty is so advanced now that it is difficult to imagine our humble beginnings of 40 years ago.

While we have evolved, we also have taken on tasks that, while necessary, ideally would be done best elsewhere. How many of you enjoy being the drunk tank for the police, the dentist, the scut-boy (or girl) for the doctors who use the ED as their admitting service, the psychiatric clearinghouse, the homeless shelter, the temporary ICU, the writer of admitting orders, the social worker, the detox clearance station, and the chronic pain doctor?

Individually and in small amounts, these tasks, which are outside our area of expertise and mission, are just a nuisance. Throw them all together into a busy, overcrowded, underfunded department, and they are more than just a nuisance. These things distract us from our true mission, contribute to the dissatisfaction and burnout levels in our ranks, and, most importantly, put patients at risk.

I feel fortunate at my place because, while at times we become overwhelmed, for the most part we get through the day without a major crisis. For many departments, however, crisis mode is the norm, and they desperately need to create a safety valve.

One problem in creating a safety valve is maintaining compliance with the Federal Indentured Servitude Treatise, better known as EMTALA. The University of Chicago quickly learned that EMTALA compliance will be used as a weapon to try to maintain the status quo.

I’m not suggesting that people be turned out on the street like they do at the orthopedist’s office. I’m suggesting that there are other (and often better) alternatives that can solve the problems at hand.

This brings us to the second problem, which is getting entrenched hospital bureaucrats and doctors to help implement solutions that are a winner for both the patient and the emergency department.

Nowhere will you find more resistance to change than when you are doing a difficult, uncompensated, or unpleasant task—and well—that nobody else wants to do.

Never mind that elective detox patients can be screened at 8 a.m. in the detox unit rather than 10 p.m. in an overcrowded ED. Never mind that stable patients should be directly admitted to the floor rather than making them wait in a crowded ED and receive an unnecessary bill. You have plenty of time, space, money, and staff to do these “favors.”

If we are to give the best care to the patients with true emergencies, we need to stop trying to be all things to all people. We need to return to the foundation of our work.

Let’s stop watering the grass and concentrate on putting out the fire.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo Medical Center. Your feedback is welcomed at David.Baehren@utoledo.edu.