A Timeline Tool For When You Are In The Emergency Room

Dear Viki,

I got a call from someone as her grandmother was being taken to the hospital. Her grandmother’s doctor wouldn’t come to the hospital even though her mom had chest pain and very high blood pressure. After asking more questions, I explained to her that the probable reason the doctor wouldn’t come to the hospital was that he didn’t want to interrupt his weekend plans. I know it is cruel to say, but it is probably true. I know there are lots of great doctors out there but you have to realize that I only get called when there is a problem. (Now before the doctors reading this get angry, the person had a blood pressure of 240 over 110, chest pain, vomiting and the doctor said to not take her to the hospital. And the doctor was on call that weekend.) I also know that doctors are real people and they hate being on call on a holiday weekend. I don’t blame them. How would you like to have your day interrupted and have to leave in the middle of your most precious family events? This is one of the sacrifices they make for us.

So back to the story:

I talked the person through what to say to the ER doctors to make sure they got what they needed. I explained how to get the services she needs by using respect and good communication. You have to make it easy for the doctor because time is limited. You need to organize what you are going to say, be clear and give both the current facts as well as the past medical history. Here is where you have to be careful. You have to focus on telling them what is relevant to this situation. My dad would go to the doctor for a pain in his leg and then spend his time talking about his dysentery from World War 2. It was not the same body part and it was 60 years ago. Yes, you should give information about the person’s medical past but try to make sure it is relevant to the situation. But you may not know what is relevant so instead you can create a timeline for the doctor. (Keep a copy with you and with the patient for emergencies.)

One way you can do this is to construct a written timeline of the patient’s health. Here is an example:

1945: dysentery during the war
1988: cataracts diagnosed
1998: double bypass surgery
1999: cataract surgery
2001: prostate surgery for enlarged prostate
2002: allergic reaction to sulfa drugs
Include a list of medications and allergies

Now the doctor can see all the important events and he can get to the information quickly and effectively. Then you can spend more time talking about the present situation. The more you help the doctor whether it is in the office or in the hospital, the more they can help you.

Have a kind and respectful day. Viki Kind at KindEthics.com

Be careful about going to the hospital in July – It could be dangerous to your health

I was talking to legal nurse expert, Patricia Coonan, and she was telling me that there is a definite increase in medical errors in July. I have heard this joked about in the world of medicine, but it is not a joke. Errors increase every year at this time because this is when doctors in training shift to a new level of responsibility. The newly graduated doctor becomes an intern, the intern becomes a resident and the resident becomes a fellow. With this increase in responsibilities practically overnight, the doctor needs to be ever more vigilant about asking for help when they get into an overwhelming situation. It is normal for them to need help occasionally and they need to speak up at those times. Patricia says that medical negligence is usually not because the patient has the negative side effect, but is when the doctors or nurses don’t notice and fix the problem. Medical errors are normal because humans are taking care of us. And the younger doctors are still learning.

I am not telling you this to scare you but to make sure you are educated. You should always have a patient advocate at the hospital with you. You should ask what medicine is being given to you and what dose you are getting. If it is not on your list of medicines, ask why you are getting this new drug. You should make sure people are washing their hands before they touch you. You should make sure you have all of your questions answered before you sign a consent form. If you can, ask questions and make sure you are getting a consistent message from your doctors. If you are too ill to watch out for yourself, then get a love one to protect you and ask questions.

The only way you get new doctors is to train them. And they get trained by learning on all of us. These are real doctors and they have been well trained. I have had all of these levels of doctors take care of me when I was in the hospital and I was just fine. So, I am not saying you should be afraid of interns, residents or fellows. This is just a reminder to be your own patient advocate.

When I go to the Emergency Room, why is the wait so long?

Dear Viki,

When I go to the Emergency Room, why is the wait so long?

Basically there are only so many beds in a hospital and an emergency room. If there is overcrowding in the hospital, the emergency room will get overcrowded with people waiting to be admitted to the hospital. I know someone that spent three days in the emergency room because there were no beds available in the rest of the hospital. She got her meals, her physical therapy, her medical tests, her x-rays, etc done while she lay in the hallway of the ER. Eventually she got better and was discharged home. She never made it to a regular hospital room.

So how long you will wait to be seen in the emergency department will depend on many factors. Here are just a few:

• How many people got there before you
• How sick you are
• How sick the other people are
• How crowded the whole hospital is
• How many ambulances are arriving outside
• How many other ER’s are available in your area
• People go to the ER when they have a cold or aren’t really sick and take up the doctor’s time
• People go to the ER because they don’t have insurance and the ER has to treat you even if you can’t pay
• People go to the ER because they didn’t want to take time off from work to go to their doctor’s office
• People go to the ER because they kept waiting and hoping they would get better and by the weekend, they still aren’t better

If the other patients already there and those in the arriving ambulances have a more life threatening condition, your wait will be really long. Sorry. Basically the nurses will do something called triage. They have to evaluate who needs help right away and who can wait. I live in an area where many of our emergency rooms have closed because there wasn’t enough money in Los Angeles to keep them open. It puts tremendous pressure on the hospitals that still take care of emergency patients and increases our wait time.

What can we do?

1. Don’t take it out your anger and frustration on the nurses and doctors in the emergency department. They know you had to wait and they wish it was different too. When they go to the ER themselves, they have to wait. They understand and are doing the best they can.

2. If you aren’t really, really sick, go to your doctor’s office. Or go to the urgent care.

3. If you are sick on a Friday morning, go to your doctor’s office. Don’t wait until 6 PM and then go to the ER.

4. Go prepared. Bring all of the medicines and other pills that you have been taking with you in a bag. You shouldn’t be surprised to have to wait.  Bring something to read or do with you.

5. Ask your state to provide more resources for the local hospitals.

Have a kind and respectful day.

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