Guest blog entry: Scalpel or Sword

This week's guest blog entry is from the author of the medical blog…Scalpel or Sword. The author of the blog is an ER physician in Texas and I urge you to give it a look. Today's guest entry adds to that of a former guest blog entry about preparing for ER visits. This entry was written exclusive for the MedFriendly with blog and with that, here is the entry:

I’m going to expand on Kim’s excellent suggestions for making your ER visit go more smoothly for you and the staff.

1) In addition to your list of medications and your medical and surgical history, be sure to write down your history of allergic reactions to medications. It really isn’t much help if you tell us that you had a reaction to “some antibiotic.” There are literally thousands of medications out there, and many of them are chemically related; we need to know precisely which ones caused you problems. The specific reaction that occurred is also helpful, with the most important examples being rashes, swelling, difficulty breathing, or fainting. Even medications that caused you unpleasant side effects or that your doctor has recommended you avoid should be included. If a certain blood pressure medication caused your kidneys to fail or your heart to slow down too much, go ahead and list it under allergies although it isn’t really a true allergy.

2) Bring copies of your previous workups with you if you are coming to a different hospital. Discharge summaries, CT or MRI results, lab tests, and procedure reports are particularly helpful. If you bring us this information, you will have a quicker and more cost-effective evaluation.

3) If your doctor tells you to come to the ER to be admitted, understand that
a) he probably hasn’t notified either the ER or the hospital to expect you
b) you are going to have to be triaged and wait in line, depending on the severity of your illness
c) he probably hasn’t told his partner who is on call for him anything about you whatsoever, so
d) you ultimately might not be admitted after all, and
e) this is not the fault of anyone in the ER, it is your own doctor’s fault for misleading you
If your doctor ever tells you to go to the ER, ask him to clarify his intentions or even to make you a "direct admit" so that you can avoid the ER altogether. Ask him to call the ER to let us know you are coming so that we can provide continuity of care.


4) Know exactly why you are coming to the ER and accept the fact that you are going to have to tell at least three different people why you are there. The triage nurse, your ER nurse, and at least one physician will need to hear you tell us why you are seeking medical attention. Don’t expect us to have already “read your chart” - each of us needs to hear you explain your condition directly. Here’s why: when you repeat your story, you are more likely to remember important details, and when different interviewers hear your story, we are more likely to extract subtle but potentially critical bits of information that might be missed if you only tell us one time. Plus, you get to rehearse so that you can get to the point when the physician finally sees you.

Try to be focused and concise. We don’t care what your granddaughter got for her birthday or what your sister’s husband thought might be wrong with you. Just tell us your symptoms. If you have a pain, we need to know exactly where it is located, what it feels like, when it started, how often it happens, what makes it better or worse, and any other symptoms that are associated with it, among other things. Adding extraneous commentary, particularly during the initial phase of your evaluation, makes it more likely we will cut the interview off short and miss some potentially useful information.

5) Be patient. You are likely going to be waiting a long time, particularly if your condition is not life-threatening. If you are not having abdominal pain, chest pain, trouble breathing, neurologic deficit, or a severely traumatic injury, then you are going to have to wait behind those who do have such issues, and it may take hours for you to be seen. Be thankful that you are not as ill or injured as those other folks. Understand that the purpose of the ER is to prevent death or disability, not to promptly treat your stuffy nose or sprained ankle.

If you think that you might have been overlooked or that your condition is becoming more serious, then please let the staff know, but do so in a calm, nonthreatening, nonabusive manner. We do occasionally misinterpret the severity of someone’s condition, and occasionally charts do get lost in the pile. But yelling at the staff simply because you are unsatisfied with the waiting time is not going to help your situation.