12 Nov

Handling the delicate balance as an ER patient

Below is an article from KevinMD.com on the balance of waiting and advocating for patient care when visiting the Emergency Department of your local hospital.

 | PHYSICIAN | NOVEMBER 8, 2013

Sometimes it’s difficult to practice what I preach. But I try.

A couple of weeks ago, I spent the evening in the emergency room with our youngest son (don’t worry – he’s fine). I hate going to the ER, but every once in a while circumstances necessitate it. I called doctor friends in the relevant specialty, as well as our son’s pediatrician, to confirm the need for the trip. They said to go. So we went. And this particular ER encounter did not make me like the patient side of an emergency department any more than before.

We were there for an issue that is time-sensitive — it’s certainly on the list of things that need super-quick evaluation. It took longer than it should have to get through triage and into the actual ER (maybe 20 minutes or so), but to the hospital’s credit, once we were actually in the room, the ER resident saw us almost immediately, realized the potential urgency, and had the attending doctor come right away. They ordered the necessary test, called the department to make sure it would be done immediately, and let us know that my son was the next person on the list and would go up promptly.

We waited about fifteen minutes. I checked with the nurse, who informed me that “they’re on their way” to get my son for the test. We waited some more. After another fifteen minutes or so, I checked with the nurse again. The same reply: “They’re on their way.” Another ten minutes went by. I got the resident’s attention and asked him if he could call up and see what was happening. He told me that he didn’t have a way to call anyone else. Another ten minutes. Went to check with the nurse again, who at this point gave me a really annoyed look and repeated that “they’re on their way.”

Honestly, the only way that they could possibly have been “on their way” that whole time was if they had been coming from Ohio.

We waited far longer than we should have for the test that determined whether a surgical emergency existed. It should have been done immediately, but it took significantly longer than an hour to obtain. And my polite advocating for my son did not seem to be fruitful. One of my specialist friends called and texted several times to check up on us, and kept urging me to push harder to get that test done.

I pushed. And it was very frustrating. I kept my composure and stayed polite, but I was seething inside. The nurse made another phone call. And it worked.

When the woman came to transport my son, I don’t think it would have been possible for her to move any more slowly. She was perfectly pleasant but showed absolutely no sense of urgency. I smiled and helped her push the bed so that we could make better time.

Emergency departments are grossly overused. They are filled with people who have had sinus congestion for two weeks or lower back soreness for a month, symptoms which should be addressed in a physician’s office. I understand the frustration of ER personnel and the at-times jaded attitudes of the staff. But it is the job of the healthcare workers to get beyond the workplace frustrations and to look at each situation through the eyes of the patients and their families.

Yes, there are people who use emergency room resources when they’re not needed. But most of us go out of our way to avoid emergency rooms. When we’re there, it means we’re really concerned about something. Assuming people are being polite, medical personnel should not show annoyance. A person transporting a patient for a “STAT” test should look like she’s hurrying. Residents should know what phone numbers to call to expedite what needs to be expedited.

The test turned out normal. No need for surgery. A little rest would do the trick. The fact that it then took another hour-and-a-half to be discharged was merely an annoyance, not a worry.

But believe me, I get it. When I tell my clients and my readers to advocate for themselves and their loved ones, I know it’s hard. I know it’s a delicate balance between making sure you get what you need and not annoying people in the process. But it has to be done. And hospitals are working on seeing things from the patients’ side. The gentle reminders and the self-advocacy help them get there.

The bill for the ER visit arrived in our mail today. That’s a subject for another day…

Abigail Schildcrout is founder, Practical Medical Insights, and blogs at DocThoughts.