Emergency! Things Your ER Staff Wants You To Know
Currently at WebMD there is an article called the "7 Pains You Shouldn't Ignore." It's an article that helps people without medical training to recognize the common symptoms of potentially life-threatening illnesses. Patients in the emergency department (ED) where I work often wonder if they have wasted their time (or the medical personnel's) by coming in for something they aren't certain about. Please, never worry about that!
The reason the ED exists is to make certain that you aren't having a medical emergency. If it turns out to be "nothing" then we'll do the happy dance with you. We would much rather that you come in earlier so that real problems can be treated in a timely manner, than to have you stay home while your heart attack or stroke or other serious illness gets worse. The sooner we can start treatment the more likely you are to have a full recovery to your former healthy self.
One word of advice however. It is not the job of the ED staff to diagnose your long-standing health problems. So if you suddenly decide that you 'can't take it anymore' in the middle of the night and come in for the chest pain that has been going on for months, don't expect that you're going to get the million dollar workup right then and there.
We'll make sure that you aren't having a heart attack, and then we'll tell you that we're pretty sure you have a little excess stomach acid. We will give you a prescription to stop acid production in the stomach and tell you to make an appointment with your primary care provider (PCP) for follow-up.
We'll only give you 10 days to 2 weeks worth of medication though, because we want you to see your PCP to make SURE that's the problem. It might be that you actually have a bad stomach ulcer, and you really need a check-up to make sure that it's not bleeding. You'll be sent to your PCP for the follow-up.
This brings me to a point that the ED staff would really like you to know. I don't care how young or old you are, you need to have a PCP in your community.
No health insurance? Then find a community health clinic that takes people without insurance and go there. Yes, hospitals HAVE to provide "free care" to those without insurance, but that doesn't mean that it happens easily. There is a lot of paperwork to fill out, you get good, but not personalized care, and you still get a portion of a very large bill.
Depending on what time of day you come in you also may have to wait HOURS to be seen! Better to call the clinic and get seen on the same day by someone who knows you and pay little to nothing based on an income scale. It will make you feel more like a human being that counts than someone the ED staff treats badly because you don't belong in the ED. I know it shouldn't be that way, but it happens.
We're not a primary care office. So when people decide that that they suddenly need their allergic, sneezing, runny nose treated or that ugly mole removed, or they can't stand the heartburn any longer and they have to drag the kids into the ED in the middle of the night, they should know they're going to get a little attitude from the ED staff. They want you to see your own PCP in the daylight hours for that stuff.
It's not that we don't want to work. I'm telling you, there are plenty of sick people who come to see us every day, and really need to be in the ED. But we want to concentrate on them, and we know you'll get better care in your PCP's office, with less expensive co-pays than you'll have to fork over in the ED (now typically $50.00 or more). We're also worried about the GERMS!
One word that DOES define the ED is germy (it contains a LOT of germs!). EDs and hospitals are full of sick people, so you need to consider whether or not it's worth exposing yourself to them. Ditto for your kids. If at all possible, don't haul the little ones along with you to keep you company in the ED. If you have to, then get someone to come pick them up as soon as you can.
Kids are going to get bored quickly and then they'll want to wander. If you're really sick you don't need to be worrying about what they're doing. If you're not, you'll soon see the wrath and annoyance of a busy ED nurse who is wondering why you had to drag the whole crew in at midnight while we looked at the earache you've had for 10 days.
The ED is a great place to go if you are really sick, including those items on the "7 pains" list. I would also add to that list any fever that you can't control with over the counter medications, and uncontrollable nausea and vomiting. We're here to help you to feel better, including treating life-threatening illnesses and getting you admitted to the hospital if needed.
If there is ever any doubt in your mind about whether or not to visit your local ED, then go. Better safe than sorry, and I promise you that no one will tell you that you should not have come for those 7 painful conditions, a high fever, or not being able to "keep anything down" in your stomach.
But always consider this question early in the day if you aren't feeling well: "What will I feel like 6 or 8 hours from now if this progresses?" If the answer causes you to be concerned, then you should call your PCP's office and ask for a call back from the provider.
