by Douglas J. Segan, MD, JD, FACEP
Most of us dread going to the emergency room when we are sick or injured. Even under ideal circumstances, it is a scary experience. The pain, the noise, the dread of the unknown diagnosis, the long waits to be seen and for test results to return, the loss of privacy–and fear of a huge bill. And while we don’t like to think about it, we know that there is always the risk of bad news and bad outcomes.
One in three Americans will visit the ER this year. ER visits in this country are increasing for a variety of economic and social reasons. While there are many aspects of emergency care that you can’t predict or control, there are some things that you can do to optimize the likelihood that the experience will be less miserable and more beneficial.
1. Prepare in Advance
Evaluate your choices for emergency care before the need arises. Ask your healthcare providers, friends, and relatives about their preferences for ER care in your area. Every hospital has its strengths and weaknesses, and you should learn about the ones near you.
Your insurance company may use financial incentives to encourage you to go to a particular ER or hospital. If you have a serious or unusual medical problem, find out now which ER is best able to take care of your problem.
EMS providers are trained to check your cell phone for your ICE (in case of emergency) numbers in the event that you are unable to communicate. If you have not entered an emergency contact number in your phone, do so now, and be sure to indicate that it is ICE.
2. Put your critical medical information in your wallet and cell phone
If you have serious medical conditions or allergies, wearing an identification bracelet that EMS and ER personnel will find easily could be lifesaving. There are a number of companies that offer such items, like the nonprofit MedicAlert Foundation (888-633-4298 or www.medicalert.org).
Even if you don’t have a serious condition, you should write down your key medical and contact information, make a few copies to give to loved ones, and store it in your wallet and cell phone. The stress of being in the ER can interfere with our ability to recall the names and dosages of our meds.
A sample model form can be found at the ACEP (American College of Emergency Physicians) website: www.acep.org (search for “permedfm”). We have also created a Medical History form for you to use. If you fill out your own form, it should include, at the minimum, your medications, dosages, and how you take them (with food, in the morning, etc.), including over-the-counter and herbal meds; your allergies; your medical and surgical history; your physicians’ names and contact information; and your emergency contacts. It should be updated regularly.
If you have not written down your current meds and you are about to go to the ER, ask someone to put your meds in a re-sealable bag and take them with you.
3. Bring an Advocate
If at all possible, bring a trusted friend or relative with you to the ER. Ideally, it will be someone who knows both your medical history and your recent symptoms. It would be a bonus if she were a careful listener, had a good sense of humor, and the patience of Job.
In many ERs, the staff is pulled in multiple directions at once, and an advocate can help reduce the chance that you will be overlooked in the chaos or that something untoward will happen.
You need an advocate to help you get urgent assistance if you need it, aid the staff in reducing your risk of falling, help you remember instructions about your care, and give you a hand with things like phone calls. Time will pass more quickly if you have the right advocate at your side.
4. Lower your expectations
ER staff saves many lives and alleviates suffering every day. But the great benefits of ER care also come with some risks.
If you have watched too many ER television shows or been bombarded by too many ads from hospital marketing departments, then you may be disappointed in your ER care. The vast majority of ER nurses and doctors are caring and very competent, but while many are superheroes, they are also human. The ER you go to may be understaffed, overwhelmed, or tied up with critically ill or injured patients. The staff may be hungry and sleep-deprived, and may have had just one too many tragic situations to deal with that day.
All the usual risks that apply to being in any healthcare setting (falls, medication errors, catching an infection from another patient or from a staff member, incorrect diagnoses, over- or under-treatment, etc.) can be magnified in the crowded and hectic environment of many ERs.
Many patients come to the ER with high expectations and are disappointed when they are not met. Previous medical records are sometimes tough to find, your primary doctor may not be available, and the specialist that you need may not be available. Try to be patient and understanding while also not being afraid to stick up for yourself if something just does not feel right. Your advocate should be able to help with that.
5. Anticipate waiting
America’s ERs are getting busier. Generally, you will be promptly seen by a triage nurse, but then you may have to wait for quite awhile to be placed in a room (or even a hallway in some ERs), and then you’ll have to wait some more to be seen by the doctor. Patients are seen based on the acuity of their conditions, not on how long they have been waiting. If your condition changes while you are in the waiting area, let the triage nurse know.
