that you have one of those problems

micevan1l6

By Dr Zulfikar BuxAssistant Professor of Emergency MedicineAs I was reading a blog from an emergency medicine physician on patient misconceptions of an EmergencyDr Zulfikar BuxDepartment (ED), I couldn’t help but to share some of it today and add some local flair.It is unfortunate but EDs are considered to be one of the most misunderstood places. Even Hospital Administrators often fail to grasp the real role of EDs. It is a dynamic environment where the best decisions are most often made by the persons working there daily.Today I will share a few of many misunderstood facts on EDs which I hope to help enlighten you on what’s really going on in the medical fast lane.OUR MAIN GOAL IS TO SAVE THE SICKEST FIRSTWait times in most EDs are ridiculous. But, if you have a real emergency, you won’t have to wait. We have protocols that classify persons according to their levels of illness. If you have a life-threatening condition you will be seen long before the person who checked in for a police medical because of a spat with someone else. Patients with chief complaints like “gunshot to abdomen” and “found down/unresponsive” don’t wait to be seen. And if the day ever comes (God forbid) that you have one of those problems, you won’t either.WE MAY NOT ALWAYS TRUST YOUYou may be the most honest person in the world, but a little bit of skepticism is part of doing our job well. We have patients who fake illnesses just to get family attention. Then there are relatives who make up symptoms so that they can leave their elderly relative with us while they get on with life. So please bear with us if we do a pregnancy test although you said you are not sexually active.PHONES ARE NOT YOUR FRIEND IN THE EDPlease put down your phone while we’re in the room. If you answer your phone while being spoken to then it tells the ED staff that although you came to see a health care professional you are, in fact, more interested in speaking with someone else. Taking videos of patients and staff is also wrong and unethical.EATING IN THE ED IS OFTEN NOT THE BEST OPTIONIf you’re the patient, don’t expect to eat until your workup is over. Nurses spend ridiculous amounts of time trying to track down doctors to ask if the abdominal pain patient on bed 18 can eat. Every shift I hear a patient literally complain about hunger (Which is often a good sign that he/she is not that sick.) If there is any possibility you might need to be sedated for a procedure, you don’t get to eat. You won’t starve. I promise. It’s one of those places where eating may cause more harm than good.PAIN HAS NEVER KILLED ANYONE AND SOMETIMES ZERO PAIN IS UNREALISTIC.When you put your hand on the stove, pain tells you to pull it away to avoid deeper, more serious burns. Pain is a safety mechanism, a warning. Acute pain is miserable and all-consuming, but it won’t kill you unless the cause will kill you. Chronic pain is depressing and debilitating but if the cause is not life-threatening, the pain is not life-threatening (it just feels like it). Sometimes the only possible way to take away all your pain is to give you so much medication you stop breathing reliably. You living on a breathing machine until your neck strain gets better just isn’t an option.WE MAY NOT ALWAYS BE ABLE TO COMFORT YOUR WANTSHospitals are putting a huge emphasis on service and “customer satisfaction.” But we are busy. If I’m rushing to get back to a patient with a heart rate of 160 and you ask me for a blanket, it puts me in a bad spot. I want to acknowledge your request, but it’s hard for me to justify going to get it right at that moment.I can’t tell you the number of times I’ve finished running through a plan with the patient (my priority) when a family member asks me to get him/her some food or coffee. Administration wants us to serve you, to look out for your comfort, which is important, but we are more concerned about the other sick patients waiting for us to come to their help. It is a hard road to walk, but we will always have to err on the side of taking care of the sick over comfort.WE MAY NOT ALWAYS MEET YOUR EXPECTATIONSWe don’t want you in the ED any longer than you have to be in the ED. We’d love to discharge you. We’d love to get you a bed upstairs. But if these things aren’t happening, it’s not because we’ve forgotten about you. If you get labs and an imaging study, no less than seven people will have been involved in your ED course.Your care may not be efficient, but it should be thorough and excellent. Sometimes, your expectations won’t be met. This may be because your expectations were inconsistent with sound medical guidelines; or it may be because, despite our best efforts, we failed to provide you with ideal care, but everyone is genuinely trying to do right by you. If you have concerns, please voice them (as calmly and respectfully as you can). We want to figure everything out, make you feel better.My best advice is to avoid the emergency department altogether if you can. But if you have a real emergency, there’s no better place to be.