Diary of an Emergency Room (ER) Doctor. Up or Out. (blood, toddler)
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^^Interesting story #1. Let me ask, did your physician have an on-call service? Most, especially peds, do. You could have called and he might have instructed you better on what to do.
Story #2 is very scary and the reason why doctors don't like to "assume".
When my daughter was about 5, I took her to the ER on a Sunday for a bad stomachache. They diagnosed her with a UTI and sent us home with an antibiotic.... .
Early in my career, I got a call on the weekend from a young lady who complained of burning on urination for several hours. She had had several UTIs in the past and "her old doc always just prescribed ampicillin." I told her I was uncomfortable with treating over the phone and suggested she go to the ER. She wasn't happy about that, but did go. She went into septic shock just after registering there....Had I phoned in the rx and she stayed home, she probably would have died there.
There's a lot to be said for getting the opportunity to actually see the pt: many times the "they just don't look right" feeling surpasses the "tests say you're ok" pitfall.
...The group that is most likely to rely upon the ER (and overuse it) are the poor and immigrants.
That's not what Katarina Witt's anecdote would seem to suggest when she relates:
Quote:
Originally Posted by Katarina Witt
I agree with the premise of this thread. I used to work in a pediatrician's office. Many of our patients would take their kids to the ER when the office was closed, then sometimes call us the next morning to ask if the care was appropriate.
That sounds a lot like insured folks. Speaking of insured folks:
Any County with a Level 1 Trauma presence is going to have a well populated outpatient clinic on premises.
Yes, most of our patients were insured.
I also posted some links about ER useage in the uninsured, below:
Quote:
Originally Posted by Katarina Witt
^^I have mixed feelings about your post, mark.
#1. I have not a lot of knowledge about orthopedics. However, medicine is always moving on, and a treatment that was the "gold standard" in 1970 isn't the gold standard today. That may be the reason for the CT rather than a plain X-ray. I worked in a physician's office with 5 doctors and frankly, I do not recall any comments about malpractice or attorneys.
#2. That's more what I was getting at. I honestly don't think doing an EKG is inappropriate in the situation you describe. Just because someone has a history of reflux, it doesn't mean he can't be having a heart attack today. These doctors don't know this patient, or that he's having his typical chest pain, which does beg the question of why he went to the ER in the first place. I doubt the family doc would shake his head over what the doctors did. Family Doc may question why the pt. didn't call his "after hours" number (which is usually the same as the daytime number) and ask for advice before going to the ER.
I agree with the premise of this thread. I used to work in a pediatrician's office. Many of our patients would take their kids to the ER when the office was closed, then sometimes call us the next morning to ask if the care was appropriate. They did not seem to want to utilize the on-call system that was set up. Patient only needed to call the office # 24/7. When the office was closed, calls got routed to the answering service. Doctor would call patient back. Granted, sometimes the advice was then to go to the ER, but other times such a visit was not necessary and home care advice was given. My point is that patients should utilize their office's on-call system first, instead of going to the ER or even Urgent Care unnecessarily.
Hands down; pediatricians have the best after-hours triage services I have ever seen. And definitely under-utilized.
I had some advantage with my kids' pediatrician as I had worked with him before in the hospital & I have now known him for almost 34 years. There were times when he WOULD just call in a script for me & I would follow-up with him the next day.
Even if my mind was made up & I was going to the ER at 2 am with a kid; I called first to let them know & my judgement was always supported.
I have also worked in the ER at my hospital of choice (which happens to be the busiest ER in the state) & I have never felt that unnecessary care or tests were ordered. We did have a lot of uninsured patients come through because we were a city-owned hospital but our admit support people were very resourceful. Many times a patient would come through the door uninsured but leave having qualified for Medicaid or an Indigent Care program.
2. A patient who is 45 years old comes to the hospital complaining of chest pain. A careful history reveals that the patient is susceptible to heartburn and reflux. Further, the patient has been taking an antibiotic that does cause stomach upset. No shortness of breath is observed. Yet, an EKG is ordered and performed. The patient is observed for several hours before being allowed to go home. The patient's family doctor just shakes his head when he hears all this. He tells the patient that chest pain is actually fairly common and tells him never to go to the ER again unless his symptoms are worse.
Honestly, the old cliche about "taking two aspirin" and calling your doctor in the morning makes a lot of sense.
I also worked in the cath-lab at our city owned hospital. I think people would be surprised at how many 40-somethings came through the ER doors with symptoms of gastroenteritis & wound up having an emergency angioplasty.
So. Many. Times. I have taken care of people who were gobsmacked by the fact that if they had gone to bed; they would have been dead by the morning.
^^Interesting story #1. Let me ask, did your physician have an on-call service? Most, especially peds, do. You could have called and he might have instructed you better on what to do.
Story #2 is very scary and the reason why doctors don't like to "assume".
The pediatrician did have an on-call service and I usually used it. In fact, one of the doctors would go to the office for a few hours on the weekend days to see sick kids. I don't remember why we ended up at the ER that day instead of at the dr's office; it was a long time ago. I do remember being instructed to head directly to the ER when the same kid had a reaction to shellfish (turns out she's allergic) and once in the evening when my son was suspected of having testicular torsion (turned out he didn't, thankfully). Even when my daughter sliced her forehead open as a toddler, they took her in the office (said to head to ER if I couldn't get the blood to slow in 5 minutes, otherwise, head to them) and also on a weekend when my infant son had hand-foot-mouth virus and had a high fever. I wish all doctors were like that practice!
Yes, ER should be for true emergency. For instance, I had leg swelling and pain back in August which I thought was sports injury. When it got much worse I went first to urgent care; who promptly referred me to ER for blood clot, and they took me in right away.
There are a lot more urgent care places opening up, and while in my case I should have gone straight to ER, many people can be seen and treated by the urgent care clinic.
I think a lot of people use the ER because they cannot refuse to treat anybody despite whether or not they can pay. I don't believe it is the same with Urgent Care.
2. A patient who is 45 years old comes to the hospital complaining of chest pain. A careful history reveals that the patient is susceptible to heartburn and reflux. Further, the patient has been taking an antibiotic that does cause stomach upset. No shortness of breath is observed. Yet, an EKG is ordered and performed. The patient is observed for several hours before being allowed to go home. The patient's family doctor just shakes his head when he hears all this. He tells the patient that chest pain is actually fairly common and tells him never to go to the ER again unless his symptoms are worse.QUOTE]
The reason for the bolded is because of lawsuits. The hospital wants to cover their butts in the unlikely event the chest pain was actually a cardiac event.
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I do remember being instructed to head directly to the ER when the same kid had a reaction to shellfish (turns out she's allergic) and once in the evening when my son was suspected of having testicular torsion (turned out he didn't, thankfully). Even when my daughter sliced her forehead open as a toddler, they took her in the office (said to head to ER if I couldn't get the blood to slow in 5 minutes, otherwise, head to them) and also on a weekend when my infant son had hand-foot-mouth virus and had a high fever. I wish all doctors were like that practice!
