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What To Expect From Your ER Doc ...

Posted Sep 12 2008 12:10pm

What To Expect From Your ER Doc

People bitch about doctors a lot. Not necessarily to me, but in my presence. I don't mind, most of the time. Many times these people have legitimate beefs. But more often than not, I think that the problem lies in poor communication. Doctors often assume a level of medical knowledge in the general public that simply isn't there. And patients, for one reason or another, don't ask questions. When this is the situation, the patient will leave the encounter upset, and the doctor will have no idea that the patient wasn't satisfied with the result.

A patient's expectations should be different depending on the physician and the circumstances. This view may reflect the fact that I am currently awkwardly straddling my roles as family physician and emergency physician, have have yet to become truly comfortable with either one. But I find that whereas a certain degree of bedside matter and handholding should be expected of a family physician, to expect the same from an emergency room physician is misguided. Not to say that ER docs have free reign to be assholes, but their role is different.

So here's a quick primer on what you should expect from your friendly emergency room physician:

1. To be appropriately triaged.

The first thing that happens to you in the emergency room is that your complaint is ranked on a scale of how likely it is to be life-threatening. This system may not seem fair, but it usually works very well. So if you're grumbling because the young girl in the corner with seemingly minor stomach pain is seen before you in spite of the fact that you're puking from your horrendous migraine, remember that you don't know the whole story. If there is a chance she's pregnant, the possibility that her pain is resulting from an ectopic pregnancy definitely outranks your migraine (which, although obviously unpleasant, isn't likely to kill you). See how this works?

2. To have life-threatening conditions ruled out.

Let's say you're the one with the belly pain. If you're not pregnant, not bleeding, have no signs of an acute (aka surgical) abdomen and aren't dehydrated, you'll likely be discharged. I can understand that people want answers, but sometimes we're not going to be able to give them. It might be gastro. It might be food poisoning. It might be muscular. It might be very early appendicitis that just hasn't 'declared' itself yet. If it's the latter, that will become clear soon enough. It it's any of the former, it won't kill you. So we're sorry that we can't tell you exactly why you woke up with belly pain and had some diarrhea, but we don't have all the answers.

3. To do what is medically indicated for your condition.

Not everyone walking into the ER warrants extensive investigation. The job of the EMERGENCY room is to rule out EMERGENCIES. See how this works? So once it has been established that your presenting complaint is unlikely to cause you significant morbidity or mortality any time soon, you may find yourself punted in the general direction of your primary care provider for further care.

4. To see the doctor (although the length of time you waited is not reflected in the amount of actual time you spend with him/her).

This may come as a shock to those of you who have waited 3-4 hours in the ER only to get less than 30 seconds of face time with the physician who breezes by to tell you that your wrist is not broken (and, if you're lucky, perhaps a script for some Tylenol #3's). But if you're looking for a longer discussion about how long you can expect to be in pain, what kind of limitations you should put on your activity, how you should ice it, what kind of exercises you can start doing and when to regain strength... well, you're best to see your family doc.

This may seem unnecessarily harsh, but it's reality. Not only is the ER doc usually the ONLY doctor in the emergency room (and therefore balancing the multiple needs of many patients, most of whom are far sicker than you) but it's often hard to muster up convincing sympathy for someones infected ingrown toenail when you've got people actively trying to die in 3 different resuscitation rooms. This is not usually the place for handholding and sympathy.

5. To be waiting longer if you abuse the nurses.

Wandering back and forth to the nurses station to complain about the wait and threaten the nursing staff will prove to the nurses (and, by proxy, the doctor) that you are well enough to ambulate and complain and therefore not sick enough to warrant immediate attention. So stay where you've been put and wait your turn. Besides, wandering around the emergency department compromises patient confidentiality-- would you want people wandering around overhearing the doctor ask you personal questions? I think not.

6. To be treated respectfully.

Although you might not get stickers and hugs, you should expect to be treated as a human being. That means that your dignity will be preserved as much as possible in an environment like the ED, you will be treated fairly, and you won't feel as though you are being judged for your problem (particularly if it involves mental illness, substance abuse, physical/sexual abuse or sexually transmitted infections). If this is NOT true of your emergency room visit, this warrants an official complaint.

No doubt I'll be adding to this list as time goes on. But for now, please excuse the disjointed blogging... there has been a lot going on in my real life, which hasn't left much time for blog updates. More to come soon.
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