If he or she advises coming to the ED, please come. But wouldn't it be better to get some advice from someone who knows you well, and can help you decide the best approach to your problem? It may be that with that kind of advice you can be saved a trip to the germy, overcrowded emergency department.
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Technorati Tags: ER, emergency room, emergencies, heart attack
The reason the ED exists is to make certain that you aren't having a medical emergency. If it turns out to be "nothing" then we'll do the happy dance with you. We would much rather that you come in earlier so that real problems can be treated in a timely manner, than to have you stay home while your heart attack or stroke or other serious illness gets worse. The sooner we can start treatment the more likely you are to have a full recovery to your former healthy self.
One word of advice however. It is not the job of the ED staff to diagnose your long-standing health problems. So if you suddenly decide that you 'can't take it anymore' in the middle of the night and come in for the chest pain that has been going on for months, don't expect that you're going to get the million dollar workup right then and there.
We'll make sure that you aren't having a heart attack, and then we'll tell you that we're pretty sure you have a little excess stomach acid. We will give you a prescription to stop acid production in the stomach and tell you to make an appointment with your primary care provider (PCP) for follow-up.
We'll only give you 10 days to 2 weeks worth of medication though, because we want you to see your PCP to make SURE that's the problem. It might be that you actually have a bad stomach ulcer, and you really need a check-up to make sure that it's not bleeding. You'll be sent to your PCP for the follow-up.
This brings me to a point that the ED staff would really like you to know. I don't care how young or old you are, you need to have a PCP in your community.
No health insurance? Then find a community health clinic that takes people without insurance and go there. Yes, hospitals HAVE to provide "free care" to those without insurance, but that doesn't mean that it happens easily. There is a lot of paperwork to fill out, you get good, but not personalized care, and you still get a portion of a very large bill.
Depending on what time of day you come in you also may have to wait HOURS to be seen! Better to call the clinic and get seen on the same day by someone who knows you and pay little to nothing based on an income scale. It will make you feel more like a human being that counts than someone the ED staff treats badly because you don't belong in the ED. I know it shouldn't be that way, but it happens.
We're not a primary care office. So when people decide that that they suddenly need their allergic, sneezing, runny nose treated or that ugly mole removed, or they can't stand the heartburn any longer and they have to drag the kids into the ED in the middle of the night, they should know they're going to get a little attitude from the ED staff. They want you to see your own PCP in the daylight hours for that stuff.
It's not that we don't want to work. I'm telling you, there are plenty of sick people who come to see us every day, and really need to be in the ED. But we want to concentrate on them, and we know you'll get better care in your PCP's office, with less expensive co-pays than you'll have to fork over in the ED (now typically $50.00 or more). We're also worried about the GERMS!
One word that DOES define the ED is germy (it contains a LOT of germs!). EDs and hospitals are full of sick people, so you need to consider whether or not it's worth exposing yourself to them. Ditto for your kids. If at all possible, don't haul the little ones along with you to keep you company in the ED. If you have to, then get someone to come pick them up as soon as you can.
Kids are going to get bored quickly and then they'll want to wander. If you're really sick you don't need to be worrying about what they're doing. If you're not, you'll soon see the wrath and annoyance of a busy ED nurse who is wondering why you had to drag the whole crew in at midnight while we looked at the earache you've had for 10 days.
The ED is a great place to go if you are really sick, including those items on the "7 pains" list. I would also add to that list any fever that you can't control with over the counter medications, and uncontrollable nausea and vomiting. We're here to help you to feel better, including treating life-threatening illnesses and getting you admitted to the hospital if needed.
If there is ever any doubt in your mind about whether or not to visit your local ED, then go. Better safe than sorry, and I promise you that no one will tell you that you should not have come for those 7 painful conditions, a high fever, or not being able to "keep anything down" in your stomach.
But always consider this question early in the day if you aren't feeling well: "What will I feel like 6 or 8 hours from now if this progresses?" If the answer causes you to be concerned, then you should call your PCP's office and ask for a call back from the provider.
If he or she advises coming to the ED, please come. But wouldn't it be better to get some advice from someone who knows you well, and can help you decide the best approach to your problem? It may be that with that kind of advice you can be saved a trip to the germy, overcrowded emergency department.
