I tend not to think much about the flu. But last winter, when I had to take my daughter to the emergency room for an allergic reaction, almost every single person in the waiting room had the flu. They were using the emergency room as their primary care provider.

I don't understand people who don't get a flu shot. They're inexpensive and readily available most years. Last year, I got my shot at the neighborhood grocery store. Any discomfort one experiences is minuscule compared to contracting the flu.

But I shouldn't be so quick to judge about using hospital emergency rooms for primary care. There aren't a lot of options out there. Recently, I read in the San Francisco Chronicle that a growing number of people who have insurance are turning to hospital emergency departments, too.

They go because they either do not have access or they cannot get appointments with the primary care providers. According to a Centers for Disease Control and Prevention study, emergency room visits increased 32 percent from 1996 to 2006, which outpaced population growth. About 13 percent of ER visits resulted in hospitalizations, although more than half of admissions in 2006 came through emergency rooms. That's up 38 percent since 1996.

This is a trend that cannot be sustained.

I don't pretend to have the answer. The private sector has attempted to fill the gap. There are a number of small medical clinics in grocery stores in Utah. Some retail pharmacies perform services such as vaccinations and bone-density tests.

For the occasional sore throat or minor injuries, storefront medicine can work. It's not optimal because you have an established relationship with your family or personal physician. They have access to years of records and can quickly determine what prescriptions you take and how they might interact with something else you might need temporarily.

There are times you can't seem to make an appointment with your primary care physician. I once injured my shoulder before Thanksgiving. Because I was traveling out of state for the holiday, I tried for days to make an appointment. Only when the receptionist discerned that I had two forms of insurance was I given the golden ticket of admission. But I had to see a medical resident, who wasn't altogether sure what my problem was. He wrote me a prescription for some high-power ibuprofen, which helped with pain and inflammation until my body could heal itself. No harm. No foul.

I still wonder what would have become of me if I hadn't had insurance. Or if I had only one form of insurance. I know hospitals, clinics and medical providers have to stay afloat, but the issue of access has become its own emergency.

Most of the medical students I meet during occasional doctor visits tell me they want to be specialists. From an economic and quality-of-life point of view, that can make a lot of sense. There's a lot more money in heart surgery, for instance, than in family practice.

But if there were more front-line providers who could establish relationships with patients, ensure they receive preventative care and attempt to address small problems before they become the type of issues that legitimately require emergency care, all the better. And when there are fewer and fewer primary care providers, they certainly will suffer from burnout, let alone have less time to spend with patients.

There's another kink in the works. The CDC study also found that the rise in emergency room visits has coincided with the loss of 186 emergency departments nationwide between 1996 and 2006.

Many hospitals operate on razor-thin margins. They were not set up to be de facto primary care providers.

Until the nation gets serious about addressing this trend, the entire health-care system could lapse into critical condition.

Marjorie Cortez, who believes a flu shot also helps ease the financial burden of your friendly, neighborhood emergency department, is a Deseret News editorial writer. E-mail her at [email protected]