Going to the ER? Brace Yourself.
It's a bumpy ride. But I have tips.
This post is from a couple of years ago but it’s still quite relevant. ER volumes are high, resources are low, there are shortages of IV fluids (thanks to hurricane Helene) and shortages of medications. For a variety of reasons which I have written about before, people seem sicker and more in need of medical care than ever in my 31 years of practice. In many rural areas in particular, but also in urban sites, professionals are leaving healthcare and hospitals are closing.
I believe that if the government would once again allow physician owned hospitals, and would emphasize physician led hospitals, many of our problems would improve. But that’s an argument for another day.
Here are some tips for your ER visit. I hope you don’t have to go, but if you do, these may help you understand what’s going on all around you.
The ER is kind of the epicenter of modern healthcare, for better and often for worse. Everything seems to circle around it.
So, if you have to go to the ER, you may be in for a long day. Or week. Why? Because there’s ‘no room in the Inn.’
There are always more patients than beds. So, your stay in the waiting room might be very long unless you’re having a very dangerous medical issue.
Waiting Room Tips:
Bring a book. Bring your phone and headphones. Bring a charger! Bring a blanket. It’s usually cold.
Take your necessary medications before you go to the ER and bring your medications with you in case you have to wait for a long time.
If your children have to tag along, or are patients, bring something to entertain them. They get bored and restless too, and no wonder!
If you have abdominal pain, a broken bone or any serious thing that might need sedation and a procedure, do not eat or drink before you get there or while you’re there unless you ask staff if it’s OK. (Diabetics, you’re different so talk to the triage nurse.)
In the ER tips:
When you are called back, you may well find yourself in a chair, or on a bed, in the hallway. If you’re in a room, you may find yourself suddenly and unexpectedly moved elsewhere for a critical patient to take your room.
Many things are out of your control there. But you can at least manage your expectations. Things are moving slowly. There’s a huge nursing shortage and a not-insignificant physician shortage. Odds are you aren’t being ignored. It’s just that the staff is quite literally overwhelmed by numbers of patients and the acuity (the high degree of illness or injury) of those patients. Not so long ago, doctors would enter orders for medications and they happened fairly quickly. It’s harder now. It’s frustraging but try to be kind.
If you have a change, become more short of breath, have new pain, bad chest pain, abdominal pain, anything concerning, ask someone walking by to get your nurse or physician.
Again, don’t eat or drink unless you’re told that you can. This isn’t to punish but to keep you safe.
Communication Tips:
Always bring either your medication bottles or a list. Your smartphone probably has an app on which you can list them. Or at least, take photos of the bottles or your list and keep it readily available.
Keep a similar list of your medical and surgical history. Not all hospitals have computer systems that communicate so one may not have access to your information.
If you have family members present, appoint one to be the spokesman and relay things to the rest. It’s much easier for everyone
Admission Tips:
If you get admitted, you may be in the ER for 12 hours or three days. It’s hard to say. Nobody is trying to be difficult, it’s just that hospitals are completely full these days. If you want to talk to the charge nurse or a patient advocate to ask questions, it’s fine. Just understand that the staff want to move you into a bed as much as you want to go to one. Also, due to the busy nature of things, admitting doctors (called hospitalists) and consultants like cardiologists or surgeons are also very busy and trying to get to you as soon as possible.
Tips on What You’ll See:
The ER is a scary place. Whenever it can be safely avoided it’s best to do so. But while there, it’s not unusal to see people receiving CPR, crying family members, demented patients screaming out in confusion, injured people crying out in pain.
Likewise, it’s not unusual to see men or women in handcuffs as well scuffles between security or police and patients who are either mentally ill or under arrest.
Those with psychotic mental illnesses may leave their rooms and have to be redirected or restrained by staff. Some of them are delusional and hallucinating. Likewise, those using drugs like methamphetamine or cocaine, or marijuana and other hallucinogens may seem very odd or confused. They can seem frightening. If you are uncomfortable with someone, please tell the staff.
You may also see angry, exhausted nurses and physicians. They are really just frustrated, understaffed and often overworked. But they come back day after day to do the right thing.