Related Topics:
Timely Hospital Care With Computerized Bed Board, Men Delay ER Trips to Watch SportsTechnorati Tags: ER, emergency room, emergencies, heart attack
23 Comments:
As a former ER technician, I completely agree with this article. We're gladly there for those who need us; we're just so busy that treating those who can really wait until the PCP's office opens makes us miss dinner and have to spend all TWELVE hours on our feet. Try it someday, and you'll see how exhausting it is. Please, save the ER for what it's named for: emergencies.
I couldn't have said it better myself, Laurie!
I always love the, "I started having these crushing pains, so I drove myself in..." Makes me glad I wasn't on the road at that time...
As patient in the ER... the ambulance took me into the ER one morning this summer at 6:00 AM from work. I had had a couple of episodes of chest discomfort the evening before, the last one of which was relieved with nitrostat. I was planning to call my PCP's office when the lines went up at 7:30. I had had the endoscopic look and barium swallow for GERD evaluation about 15 months prior, and was on a PPI. I knew this was different. When the discomfort started, I rested, took the first, second and third nitro with minimal relief. When the ER doc got me hooked up to the EKG, he said my heart pattern didn't look bad, just some ST,T wave depression, which I have had for a number of years. I was laying on the gurney, and the discomfort level was reduced from about 8 to 2-3 with additional medication. I did not have classic chest pain, instead I was presenting with jaw, ear and left arm pain and chest "squeezing" pressure. (Not unusual for women.)When they got me up to the restroom, the discomfort returned, though not to the previous level. My PCP reviewed, and admitted me to the cardiologist for consult. His physicians assistant gave me the routine about gastroesophegal reflux etc., however he agreed that the only way to rule out cardiac was to do the heart cath. By 5:00 PM I had two stents and one driver in my right coronary artery, one blockage of 80%, one blockage of 95%-99%. (Thank heaven that my PCP knew me well enough to understand that after 20 years as a department head in a hospital I knew how I felt, and was able to explain it. I have seen people be sent home from the ER with chest pain that was not identified as cardiac, and four days later attended their funeral.) The moral of the story is: sometimed the hoof beats in the park really are a zebra, not a horse. Do not ignore the symptoms.
It is not always worth the risk to wait until the phones are turned on at the doctor's office before getting care.
Our ER's are sometimes the last resort for the uninsured. They have no Primary Care Physician. Not a good plan, however until there are other options in our country, this will continue.
I've subscribed to WebMD's newsletters for several years now. As a result I was able to recognize the symptoms of a heart attack when I had one three days after Christmas in 2004.
I took an aspirin and called 911. Although my home is less than five miles from our local hospital I knew better than to drive myself. I also called my family doctor while waiting for the amulance.
I was lucky. My cardiologist says there was very little damage to the heart muscle itself, probably because I took the aspirin when I did.
The emergency room staff could not have treated me better. The calm professionalism of everyone I came in contact with was instrumental in helping me get my fear under control.
Thanks to Web,MD and a great ER I'm still alive.
Laurie wrote a very good article. My only concern was that paragraph 7 might be confusing to some people, not to me having been in the medical field for many years, but the ststement about ED's giving "free care" about 1/2 way through the article, and at the end of the article saying you may receive a large bill might confuse some. I think I would have said people without insurance would receive care, but at a reduced rate. That way it would be clearer to people that it's not "free"
I was sent to an ER for stroke-like symptoms by my PCP, directly from the clinic. Although I did not have to wait long, the care I got was scarey. One doctor asked me if I took a drug overdose to get attention. Another doctor asked me if I was stressed out. No tests besides lab work were done. No MRI, EEG, EMG. Nothing. It turned out to be a an accute-onset, multisystemic, muscle-wasting illness. If it were not for my PCP, I would've been sent home unable to eat, poop, walk,and breath without my CPAP machine. The ER staff thought I was faking it! If it was not for the insistance of my PCP who had me admitted to the neuro unit, I would've gotten no care at all. So, going to the ER is not always a guarantee that you are going to get appropriate care in the first place. They can and do blow people off. That's why it is so important to have a PCP. They can advocate for your care with ER staff who sometimes ignore blatent medical problems/symptoms.
