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How to get the most out of the modern day ER

Mark Coggins

When people hear “emergency room,” thoughts of high stress medical situations that could play out on televised shows such as ER often come to mind. While this is fitting to a certain extent, more and more people are finding themselves at the ER to deal with situations that used to be dealt with in the doctor’s office. This is because the ER has changed dramatically in more ways than one.

This week on Take Care, Dr. Leana Wen discusses how the modern ER works and how to prepare for a visit to it. Dr. Wen is an attending emergency physician and director of patient-centered care research at George Washington University, and the author of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.

Click 'Read More' to hear our interview with Dr. Wen.

“Forty years or so ago, it used to be that the ER was literally a room that nobody wanted to go to,” says Dr. Wen. “It was a place where patients were triaged, that they were determined to either have a surgical issue, a medical issue, a neurological issue, and that’s basically all that happened there.”

Many significant changes have occurred over the years that have modified how the ER works. For example, doctors who work in the ER now have to undergo very specific emergency medicine training and receive certification. Changes in technology have allowed for much more efficient triaging, or prioritizing the treatment of patients based on the severity of symptoms, and shorter wait times. Also, Dr. Wen notes, the ER is “the modern home of diagnosis, so it’s not just triage that happens in the ER, but actual diagnosis as well.”

“The patient experience is now much more valued in emergency care than it previously was,” says Dr. Wen, as the focus of the changes in emergency care have been patient-centered.

Improvements in technology have allowed for most of these changes to occur and play an important role in an ER visit. Technology has brought many positives, but Dr. Wen says to still be cautious.

The most obvious and significant change emerging technologies has brought is the availability of more medical tests. While this can allow for faster and more efficient diagnoses, the risk of over testing has increased as a result of this. “If a test is being recommended make sure to ask what is it for, how is going to change management and also what the risks of the testing will be, because every single test does have risks,” says Dr. Wen.

Another significant change is the increased availability of medical records between primary care providers and ERs. While the increased communication allows for more efficiency, Dr. Wen says “don’t assume that just because they have some of it that they have the most up to date information. You should still be the person in charge of your own medical records and your own medical history has much as possible.”

In terms of whether to go to the ER or to wait it out and see a primary care provider, Dr. Wen says, “There are a few things that are critical, absolutely critical. These things would be chest pain and stroke-like symptoms. So, if you have chest pain or difficulty breathing, these are symptoms of a heart attack or stroke, and you should definitely go to the ER at that time.”

If the symptoms are not as severe, Dr. Wen suggests, “even if you feel ill but you’re a relatively healthy person, then likely you can wait longer. You can call your primary care doctor, call the coverage person, and get their advice.”

Dr. Wen recommends three things to get the most out of an ER visit:

  1. Bring someone with you: “If you’re sick enough to go to the ER, then you’re probably not feeling well. So, having someone else there who can serve as your advocate is really important, because they can remind you of things you left out and help ask questions when you feel too ill.”
  2. Bring your medical history and medications: “Don’t assume that you’re doctor, who has not met you, in the ER is going to know your past medical history.”
  3. Know and practice your story in advance to get the doctor’s attention immediately: “Know that your doctor in the ER is going to have limited time with you.”

Finally, if the symptoms are severe enough, Dr. Wen suggests one final piece of information: “Call 911. If you have an acute illness, if you think you’re very ill, do not delay by walking into the ER yourself.”