5 Strategies for Surviving the Emergency Room

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Because of your ER doctor’s difficult work environment, it is important for you, the patient, to know what conditions should make you go to the emergency room, as well as how to navigate the process and come out on the other side with the best care possible.

Ask yourself the following questions:

1 – Acute problems: “Did my symptoms occur within the last 3 days?”

Sudden onset of symptoms, that are severe or are getting more severe since the beginning, not more than three days, and most commonly the symptoms for severe (acute) emergencies occur over 24 hours and become so severe that the patient either cannot stand the pain, or a fever increases to causes delirium, or for example bleeding cannot be stopped by pressure at home.

Chronic problems are not meant for the emergency room and are handled in the doctor’s office. Chronic disease goes on for a long time and waxes and wanes. If the symptoms don’t progress to indicate another problem that is a fast progression of the problem, then these symptoms should wait for a doctor’s office visit.

2 – Is your symptom, or symptoms the sign of a life-threatening illness?

This is a tough one, but most people know if they have something that might end their lives. This gut-feeling is probably your best guide. In the case of life-threatening problems it is more dangerous to stay at home than to go to the ER. Emergency rooms deal with life-threatening illnesses around the clock and ERs are staffed to care for those problems at all times of the day and night.

As a doctor I am reticent to go to the ER unless I can’t wait for some reason until the doctor’s office opens, for fear of wasting the time of the ER staff. I have personally gone to the ER for a dislocated shoulder (yes, it’s an emergency), a traumatized finger with loss of a finger nail that required stitches and pain medicine, an ectopic pregnancy that presented like appendicitis but I actually had two liters of internal bleeding. All of these problems were life-threatening, or required suturing (deep cuts must be stitched in 36 hours or they cannot be stitched) which usually must take place in the ER nowadays.

If you think you are going to die, can’t breath, have chest pain, the worse headache of your life, head injury, or any type of accident that may have caused you to break a bone, or have internal bleeding then you have a life-threatening illness that should be handled by the Emergency room doctors.

3 – Do you think you will need an Xray, breathing treatment or procedure immediately?

If you think—“I have a sinus infection and don’t have a doctor”, then an Urgent Care or Walgreens with a nurse practitioner can take care of your problem by writing a prescription.

On the other hand, many times you have an idea of what is wrong and what you need. For example, if you have the worst headache of your life, then you definitely should go to the ER as soon as possible! You suppose that the doctor should look at your head with an xray or CT, or MRI to rule out a brain mass or stroke.

Sometimes you may know you have a medical problem but it has not become emergent so your primary care doc has told you to “watch out” for a set of symptoms and that if they occur then you should go to the ER for a procedure. An example is gallstones that have been diagnosed but have not caused you to have the gallbladder removed is a situation that you can wait until you have right upper abdominal pain, a fever and nausea, and then you will need emergent surgery. In this case it is more than appropriate to go to the ER right away.

4 – Your spouse, partner or grown child insists you go to the ER for emergent care.

Some times you are not the best judge of your own injury, or symptoms. Especially in the case of head injuries or diseases that alter consciousness, the people who witnessed your injury are the best judges of how bad your condition is and how emergently you should see a doctor. Most doctor’s offices cannot handle a work up of a head injury so this problem must go to the ER.

Tip: If a person loses consciousness then they should have an MRI, CT or other head Xray, followed by neuro-checks for consciousness for the following 12 hours.

5 – After you have been to the ER and received treatment are you well enough to go home?

Many patients are given a diagnosis in the ER, but are not well enough to go home. There is pressure from insurance companies and hospital administrators to send people home after an ER visit. Often patients are sent home with no follow up scheduled, without a diagnosis, or with pain medicine instead of treatment for the problem they came in for. This type of inadequate treatment is a violation of the standard of care for medicine, and can be harmful to you as the patient.

Stand up for yourself. You must always tell the ER doctor if you are not well enough to go home or if you feel that the treatment or instructions are confusing or inadequate.

Before you leave the ER: Ask the following questions if you don’t feel the problem has been fully diagnosed or treated:

  • What is my diagnosis?
  • What did the treatment you gave me do for my problem?
  • What can happen if I go home and get sicker?
  • What doctor should I see and how soon should I see him/her?
  • When should I feel better?
  • What activities, food, work should I avoid and for how long?
  • Would I be better to stay in the hospital for observation (if you feel uncomfortable going home)?

If you do not agree with your care, or don’t feel well enough to go home, then you are your best advocate and you must stand up for yourself, with all courtesy and tact. If you feel misdiagnosed, you can always ask your nurse to have the head of the ER come talk to you and you can get his or her opinion of your situation.

Remember that you are not a doctor and two medical opinions trump your opinion as a patient, so if the Medical Director agrees then follow his/her advice. If you get your symptoms back you can always go to another ER!

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