I hope Laurie's letter gets people to choose a primary care physician or clinic. Follow-up is ususally needed even if there is a true emergency.
I agree with the article. As an ER physician I get to see just about anything coming in at all hours of the day and night. We have been having increasingly longer waiting room times due to the amount of people that arrive for evaluation of minor injuries, colds and congestion, and routine screenings. I think the general public might be amazed at what some people use the ER for.
The unfortunate thing that many do not understand is that the ER is not designed to make diagnoses. We have a limited number os tests that can be performed. Many aspects of the evaluation need to be completed either after an admission or as an outpatient from the PCP's office, with referrals to a specialist. The ER is designed to rule things out, not rule them in. If someone comes in, for example, with chest pain that sounds like it could be related to the heart or other serious condition, odds are that they will be getting admitted for further monitoring and evaluation. That comes as a big surprise to many people.
There are "bad" doctors and nurses in the profession, just as there are bad mechanics or any other profession. For the most part, however, they are good people who do their jobs well and function at the best of their ability under the constraints that are applied to them by the government, hospital administrations, and patient expectations.
Where else can you go to get treated by a licensed physician for your tooth-ache in the middle of the night? Or have direct access to a physician throughout your entire stay in the Emergency Department? ER doctors and nurses are some of the most under-appreciated and under-respected people in the medical profession, and work under the most stressful of circumstances.
I went to the ER with chest pain and, as a female I believe, was treated for gastric disorder FIRST. My daughter took me and I have insurance. I also have a history of heart disease, 3 previous small heart attacks, and my cardiologist works from that hospital. The ER doc that had to wake up from his nap was rude, caustic, and had very poor bedside skills (and morning breath).
I asked for my cardiologist to be called in and the doc refused. I left and later in the morning called my cardiologist and he checked the EKG from earlier, and told me to get there NOW, I had a heart attack and the ER doc couldn't read the EKG apparently!! My cardiologist ripped that ER doc and I was asked by the hospital not to press charges. By the way, that ER doc is still there.
ER doctors don't care about you. I went to the ER last night because I have had a headach with a sharp pain running down my neck also on top of that a sharp pain in my right side that hurts when I move that way or lay on it. This has been going on for about a week. My doctor couldn't fit me in so I went to the ER. Well on top of waiting for hour's they gave me a few pain pill's and let me fall a sleep. I woke up to some spanish guy nurse telling me he was going to stick me in the hall way because a guy that was sicker than me needed my room. I got wheeled into the hall half naked in a gown, while people walked by and staired at me sitting on this hospital bed. I was so mad and upset that they didn't do anything to help me. In the end when that so called DOCTOR found me he told me I had a viral infection???? OK! So how did he find this out? Just by looking at me from the outside? Well I guess so. That is why these doctors go to school so long huh? So they can make up stuff just to get rid of someone. So as for the ER...It can blow up for all I care.
I want to thank you for this informative article. I just have one comment and that is on PCP's. In Canada, where I reside Doctor's are scarce. I myself had to wait 3 years for a PCP. So follow up is not a possibility for a lot of people. Insurance we have - doctor's we don't!
I am a nursing student going into my second year of clinicals. I want to "focus" and eventually devote my skills to the ER department because I feel that the people in the ER are quick and respond very well to stress and pressure. Yes, people will come upon nurses and doctors that will not respond to common needs of the client because of their lack of "interest" and lack of "care." But I will admit to the skeptics that nurses and doctors in the ER do not receive as much credit as they should. I feel that sometimes people scorn and look down on the ER because of a faulty experience with "one" doctor or nurse. The ER is designed for immediate care, not for long-term care. I feel badly for you all that claim that you received poor care in the ER, and I hope that these health care professionals were repromanded and that an official apology was made to you for your bad experiences. But, all in all, be glad that the ER is there because there are people out there that do care about others and their health. I have had poor physicians and medical specialists myself, and my recommendation is to find another doctor or ask for another health care professional at that time to look after you. You can do this! And if you are not concious, make sure that there is always an advocate looking after you!! You can not put a price tag on your life, and I hope to goodness you would not let someone else! Stand up for your rights as a patient!
