Hopefully you won't need this place; but you may!
Prelude: The Daily Kos community has meant a great deal to me over the past decade — and I have wanted to give back to this group of humans that I adore. This led me to one of my New Years resolutions for 2019: to finally start a monthly blog on emergency care topics. My reasoning: (1) I’m a long-time ER doc and medical school professor, and common advice to writers is “write what you know about”; and (2) all of us, sooner or later, have an emergency medical condition — so I hope some sharing of knowledge might be helpful to many of you. I meant to start this monthly blog a while back; if you want to see my first such piece (on cardiac arrest), you can find it HERE. In future, I will aim to cover specific medical conditions, but this month I will provide some orientation and pro tips to the ER experience.
The scenario: it’s 2 AM, and you feel awful
You suddenly have chest pain, or worsened difficulty breathing, or severe vomiting — and you just can’t avoid the frightening truth that you need to go to the local ER. Maybe you’ve never been to the ER before, or have only been there a few times and have found it to be a slow and unpleasant place. But here you are, it’s 2 AM, and you are scared that something serious is happening, something that needs medical care…. NOW. You hastily grab your wallet, keys and phone and head for the car, or you call 911 for an ambulance — but either way, you grimace and head to the hospital.
What an ER does well, and what is does not do well
The first and most important thing to understand is that ERs are designed to care for potentially life-threatening or serious acute conditions. Heart attacks, bowel obstructions, kidney stones, allergic reactions and the like — these conditions are what ER staff are trained for, what they generally diagnose and manage quite well. So if you have a relatively new, or a newly worsened symptom such as chest discomfort, difficulty breathing, vomiting, severe abdominal pain, or a new itchy rash all over your body, the ER is the right place for you. What ERs tend to do a lousy job with are conditions that are more chronic in nature — one month of abdominal pain, several weeks of back pain for which you have seen a specialist already, or intermittent headaches for 6 months. We just don’t have the resources, time, or ability to do a great job with such conditions, and your visit to an ER is likely to be frustrating, and result in an expensive co-pay without many answers. Sometimes you just don’t have a choice (maybe you don’t have health insurance or don’t have a regular primary care provider) — but your ER visit often won’t get you the care that you need.
The discussion above may sound obvious to you — but you’d perhaps be surprised to know that easily half of the patients that I see in my ER have conditions that are chronic or mild in nature, and would have been more efficient and more pleasant for the patients to manage in a clinic setting.
Orientation to the ER: who are these medical people and what crazy language are they using?
There are a bewildering array of staff who work in the ER setting. Knowing who they are, and the roles they play, can be a useful bit of knowledge when you visit the place. The ER also has a whole set of bizarro jargon terms, often used by staff to patients without remembering that “civilians” don’t use these words — thus adding to confusion and miscommunication.
who are these guys?
The ER is generally led by a supervising physician (known as the “attending physician” or simply the “attending”, a word I dislike because no one outside an ER actually knows what this means. I always introduce myself as the “supervising physician” to patients and families, everyone gets the meaning of that). The supervising physician makes the final decisions about “disposition”, meaning whether you stay in the hospital or go home, and what treatments you will receive. At many hospital ERs, there is a junior group of physicians who may care for you, physicians-in-training known as “residents” (much more familiar term, thanks to all the medical TV shows out there). If you are in the ER, and a physician walks in and says “Hi, I’m Dr. Jenkins” , it’s important to know if they are resident or supervising doc. It’s totally fair to pleasantly ask them, “Hi Dr. Jenkins, nice to meet you, are you the resident or attending physician?” That way, you will know if they are really calling the shots. It is absolutely your right to speak to the attending; if the resident physician says “you’re going home, everything checked out just fine” but you haven’t actually spoken to the attending (believe it or not, this happens not infrequently, but is not OK) — ask to speak to them. Ditto if the resident is telling you things that are totally confusing, it’s always fair to nicely ask “I appreciate what you are trying to say, doctor, but I’d like to ask some questions of the attending when they get a moment”.
The other crucial person on your ER team is the “primary nurse” — that means the nurse assigned to you during your stay. ER nurses are some of my favorite people in the world — generally strong-willed, sometimes blunt but deeply caring under that gruff exterior, smart and dedicated to their vocation. They can be your best ally during the ER stay — so make sure you are as courteous to them as your condition allows. Like flight attendants, they have a really tough customer service job, with most people complaining or being rude. A few kind words of appreciation towards a primary ER nurse can make a huge difference in their day, and often in the attention paid to you in the ER. You may also meet an “ER tech”, often a paramedic. These techs do a range of activities to support your care, including placing intravenous lines, preparing splints for sprains and fractures, and sometimes serving as a transporter to get you to x-rays or CT scans. Another member of the cast of characters is the “registration clerk” who will collect your information (insurance, drivers license) during your stay. “Consultants” are other physicians you may meet during your stay, called upon for specific expertise, such as surgeons or dermatologists or neurologists. They will help the ER team make decisions, but often are not ultimately responsible for your care.
ER physicians and nurses tend to work fast, and they often forget to drop their ER-speak. Here’s some common terms you may hear: “dispo” means disposition, or whether you are going to be admitted to hospital or sent home — if you hear a nurse say “let me find Dr. Jones and find out your dispo” that’s what they mean. Often abbreviations are used with patients (inappropriately) to explain test results. If a resident says “good news, your CBC was normal” — they mean your “complete
hey, wait, that’s MY blood. Here’s a tube for a CBC.
blood count”, a lab test that measures the number of white blood cells, red blood cells and platelets in a given volume of blood. If they say “we’re going to draw a BMP” — sometimes called a “Chem-7”, that means they are going to measure blood electrolytes (such as sodium and potassium). Another common ER blood testing term is “belly labs” — this means blood tests for the liver, gallbladder and pancreas. Another term that is often thrown out there to patients: “acute abdomen” — if a resident says “Mr. Adams, we are worried you have an acute abdomen”, that means they are worried you may have a sudden process in the abdomen often requiring surgery (conditions such as appendicitis or bowel obstruction are often considered “acute abdomens”). If a nurse says “I need to stick you again, Ms. Ramirez”, that means he or she needs to draw blood for another test. They may grab a “butterfly” to “stick you”; a butterfly is a form of needle to draw blood. If you are a family member, and someone tells you that your confused loved one (the patient) is “only A and O x 2” that means alert and oriented to only two criteria (the three criteria often used are person, (“tell me your name”), place (“where are we right now?”) and time (“what is the date today? what day of the week?”). Unfortunately, there are many more jargon terms, enough to fill a book, but hopefully this list of common ones may be useful as you interact with the ER team.
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