How to Get Better Emergency Room Care

Introduction

At one point or another, you will probably need to go or be taken to the Emergency Room (ER).  While experts would agree that in most cases you should preferably be seen by your primary care doctor instead of using the ER, you may not have a choice in the matter, especially if you, say, are involved in a serious-injury-inducing car accident.

In fact, it may come down to whether you are a legitimate, ideal ER medicine candidate.  Unfortunately, some people use the ER even though they aren’t ideal emergency medicine candidates. Misuse and over-use of the ER are only two of the many reasons why ERs are over over-crowded and overwhelmed.

Assuming that you are indeed in need of immediate medical care, the last thing you want to become a victim to is unnecessarily slow or excessively bureaucratic services.  Your experience in the ER should proceed more smoothly, though, if you abide by or seriously consider the following concepts and realizations.

Are You Truly in Need of Emergency Room Care?

This may sound like too obvious a question to ask yourself but, since so many people flock too readily and unnecessarily to the ER, it may be the first thing that needs to be established.  Many people will probably try to weasel out of a sincere answer by countering with: “I’m not a doctor—how am I supposed to know I didn’t really need to go to the ER?”

Folks, 95% of the time, whether you need immediate medical care or not should be fairly obvious. Here are some excellent reasons to head or be transported to the ER:

--There are indications that you are having or recently had a heart attack or stroke.

--You are having difficulty breathing, swallowing or performing any other life-preserving functions.

--You have a high fever (103 or higher) that refuses to go down or is accompanied by an infection, severe pain or other potentially serious situation.

--You broke a bone or sustained a fracture.

--You sustained a deep cut, one that won’t stop bleeding or one that requires stitches.

--You were involved in an accident or incident that may involve internal injuries or bleeding (which is usually accompanied by ongoing pain, discomfort or noticeable bruises).

--You feel like you’re losing consciousness or fainted.

--You are experiencing a pain or discomfort that won’t go away or is very intense.

--You suffer from a serious medical problem (i.e., diabetes mellitus) and have been experiencing severe symptoms (e.g., excessively high glucose readings) but haven’t been able to reach your primary care physician to see know what to do about the problem(s).

--You’ve been stabbed, beaten with a heavy or serious-injury-inducing object

--You’ve been shot.

--You’ve sustained 3rd degree burns.

--You were raped or been the victim of physical abuse/assault.

--You noticed signs of abuse or molestation on a child, someone with mental health issues, incapacitated or unable to fend for themselves.

Understand What “Triage” Is--How Patients are Prioritized in the ER

Some people don’t realize that the reason they may not have gotten serviced in the ER more quickly or efficiently than other people is because they, having a poor understanding of what triage is, said or did the wrong thing at the ER. One mistake that some patients make, for example, is to downplay or inaccurately report their symptoms.

When the nurse, medical assistant or patient care tech, for example, asks you what level of pain you are presently feeling, don’t give a low number simply because your pain subsided when you were asked the question or if, as is usually the question, the pain keeps subsiding at times but increasing in intensity at other times.

You should report the pain level that has been worst, whether it stays at that level or not.  If your pain, for example, goes to 9 out of 10 (but then goes down to 4), use the number “9” instead of the number 4. The lower your pain level, the less serious your case will be categorized.

Whatever you do, don’t exaggerate or fabricate symptoms or the severity thereof, but, by the same token, don’t make things sound better than they are or become periodically.  An intermittent high level of pain can be just as dangerous as a pain that remains at a high level for a consistent amount of time.

What you need to remember is that in the ER patients are “triaged” (that is, evaluated based on the level of seriousness or severity) according to their symptoms, complaints and signs.  Here are some of the things that will tell medical staff (if they know what they are doing or have been well-trained) that you need to be seen ahead of other people:

--Chest pain or discomfort, or any other symptoms associated with a cardiovascular event (e.g., a myocardial infarction or heart attack)

--Bleeding that won’t stop or signs of internal bleeding

--An irregular or excessively high/low heart rate

--Syncope (fainting); and/or being disoriented, poorly coordinated or having slurred speech

--Numbness in any part of the body

--Loss (partial or complete) of any of the senses

--Having been involved in a serious accident or fall

--Having been shot, stabbed or beaten with a heavy, blunt or sharp object

--A high fever

--Serious burns

--Difficulty breathing or swallowing

--Intense, on-going pain or discomfort near one of the vital organs, especially such as might indicate a potentially-life-threatening condition (e.g., a deflated lung)

--Difficulty urinating or defecating

In general, ER staff will put off or take less seriously people suffering from the following symptoms, signs or conditions:

--Mental health issues; ER staff will often feel unqualified to treat such problems                                                           

--A low-fever (102 or less), especially if not long lasting

--Pain that is relatively low, not persistent and not accompanied by other significant symptoms and signs

 --Bleeding that seems to be under control, not involving an artery or deep, and not accompanied by other significant signs and symptoms

--Long-term, chronic medical problems that should preferably be addressed by a primary care physician; some examples include sporadically-spiking blood glucose levels; persistent pain from already-diagnosed conditions like an arthritic hip or joints; etc.