I take 4 different hypertension medications. One year ago I was admitted to the hospital for uncontrolled hypertension. I have made around 5 trips or so to the ER for chest pain. I have heartburn medication as well so sometimes it's confusing what is causing the chest pain. Fortunately I haven't had a heart attack or heart disease or stroke. In my case I worry about going to the ER yet again for 'nothing' and I don't want to be labelled as hypochondriac or a 'frequent flyer'. I will go if symptoms don't go away. I recently saw my PCP and continue to get blood work done regularly - about every 2 months. I try to do things in the doctor's office and not the ER if I can help it. My potasium levels tend to be on the low side of normal...3.5...3.1 I know when my potassium is lower my chest pain symptoms seem worse. I try to eat a banana every day and take 2 potassium pills.
I am in contact with my Internist as well regularly who keeps tabs on my BP numbers and medication.
My experience with the staff in ER has been positive.
My typical BP is 140/85.
Also, as a nurse I would like patients to know that doctors, as well as ER's are limited by insurance companies as to what they can and cannot do, which tests they can perform, etc. So don't blame the doctor or nurses if you feel that "they didn't order enough tests" In ER's only certain rooms have heart monitors, if you are there because of the earache that has been going on for 3 weeks and is now excruciating, when you never even called your doctor and you are in one of those rooms with a heart monitor, you WILL be moved if a chest pain or irregular heartbeat patient comes in. They need the heart monitor, you don't. And please don'r get upset if you feel we are giving you "attitude" we don't mean to. But it upsets us that our workload is doubled day after day after day because people who wait 3 weeks with "chest pain" never bother to call their doctor, come into the ER like they're dying. let me tell you if you've had chest pain for 3 weeks and you've been able to work, have sex and go golfing, it's not a heart attack. After enough patients like that, we're bound to be frustrated. We even have patients who boldly tell us outright that they've called the doctor and they were scheduled for the test for whatever ailment they're having, but they thought that a week was too long to have to wait for the test to be done, and they WEREN'T going to wait that long, they felt they should be seen sooner. That is arrogant and irresponsible and these are the same people who complain that they are not getting red carpet treatment AND getting it quickly, and then complain that health care costs are too high. Yes, patients have rights, but they also have responsibilities.
If you think a collection of articles on heart disease might be of interest or use to you, and want to find out more, feel free to visit www.heart-tips.com .
btw, I don't sell anything, the site is just a collection of articles that I've collated, all used with permission. (You can click on the Articles1, 2, 3 & 4 links on the top right for a list of more.)
A couple of years ago, I was suffering from severe chest pains. After multiple trips to Doctors Offices (including my PCP) and Emergency Rooms, I was labeled a "Frequent Flyer". Finally, a Doctor agreed to do a cardiac Cath which turned out to be clean. They told be that my chest pain was "all in my head" and I should get on with my life. A few months later after suffering for about a week with what I thought was the "flu", I drive myself to the local ER. I passed out in the ER waiting room and woke up with a tube down my throat and was told that my heart had stopped (3) times and was still not beating on it's own. I was on a machine that was keeping my heart beating and was transported to another Hospital to have a Pacemaker installed. After the ordeal, I was told that I had a rare genetic heart condition that caused this to happen. The ironic thing is that if I were to have 10 EKG's, 9 of them would come back clean. It just goes to show you that the Doctor's didn't know everything! I still have a hard time trusting anyone in the medical profession.
This past Christmas I had plans to go to Georgia to visit family. On the 24th I woke up with a fever of 103, I was shaking, and my head was really hurting. Since I worked in the E.R. I called one of the Docs and she told me to come in and she'll see me. I seen another doctor that I knew well and he sent me home and said I just had a nasty virus. Since I couldn't drive, I road with other family members to Georgia. The day after Christmas I still wasn't feeling any better. By this time I had bought every over the counter drung known to see if it would help. Nothing helped! The family I road with decided we would leave early and come back since I wasn't having a good time. We started back to Florida and traffic was horrible. We stopped and got a room for the night. That night was the worst. I woke up so short of breath that I couldn't take even the smallest breaths in. I got up and went to the bathroom and I started coughing up blood. I woke my family up and we drove back to the hospital that I worked at. When I got there they were prepared to intubate me. Oxygen was just not working. Everyone kept asking me.. You're only 21 how did you get so sick? I was in the hospital for four days with pneumonia. I was released and two days later I went home early from work. I came back to the E.R. and was admitted for another three days. That "nasty virus" turned into Pneumonia. I was thankful that the staff was able to treat me but at the sametime I wish I would have went to my PCP. They know you best! Others just might think you can't handle it and are being a big baby. I think from now on I will use my PCP. It was a lesson very well learned!
