You’re sitting in the waiting room, icing your sore ankle. The teenager to your right is moaning and clutching his belly. The woman to your left is coughing into her mask. A stretcher rolls by with a man yelling at the top of his lungs. An ambulance arrives. You see paramedics performing CPR.
You wonder, with all this chaos around you, how can you make sure that your emergency room doctor will address your concerns?
Along with primary care physicians, we emergency providers are the frontlines of medical care. We see people with every imaginable issue. Some ER patients are critically ill—from trauma, heart attack, or severe infection. These patients will get seen immediately and have the full focus of ER staff. Other patients are not critically ill but still have needs that must be tended to.
As an emergency physician and patient advocate, I’ve met many patients who are frustrated by their medical care. I wish I could have given them advice before they came to the ER.
I see some of the same missed opportunities and miscommunications again and again. Categorizing the clusters of difficulties can help to identify and fix the problems. Here are my suggestions for 10 types of ER patients. I don’t intend to stereotype or imply that every patient falls into one of these categories. If you recognize yourself in one of these categories, you may benefit from some guidance to help us best help you.
No. 1: The Repeat Customer. Often, ER docs will see a patient who’s had headaches for 10 years or foot pain for even longer. If you have a chronic, ongoing issue, explain why today is the day you came to the ER. Help us understand why you’re here. Maybe your symptoms have changed. Perhaps your sister just got diagnosed with cancer and you’re worried. Please tell us the truth. If there is truly nothing new and you have a primary care physician, please consider making an appointment with her. We can take care of acute pain, but you will need someone to follow you for ongoing medical problems.
No. 2: The Second-Opinion Seeker. You’ve had months of troublesome symptoms. Nobody—not your primary care physician, not the five specialists you’ve seen—has given you a satisfactory answer. We understand that you’re concerned, but it’s unlikely that in the ER, with limited time and resources, we can give you the in-depth investigation you deserve. Ask your regular doctor for referrals and further testing. Keep in mind that we have finite resources; if you’re in our emergency MRI for your chronic knee pain, that means the patient with the possible stroke needs to wait.
No. 3: The Googler. The Internet can be a powerful tool for empowering patients, but please use it responsibly. Looking up your symptoms yourself might turn up that you have a brain tumor when you have food poisoning or that you are pregnant when you have belly pain (and you’re a man). Use the Internet to help you understand your diagnosis and treatment and to come up with questions—not to diagnose yourself.
No. 4: The “Pain All Over” Patient. We call it the “positive review of systems” when you say yes to everything we ask. Headache? Chest pain? Shortness of breath? Fatigue? Muscle aches? Yes, yes, of course, yes. Some illnesses really affect many parts of the your body, but more often than not, patients will say yes to convince us they are ill. We know you aren’t well, so tell us the truth. (If you don’t, you run the risk of undergoing unnecessary testing.) If everything hurts, try to tell us your story. When did you last feel normal and well? What happened then? And please don’t exaggerate. If you say that your pain is 15 out of 10, but you’re eating lunch and texting on your iPhone, it’s hard for us to calibrate your symptoms.