Tips on Transfers:
If your physician recommends transfer to another hospital, and it’s going to take a long time, ask if it’s possible to driver yourself. In some instances, heart attack or stroke, or major trauma, that obviously can’t happen safely. But sometimes it can, when it has to do simply with absence of a particular specialist. A plastic surgeon for instance, or an ophthalmologist.
Furthermore, you aren’t a prisoner and if you want to sign out and go to another location, it’s your right. As long as you understand the risks.
I offer this because these are difficult times in medicine. And having done emergency medicine for 29 years, I want to make sure everyone understands how to navigate these times.
Stay safe and stay healthy.
Other physicians, nurses, etc. are welcome to add their own tips in the comments.
Edwin
Edwin, your recs are solid and helpful. I would add one to your list: recruiting a family member or friend with experience in health care to act as an advocate, particularly if the condition is serious. Even if the illness or injury is not serious or you think it’s unlikely to be, the presence of a true advocate may be the difference between life and death for your loved one.
I worked for 20 years in EM in small, rural hospitals in the US south and decided two years ago, half way through my career, that I could no longer continue to participate in a system that is clearly designed for failure, that ruthlessly exploits the decency, discipline, and tireless, selfless work of all the docs, nurses, and ancillary staff that actually want to provide professional care.
The exodus, during and after Covid, of a huge amount of the nursing intelligence and experience, hard won after years of giving and giving whilst receiving nothing but blatant disrespect, having their basic human needs ignored in favor of protocols and quotas designed by fools who have risen to their highest level of incompetence both within and without their local hospital system, is only hastening the demise of any semblance of professionalism within the ED.
I don’t think the average American understands that some clown in a corporate office who couldn’t find their town on a map is making disastrous staffing decisions for their local ER, happy to hire unqualified buffoons to meet the profit goals of aforementioned multinational companies. Trust me, I have lived it as have thousands and thousands of other tired, despairing souls who just wanted to do honest work for their community; to go home at night and sleep well knowing that we came together and did our damndest to help our neighbors.
If you’re one of the folks, like me, who spent a lifetime striving to achieve excellence because you believe Americans, all Americans, even those in rural areas, deserve professional level healthcare and because you take pride in the quality of your work, there is less and less room for you in this current disaster area.
In addition, with abysmal regularity, the literal possibility of accomplishing what should be a simple, efficient task in the ED is turned into an Orwellian joke. Poorly designed EMR systems, endless charting distractions, bumbling “managers” and a ruthless, exponentially expanding bureaucracy of idiots who never even bothered to become professionals can eventually overwhelm even the most battle hardened decency of dedicated humans.
In the last few years, since my departure from healthcare work, I have been able to accompany multiple family members to “doctor’s” appointments as well as to ER’s and into hospital settings. What I have seen is horrifying.
Nurse practitioners giving potentially lethal recommendations, failing to identify life threatening conditions, nurses who stare at screens like zombies, seemingly unaware of the human being in their care. I have intervened so many times that I can’t count them all.
There seems to be a widespread delusion that the “system”, that is, endless institutionalization or bureaucratization of care can improve or accomplish things that intelligent, competent and sensible humans cannot. This is simply false.
The acceptance of this view is quickly leading to inescapable ruin. A team of professional human beings, highly motivated, working towards a common goal, remains the most sophisticated technology available in the world.
The advocate, therefore, will understand these facts and be highly attuned to the inevitable and often predictable errors and failures bound to emerge in such a system based on false premises, increasingly staffed with untrained place holders instead of professionals, designed to generate profit through “acceptable risk”.
The more fearless, righteously angry, alert and indefatigable your advocate is, the more likely is your survival.
As an advocate for my family and friends, I’m a real son of a bitch, a rabid pitbull that will not let go of whatever I deem worthy of my 10k Newton bite force because I actually want my relatives and friends to survive. And, as I walk into an ER or a clinic with a clear, undeluded mind, I know something that’s becoming less and less of a secret: this system is just as happy to kill you as to heal you and there will be neither justice nor afterthought either way. Institutions and bureaucracies don’t care about you, only humans do.
In short: only humans should draw conclusions; and, there’s no greater technology than a team of human professionals allowed to do their jobs free of the failures of bureaucracy.
Get an advocate and keep praying.
Peace
Excellent advice. I describe the E.R. as the bottom point / fulcrum of an inverted pyramid of all health care. Everything rests on the ER (doc)!