I was treated at a hospital for a cocaine overdose as a 16-year-old and got nothing but hostility from everybody but the staff psychiatrist. The doctor examining me made my mother cry telling her it was her fault, and then continued to rant at me for almost 20 minutes. There was also a nurse who looked at me like I was trash. It wasn't as if they were hugely busy that night either, I didn't have to wait at all before I was examined. I was in the hospital all night on IV ativan and everytime that nurse came in my heart rate on the monitors went up. Eventually the staff changed and a new doctor came on who was much nicer.
I think there are a lot of cynics in emergency rooms who feel you are a waste of their time and your health problems are your own fault. Well, it's still your job to treat me...AND to treat me with respect. Of course not all doctors are this way, the one who came in in the morning was very considerate.
Hi my name is a crohn's patient and my name is James. There have been many times that I have been to the ED for my "long-standing health problems," especially back when I was first diagnosed back in 2001/2002.
As I read this article I get the sense that it was wrong for me to even go to the ED for my problems, that had been going on six months. Now I had been seeking treatment from family practices, gastrointerologist and they all kept saying the same thing, "ohh it's just acid reflux, here's some nexium." I'm a 6'1" tall and finally the last time I went to the "ED" for my "long-standing" health problem I weighed a whopping 117 pounds. Me, my mother, and fiancee at the time finally convinced the ED Dr. to do a CAT-scan and he found out that I had Crohn's Disease (for those of you that don't know what Crohn's disease is, it's an imune disease that causes the immune system to attack the perfectly healthy gastrointestinal tract basicly eating it alive. Crohn's disease is not curable, but it is treatable, and even thought it is treatable a patient never knows when there going to have an attack.)After being admited into the hospital I underwent several test and it was determined that surgery was the only way to repair my damaged colon. So I had the surgery and as they where operating they found that I had a hole in my bladder. After the surgery the urologist said that if I had waited to see someone only a few more days I would not have a bladder. Now from what I read in this artical I should have never visited the "ED" for my "long-standing health problem."
Now I know that there are alot of people that abuse the system, but what about those that do not. There is very little compassion shown for them anymore, and the way I take this article is I should not have, or never visit the ED for my flare ups.
First off let me say I am a nurse and most of my extended family is in medicine one way or another. I have been having cardiac symptoms for weeks now and cannot get in to see a cardiologist. I have been to my PCP several times and she has referred my to a cardiologisy but after 5 weeks I am still auditioning for an appointment. They have my packet and are reviewing it and will let me know when they can see me. Every medical office I call tells me to go to the ER because then I get an immediate appointment with a cardiologist. I know that Er are germy places, and are overused, and what I have is not truely and emergency but what is a person to do. I live in a fairly large city with several hospitals, 2 universities, a medical school, etc. Yet specialists in this town seem to rely on the ER to determine if someone "really" needs to be seen. Caught betwen a rock and a hard place.
It's common sense people - emergency being the key word here. I listen to co-workers complain about taking their child in to the ED with a sore throat and having to wait for hours. It reminds me of stories you hear about people calling 911 for an auto theft! Honestly I don't see this getting better.
Well if you or your child is sick and you are scared what are you surpost to do?
look it is called an ER aka ED and the people just need to do their job that they get payed to do!
I worked in an ED and half the time we got so far behind because of all the people sitting their butts on the comps and reading their emails or playing games.
It really was sad the lack of concern that I saw!!
OMHS in Owensboro, Ky
Oh for pity sake....just go if you need to...that's what they are there for. It's not their job to tell you you should or shouldn't be there. They are providing a service --not asking for their approval.
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