Even after you’ve been seen by the ER doctor, your test results will take time to obtain. Also, the first doctor who evaluated you may be in training, and may need to wait to present your case to a more senior physician. If you can, bring something with you to make the wait less agonizing. Some light reading or music with headphones may help the time go more quickly.
If you are experiencing a true emergency (heart attack, stroke, etc.), it is generally advisable to call 911 and be transported by EMS. Patients arriving by ambulance are almost always evaluated more quickly than walk-in patients.
6. Things not to do before visiting the ER
If you know you are about to visit the ER, it is wise not to eat or drink anything, especially if there is any chance that you will need surgery. (Some surgical procedures may be more difficult to perform if your stomach is full.)
Don’t bring valuable jewelry or loads of cash to the ER. They can be hard to keep track of in what is often a busy and overcrowded setting.
7. Help the ER staff take care of you
If you highlight your most significant new symptoms, it will increase the likelihood that the ER staff will do the same. It is worth mentioning your chronic medical problems when you are asked about your past medical history, but if those problems are stable and not the reason you are in the ER, don’t dwell on them, as it could lead your doctor to mistakenly think that is why you came to the ER.
Anticipating the questions that you will be asked may also be productive. For example: have you ever experienced these symptoms before? When did they start? Any other associated problems? Does anything make it better or worse?
If there is a particular disease or condition that you are worried about, discuss it with your doctor early on, not when you are being discharged.
Be especially vigilant and patient when there is a change of shift. If you are asked the same questions by your new nurse and doctor that you were asked earlier, try to consider that a blessing and not a nuisance.
If you feel well enough, having a sense of humor and developing a rapport with the ER staff is also a big help.
8. Ask Questions
Most ER staff members enjoy working with inquisitive patients and like explaining and teaching. Don’t be afraid to ask questions.
If you feel that things are not going well or something serious is being missed, speak up. It may not be feasible at all times and at all hospitals, but it may be worthwhile to ask for a second opinion, see a specialist, or be observed for a while. In some situations, it may be helpful to call your primary doctor. It’s in these difficult scenarios that an advocate is really helpful.
If a medication is about to be administered, remind the staff of your allergies. Ask what is being given and why. Ask about its side effects. If a test (such as a CT scan) is recommended, ask for an explanation of the risks and benefits. You are allowed to weigh your options.
If you notice that your caretakers are not washing their hands, cleaning their stethoscopes, or (if indicated) wearing gloves, gently remind them.
9. Understand your discharge instructions
It is imperative that you understand anything the medical team may have found and any follow-up treatment they recommend for you. Appreciate the uncertainty that is often part of emergency care. Medical conditions evolve over time, and some things are only clear in hindsight. Make sure you understand which symptoms to watch for, and what kinds of reactions would require a return visit to the ER. If you are prescribed any medications or administered any tests, be sure to write down what they have been prescribed for, the names and dosages, how to take them, and what side effects to watch out for. Ask if they will interfere with your other meds.
Read (or ask your advocate to read) your discharge instructions. If you don’t understand something, be sure to get clarification. If you don’t read the instructions until you’re home, it’s not too late: call the ER, and get a doctor or nurse to explain the instructions to you.
10. Obtain Close Follow-up
If the ER will give you copies of your tests on discharge, take them home with you and bring them to your follow-up appointment with your primary doctor. Review your ER visit with your primary doctor as soon as feasible. It’s especially important to review the final lab reports and the final radiology readings with your doctor.
If you prepare in advance for a possible ER visit, work with your ER providers and an advocate, and understand the things that you can do to help the staff care for you, you will increase the likelihood that you will have a good outcome.
By Douglas J. Segan, MD, JD, FACEP (Emergency Medicine Specialist)
If you would like other tips on surviving your hospital visit or a trip to your doctor’s office, you may find our new book, Top Screwups Doctors Make and How to Avoid Them, helpful.
by Douglas J. Segan, MD, JD, FACEP