Parade article about ER danger

clemmm78, RN · Oct 30, 2006

I hadn't seen that - how awful.

I remember reading an article suggesting that patients and their family members ask, whenever the nurse comes in their hospital room, "have you washed your hands?" It was to protect them from cross infection.

Although I understand the sentiment, I figure if you are a health care professional and you don't wash your hands, you are very unlikely to admit that!

Another article I read quite a while ago went as far as to suggest that the patient (or advocate) insist on seeing the nurse wash his or her hands.

I have not come across this, and to tell you the truth, I don't know how I'd respond if I ever do.

Marie_LPN, RN, LPN, RN · Oct 30, 2006

1. reminding the nurse that you are there she may "forgotten you".

This happens occasionally, whether Parades prints it or not.

caroladybelle, BSN, RN · Oct 30, 2006

http://www.parade.com/articles/editions/2006/edition_10-29-2006/How_to_Survive_Your_Local_ER
3. asking for "the attending physician." "not everybody in a white coat is a doctor." that is completely insulting to PAs and NPs.

Has the lame brain that wrote this EVER worked in health care and do they even remotely have a clue as to what "attending physician" means?

The vast majority of us may see the "attending physician" once a day if at all.

"Attendings" in teaching facilities make rounds once per day, maybe twice. They are generally not in the hospital for most of the day (either home/asleep/clinic/office/teaching/research). The rest of the time your MD is an intern/resident/fellow. This is one of the perks of being an attending.

In nonteaching facilities, your "attending" is generally your PCP, and 95% of the time, you are in the ER because you neglected to make an appt w/your "attending"/did not follow his or her instructions/ he or she fouled up or you need care beyond your "attendings" capacity. Rarily is your "attending" even at the ER nor are they likely to be come in for most of what presents there. Heck, they shouldn't even be woken up for most cases. And if you are in the ER in dire need, what you want is a specialist probably not your "attending".

Not to mention, if you are healthy enough in the ER to ask for an attending, you are probably low on the priority list to be seen, period.

mysticalwaters1 · Oct 30, 2006

Actually, I found it rather truthful and pointing out there needs to be more staffing, more space, and more resources for people without insurance. And I didn't find it slamming healthcare workers either. I was about to pounce about ER forced to be the backup for failure in healthcare such as lack of insurance, primary mds, and pt's not comming in with true emergencies but it actually mentioned all that! Ok I cringed when it said ambulance will get you in faster but they were refering to an authentic emergency and stating don't drive it it really is a problem. And DEFINITELY a pt can be forgotten despite all best intentions. I think it really is useful for pts to ask the ?s and it even points out don't be rude just firmly ask your questions. Infact I was really impressed how it mentioned if it is a simple cough go to the primary md first but does mention a problem with the ED is people with no insurance. It really is an eye opener and other nonhealthcare workers get to see it. AND THE MED LIST suggestion while common sense to me it was great they mentioned it. I think it was a good article.

mysticalwaters1 · Oct 30, 2006

http://www.parade.com/articles/editions/2006/edition_10-29-2006/How_to_Survive_Your_Local_ER
People need to learn how to use the ER appropriately. In my area we have many locations of sliding scale fee clinics with great docs. But people still use the ER's for the things that have been discussed on Allnurses.

I'm in NE pa and one of the busiest ERs in the state. We have no such free clinics at least in my several towns surrounding the hospital. There's a community center for children and it's limitted. My grandmother in CT has a "Doc in a box" and sounds great! Has an MD and it's for non real emergent stuff but to get you in quick and out than using an ER or overbooked primary md office. My area sadly really if you don't have insurance YOU ARE SCREWED. And not all jobs offer insurance or have decent insurance. Something really needs to be done with this. I really feel it's a right to have medical coverage. I really think universal health care may have to be a reality b/c I see no other way. Despite issues and cost with it we are already in a black hole now. And for those who have the money they can get it. Even with my insurance if something happened to me I barely make enough to save a little. And yea I have a nice tv, dvd, car but I'm not totally blowing money. It's just healthcare CAN be so expensive it just takes one incidence even with insurance to get you in debt. I can't help the people against fixing this or providing some solution for everyone involved are against it but wait till something happens to you and you get screwed. It's just a mess.

widi96 · Oct 30, 2006

Okay . . . so maybe some of their points were a LITTLE harsh, but Thank You Parade . . . .

'Don’t go to the ER if you can avoid it. A cough? An itchy rash? A chronic condition? Call your primary-care doctor and insist on an appointment. His schedule is probably crammed too, but with persistence and flexibility, you’ll get in. “You should insist that your primary-care doctor do primary care,” says Dr. Arthur Kellermann, the chief of emergency medicine at Emory University’s medical school. Time will be better spent calling the doctor than sitting in a waiting room.'

babynurselsa, RN · Oct 30, 2006

Actually I thought this was a much more balanced article than many others I have seen written in a while.

They do mention that you should utilize a PCP for monor complaints, they only mention using EMS for emergencies. It also has the suggstions that make me happy

1. know your medical history

2.know your meds

3.know your allergies

The part about checking with your nurse said "If you haven't been checked on IN HOURS."

All in all it was not a bad article IMHO

TazziRN, RN · Oct 30, 2006

Yeah, but in the next sentence it says to time your visits because mornings are quieter.

I got ticked enough to write. The unfortunate incident involving the shunted child sounds misleading to me, it doesn't sound like the problem was with the ER, but with the on call surgeon.

