Saturday, February 21, 2009

ER Etiquette

The media has no shortage of stories describing the extended waits patients face when they arrive to the emergency room. However, following simple ER etiquette will help your visit be as short as possible.

Upon arrival, explain your symptoms to the nurse as accurately as you can. This will help them triage you and decide how quickly you need to see the doctor. Unfortunately, patients are often motivated to exaggerate their symptoms because making their illness appear worse will result in them skipping ahead in the line. We then see an instance of game theory where every patient is motivated to exaggerate their symptoms to prevent any other patient from skipping ahead of them in the ER queue.

I don't really have any advice on how to deal with this dilemma. However, I will tell you that exaggerating your symptoms too extremely can result in a barrage of unnecessary tests. This testing can be dangerous because every test has some associated risks, whether they be exposure to bugs or radiation. The testing will also extend your stay because waiting for equipment to become available can take a long time, especially if everyone is exaggerating their symptoms.

Once you get admitted into the ER, be polite but be heard.

First, be polite. Do not talk to the staff rudely, especially the nurses. If you are frustrated with their work or attitude, you can let them know if you really want to, but talk to them like they are colleagues, not the hired help. For example, if you were promised breakfast at 8 and it's already 8:30 and you haven't got your oatmeal. When you see the nurse, you can say "Hey, I know you're really busy, but I was told I'd have breakfast at 8 and it's already 8:30, can I get you to help me out, I'm starving." This is the preferred response over, "Hey, you told me I'd get my breakfast at 8, it's 8:30, can't you do your job right?"

Seriously, be polite, I'm not trying to teach you manners, this advice will help you if you're ever in the ER. I have seen quality of care deteriorate because patients have been disrespectful. At best, the health care staff will try to admit you to a different department and your stay at the hospital will be extended longer than it needs to be. At worst, you may be discharged quicker than you should be because you are an ass. The ER staff will obviously not intentionally harm you, but it is human nature to not be as eager to help someone who is treating you like dirt.

Secondly, be heard. The ER gets VERY busy and if you are too quiet the staff may forget about you. Or worse yet, mistakenly assume that your illness isn't as serious. Though I have yet to see the latter, I have seen a girl who was forgotten because she was too quiet. She came to the ER because she had a severe bout of diarrhea, but after the doctor saw her he decided that she had passed through the worst of it and that she should be discharged. Unfortunately, he was sidetracked because there were 20 other cases that all came in at once and the girl, who was sitting quietly in her bed, spent an extra 4 hours in the emergency room before the doctor got around to ordering the discharge.

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