When to come to the emergency room

It saddens me to say this, but some people get better medical care than others. I know it's not fair, but I have watched myself and other providers consciously or unconsciously deliver care differently to different patients. It is NOT a simple calculation of the nice vs the obnoxious, the truly sick vs the people we think are full of shit, nor white v black. Prejudice is but a small part in the myriad of choices we must make in a 12 hour shift. That being said, I propose the following syllogism.

If you are: poor, homeless, unintelligent, not-white, have a psychiatric condition, are abusive to the provider, have poor hygiene, or are old and demented without good care - you are less likely to get the same care/work-up/attention that anyone who is any of these things. Why? Because the more of those things you are, the less likely you will follow the plan of care to cure or aid in healing process, and if you won't bother, then more oft than not, the provider won't bother either. You will still get good decent basic care, but no one will go looking beyond the things that will kill you; which is at the core of what we do in the ER. This is multiplied exponentially by the number of those characteristics that pertain to the you and the number of people in the ER at any one time. This is reality.

And I truly don't believe that people understand what we do in the ER. It seems self evident enough, and still I have had plenty of people tell me what my job is - and they are mistaken. We work in the emergency room, so if you have an emergency, then you come in and we make sure nothing is going to KILL YOU. We make our best efforts to change the unstable patient into the stable patient, and if we can do that and send you home, lovely. If not, we admit you and doctors continue to care for you until you ARE well, and can go home. If you want to leave before either of those things can be done, then why did you come in the first place? This ain't McDonald's, or KFC, or Taco Bell. You don't order what you want, it won't be fast and YOU CAN'T DO OUR JOBS.

It is true, you can always sign out AMA (against medical advice), but don't get pissed when you're work-up is in progress and you're tired of waiting. I thought this was an EMERGENCY?

Our job is to make sure nothing KILLS YOU. In order to do this, we "rule out" the things that might kill you. To "rule out" means we have ran tests and diagnostic studies (ultra sounds, cat scans, xrays, etc) and used our big brains to conclude you DON'T have anything that will KILL YOU, and then we tend to what we can, and give you instruction for proper follow-up care WHICH YOU MUST TEND TO, because contrary to what we'd like to believe, we don't cure everyone and can't fix everything. So despite what many people would LIKE us to do, our jobs are not to figure out what's wrong with you (though we do from time to time), but to care for you and rule out that anything might KILL YOU, including yourselves. Capice?

So, if you have a medical problem but not a medical emergency and you walk into an ER, any ER and see the place is packed - go home, see your doctor in the morning. If you don't have a doctor, go to the local clinic, we have many of them. If you don't know they exist or where they are, or it's the weekend, or after 7pm, then either sit patiently and wait your turn or go home, tolerate your discomfort awhile longer and come back at either 4 am when every patient in the ER is asleep or at 8am, just after shift change when everyone is fresh and the ER has been emptied as best is possible.

A do NOT think you are slick by calling an ambulance to bring you in, under the false premise that you will be seen quicker. Everyone, and I mean, EVERYONE get's seen and triaged by a qualified registered nurse and will be placed in the order of the severity of their MEDICAL EMERGENCY. So if you don't have one, and you came by ambulance, don't be shocked to find your ass in a chair in the waiting room. I kid you not.

Let me qualify medical problem vs medical emergency. A medical problem is something anyone can have BUT you are someone with NO ongoing medical diseases, are relatively healthy and you state: 'yo, my eye be hurting for a month and I can't take it no mo', or "I've had this rash on and off for a year", or "I got in a fight with my boyfriend/girlfriend and my heart felt like it was gonna beat out of my chest, so I just want to get checked out" or "Sometimes my feet swell and they hurt." (but they aren't swollen now) or my personal favorite "I have this terrible pain in my back and I was in a car accident...10 years ago". Get the picture?

This is not an emergency. You are a healthy person, you are uncomfortable, the likelihood that your constellation of symptoms amounts to a condition that will KILL YOU is around the order of 1 in a BAZILLION. Use your brain, or someone else's, and seek medical care at an appropriate facility like a doctors office or clinic. Here's a hint - they are open Monday through Friday from 9-5/6/7pm. Generally they like it if you call and let them know you are coming, although some do have walk in appointments, but then you have to WAIT YOUR TURN, because there WERE people who called ahead and they get to go first.

Medical Emergency: You are old and anything is wrong with you. You have chest pain. You suddenly begin to slur when you talk, can't lift one arm or leg, or lose your vision. One of your limbs begins to swell up for no reason and the rest look fine. There is blood coming out of any orifice that is NOT your nose (which you've been picking)...or it is your nose and you haven't been able to stop the bleeding for 4 HOURS, and you have high blood pressure. You've been shot or stabbed (this does not include paper cuts, wounds from plastic knives or welts from paint-gun pellets that didn't break). You fall over when you walk. You have been in any motor vehicle accident where some part of the vehicle was CRUSHED or ROLLED OVER. Scratched bumpers, paint chip off the side and the desire to sue the shit outa someone else who cut you off do not count. You fell on your head, at all. You were hit in the head with something that weighed 10 lbs or more. You can't remember anything and someone else brought you here. You have a cut and see fatty tissue down below (deep enough to merit stitches), or some white thing that looks like a thick string (tendon that allows some muscle to stay attached to the bone and move the joint - like say your finger, or foot, or knee)or the bone is poking out. You can't breath - really. I don't mean you can give a monologue with a hoarse voice or can shout at me for 5 minutes that I'm not helping you and you have asthma/a cold/walking pneumonia. I mean you can't string 3 words together without taking a breath, or you're leaning over with your hands or elbows on your knee's and can't walk because you can't catch your breath, or you truly feel like you throat is closing, or I can hear you wheeze without my stethoscope, or you feel like someone is sitting on your chest and or your windpipe is pushed to one side, or you're lips are BLUE. These are but a few examples of a 'true' medical emergency.

Remember, an 'emergency' to you may not be the same as a 'true medical emergency'. You may just need some xanax or a slap.