Ruby Vee, BSN · Oct 30, 2006

this totally had me fuming. i think parade will be hearing form a multitude of health care professionals. how about a article with information such as 1.) having a primary doctor. 2.) knowing the names of your medication. 3.) knowing your own medical history. 4.) knowing your allergies. 5.) not lying to the health care professional about symptoms. 6.) making wise health choices.

the article had sugesstions such as:

1. reminding the nurse that you are there she may "forgotten you".

2. arriving by ambulance will get you seen faster. ( gee thanks parade).

3. asking for "the attending physician." "not everybody in a white coat is a doctor." that is completely insulting to pas and nps.

in the actual magezine article there was a little box at the end of the article with the info about knowing your doctor's name and knowing your meds etc. the rest of made it sound like medical professionals are incompetent. congress doesn't need to spend more on uncompensated er care. people need to learn how to use the er appropriately. in my area we have many locations of sliding scale fee clinics with great docs. but people still use the er's for the things that have been discussed on allnurses.

thanks for posting the link.

there was a previous thread about this article, but it didn't post a link. from the notes in that thread, i was expecting something awful, but this article really wasn't that bad overall.

i doubt that arriving by ambulance will get you seen faster, but it's better for someone to travel by ambulance if they're having a heart attack, stroke, or serious injury anyway. as i've pointed out to my parents many times, you can't do cpr and drive at the same time. call an ambulance. and it's not bad advice to ask the person in the white coat who they are -- but the reality of the situation is that you're rarely going to see an attending physician, and the article should have pointed that out.

1) it's good advice to have a primary doctor, and know their name, how to spell it, and how to contact them. this information should be on a card in your wallet or in your address book in your purse.

2) also on a card in your wallet: a list of your allergies and what type of reaction they cause. ("lasix makes me pee too much" or "benadryl makes me sleepy" are not allergies, and one should know the difference.) i make my husband carry a list of my allergies in his wallet, and i have a list of his.

3) know your medications including correct spelling, dose, frequency, and why you're getting that med. it's not enough to tell me that you're taking viagra (wink, wink and sly grin to young female nurse.) don't let us assume that you're taking it to enhance your sexual function when you're really taking it for your end stage pulmonary disease. again, this should be on a card in your wallet. on another card, you're spouse's meds.

4) know -- and communicate -- your medical history. some of this will be obvious from your list of medications, but if it's not, or your caregivers are inexperienced, it's helpful to spell it out. i need to know you had an mi in 1999 and a cabg in 2000. if you had a surgery, tell us. tell us what surgery you had, why you had it, when you had it, and where you had it. (i don't need to know that your cousin's husband's best friend drove you to the er, or that all 67 of your lodge buddies visited you after your surgery. save that sort of thing for when your kids visit.)

5) and please tell us all of your symptoms. when my husband took me back to the er after my back surgery a few weeks ago, he told them i had a headache. he had forgotten to mention the discectomy i'd had a few hours ago (outpatient surgery), the projectile vomiting, or the fact that the headache was the reason i'd taken the percocet prescribed for post-op pain. the post op pain was nothing compared to the headache! it made the difference between a migraine work-up and lying flat for a week due to a dural tear. my husband should have known better, but he was frightened and upset.

so while the article wasn't bad overall, i would have emphasized what you can do to improve your care -- and demanding to see an attending "if you're not comfortable" wasn't even on my list!

BSNtobe2009 · Oct 30, 2006

This is probably going to be a very politically incorrect post, but when I go to the ER, I refuse to be seen by NP's or PA's.

I made this decision years ago, when I accidently slashed my hand at home, and had to have 14 stitches. What I thought was the doctor, came in, took a look, and returned to sew me up.

When I got the confirmation from the insurance company that paid, it was a female's name. (yeah, I know they both work under the supervision of a doctor)

That is when I discovered you get charged the same for both. I figure if my insurance is paying for a doctor, I want to be seen by a doctor. A doctor shouldn't be able to collect the same fee for never walking into the room.

I just want to note, it's not that I don't think that PA's or NP's are not qualified, that isn't even the reason, it's just that I just want to get what my insurance pays for. (or did, before I started back to school).

Antikigirl, ASN, RN · Oct 30, 2006

Some of the info is good but I will admit to being furious over using ambulances to get seen faster! Okay..yeah lets go ahead and have paramedics go on code one calls all darn day (like they are anyway...and for those not in the know...code ones are non urgent no lights or sirens but need to be evaluated). It isn't like they need to be going to serious cases of life threatening conditions while they have someone LOL complaining of dizziness and bladder pain that could have been driven in by a family member or non urgent dispatch or even taxi!

That chapps my hide!!!!! Sure...... you can get in faster...it will also cost quite a bit in my area, since our ambulances are privately owned! Got an extra 5-6 hundred dollars because they showed up and took you (not including milage or treatments) so you can get in faster???

That is a total utter lack of respect towards hard working paramedics and emts! They are NOT taxi drivers to and from hospitals (even though they are asked to do this) but certified medics that have to take so many hours of CME a year just to keep up with the latest trends (more so than MD's or RN's!). And they have to stablize ANYTHING that comes around...now that is a professional medic in my book and should NEVER be even hinted to as being a taxi service so you can get in faster!!!!!

Sorry...I will get off my soap box...I am married to a paramedic and hear how this effects them! It is akin to saying a nurse does nothing but pill pass, enemas, shots and fluffs pillows at your beck and call.