--Mild bone fractures

--Mild infections, including colds, mild forms of the flu, etc.

--People complaining of multiple medical problems (none of which sounds or appears to be life-threatening)

Strategies That Can Improve Your ER Experience

Here are some steps or suggestions that should help get you be seen more quickly, as well as be treated more efficaciously or effectively:

--Focus on one medical problem at a time (unless, of course, you think that the symptoms/signs are inter-related—i.e., if, for example, you fell and are wondering if the different things you are feeling are derived therefrom).  The ER is the wrong place to try to resolve several on-going medical problems. Decide which of your multiple problems is most important to you and concentrate on that one.

--Realize and respect the fact that the ER isn’t ideally suited for ongoing, need-of-long-term-care medical problems. Such problems are much better addressed by obtaining (if you don’t have one) a regular-care physician.

--Don’t downplay any of your symptoms, especially regarding pain and discomfort.

--Don’t put off getting medical care for a problem you think is ER-worthy—i.e., a medical issue that is life-threatening or which may become much worse if not dealt with ASAP.

--Be concise, precise, specific and to-the-point when describing your medical situation and needs.

--Being transported by ambulance is preferable to your playing “tough” by, instead, letting a relative or friend drive you to the ER or, worse yet, driving yourself there.  ER staff will often go by what they see and hear, not what is going on in your body—something that you are in a better position to assess, at least until they get you in for tests and a full examination.

--Don’t leave out any potentially important signs, symptoms or facts; these may include having fainted twice within the last 24 hours, the fact that you just started a new regimen of medication(s); the fact that you were recently involved in an accident; etc.

--Avoid giving ER staff information, symptoms or facts unrelated to the problem you are seeking help for at this time—stick to the facts that pertain to the condition at hand. For example, telling staff that you suffer from bad athlete’s foot problems, halitosis and in-grown toe-nails is only going to compel them to take your complaints of a persistent abdominal pain less seriously.

--Let ER staff know about any serious concerns you may have that are based on facts, observations or your medical situation or history.

--Avoid trying to socialize or kid around with or engage in pleasant conversation with members of the ER staff. This will only compel staff to think that maybe you’re not as sick as you may feel or actually are. You’re not in the ER to make friends—you’re there to get help for a medical problem that couldn’t be put off.

--Let ER staff know if any new symptom or sign develops or significantly worsens while in the ER; ER staff, contrary to popular opinion, aren’t mind or crystal ball readers. The only facts they know (and must go by) are the ones you relate or bring to their attention.

--Come to the ER well-prepared, if at all possible. This means being sure to bring your health insurance information, a form of identification, a copy of your medical history/records, a list of medications you presently take or are allergic to, the name of your primary physician, people ER staff can contact in case you pass out or must be rushed to surgery, etc.

Conclusion

Although how well you will be treated in the ER often depends on things outside of your control, there are things that you can do that can help you have a better experience than others or compared to how you have been treated in the past.  Additionally, there are things that you should avoid doing, if you want to be taken seriously, be seen relatively quickly and have your problem(s) addressed adequately.

Please don’t use the ER if you have access to a primary care doctor that can properly address the medical problem in question.  But if your medical situation requires immediate care, then the ER is where you belong.

Handle your situation properly and your experience there should be pleasant, efficiently-handled and medically satisfying—in other words, you will feel better after being dismissed.

Copyright, 2018.  Fred Fletcher.  All rights reserved.

Resources

 1.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021905/

 2.  https://www.rd.com/health/conditions/doctors-confess-er/

 3.  http://www.editorsweb.org/wellness/emergency-room.htm

10/12/2019 7:00:00 AM
Fred Fletcher
Written by Fred Fletcher
Fred Fletcher is a hard working Consumer Advocacy Health Reporter. Education: HT-CNA; DT-ATA; MS/PhD Post-Graduate Certificates/Certifications: • Project Management • Food Safety • HIPAA Compliance • Bio-statistical Analysis & Reporting • Regulatory Medical Writing • Life Science Programs Theses & Dis...
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Comments
I hate to say this but, sometimes, they do play "favorite" in the ER. I shouldn't divulge this but, if they think you're a troublemaker or too loud or likely to be a legal risk, as in the case of the mentally ill or drug abusers, you may have to wait longer than other people and the may use "triage" as an excuse for getting away with this nonsense. Wonderful job, Fred!
Posted by Dr. Dario Herrera
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