The Emergency Room - Dr. Heinsimer
The emergency room is best used for bona fide emergencies – definite stroke with sudden weakness or loss of function of an arm or leg, major laceration needing stitches, obvious fracture, cardiac arrest, etc. When used for these purposes, the ER is the place to be. In such cases, get going to the ER by EMS or car and call me on the way if possible or have someone call me (800-441-7707)
However, the ER is a relatively poor place to go with a more chronic problem for diagnosis and treatment. Why is that?
First, the ER is an expensive place to go for care. Even a couple of hours in the ER may cost thousands of dollars – to you, or with a copay or to insurance.
Second, ERs are busy and take the sickest folks first - meaning the true acute medical emergencies such as those described above. That means that if you come in for a more chronic problem, you may be sitting in the ER for hours for something that could have been treated more efficiently in an office setting.
Third, and most important, when you go to the ER, you are seeing a doc who does not know you or your history. You may be seeing a trainee (a resident) rather than the ER attending (although the ER doc ultimately has to sign off on decision making). You may wind up with testing you have already had or do not need. Do not assume that the ER will contact me to get my advice in your workup even if you have given them my name.
Fourth, the ER has really only 2-3 choices available to them for you care. First, they may be able to patch you up and send you home (for example, for a simple laceration or minor fracture). If a simple fix is not possible or not able to fix you in a 6 hour timeframe, the ER staff may decide to admit you (with more cost, more history taking etc). The ER staff can also put you in a short stay or observation unit in which case they hope to get you out within 24 hours – again more cost, more time, more tests, and more docs.
My suggestion is that, unless it is a bells and whistles emergency, you should call me first rather than going to the ER. Some folks go the ER rather than calling me first thinking that it will save me from being awakened or called on a weekend. This is usually not the case. If the ER needs to admit you, they will have to call me eventually, no matter what time of the day or night.
By calling me first, I may be able to help you even if we decide you need to go to the ER. By calling first, I may be able to keep you out of the ER. Second, if we decide the ER is needed, I can fax over your information to the ER to facilitate care. Third, I can use my knowledge of you and your history to expedite your care. Fourth, in some cases, I may decide the hospitalization is needed and we can bypass the ER by having you directly admitted to a bed. The simple message is call me first if possible.