Are you afraid to go to the ER?

[scrmblr]

Soooo...I believe in Karma, but sometimes making fun of people who come to the ER is just too flippin' funny. We had a rare (brief) downtime the other day and the consensus was that NONE of us would dare show our faces in the ER for anything less then an amputation. We had a new nurse (new grad, in her early 40's) present with "chest pain" the other day. She ended up with a dx of acid reflux. I think she about died of shame, poor thing.

What would bring you to your own ER for tx???

(don't include your children. I have brought my kiddo's in for a few different things that probably could have waited. The doc's I work with are super nice about taking a look at staff's kids and I really let them know how much I appreciated them!)

[Nurseboy1]

The last time I visited the ER, I was brought in unconscious, septic with pancreatitis.

However, now it would take being on death's door to go to the ER. Generally I will try to see my PCP or go to urgent care.

[Markthemalenurse]

I personally will not go to my local hospital's ER ever again. I went there for severe lower left quadrant pain, got the work-up, urinalisys, x-rays, CT scan, blood-work. Doc came back and said we didn't find anything maybe its a kidney stone ( I had these before, I know the difference) here are some vics. Pain continued, went to my PCP for the lower left quadrant pain and diagnosed me with diverticulitis.

[grace90, LPN, LVN]

for myself, yes I guess I am. Since I've been working as a nurse, I personally haven't had to go, but I've had my kids in ER a few times since. I made my husband keep quiet about me being a nurse when I was there with them. The other community hospital here specializes in AMI/cardiac surgery, so if it was potentially cardiac-related I'd definitely go there. My kids' pediatrician works through that hospital too, and always wants us to take them there.

[andhow5, BSN, RN]

Well... I'm completely S.O.L. on going to any of my local ER's...

I've worked them all in my nurse's role, and I cringe at the thought of going unconscious in a public place and waking up in the back of an ambulance, because I use my EMT and do a lot of volunteer work with EMS...

So, for me to voluntarily go to the ER or use an ambulance, you'd better believe I will be next thing to dead...

None of this is based on what I perceive as incompetence - just plain old embarrassment factor!

*Isn't it funny, when on your day off, you plan your activities/errands/routes based on who you know IS working?*

[Little Flower]

The last time I was in the ER was also a nightmare of major proportions. I wish to g-d I had not gone to that hospital. ER's are contract services operating under different rules. If they screw up they become invisible and that is all I am going to say about that.

Something that worries me is this: My PCP doesn't go to the hospital. He refers his patients out to specialists for particular needs of tx. If however you have an emergency he tells you to go to the ER. That scares me very much. I like my PCP...he is a jewel so changing docs hasn't even entered my mind.

I would most likely die from lack of treatment due to fear I acquired from the last trip to one.

I have to ask of the rest of you (not to those who are only embarrassed). There seems to be a general consensus about not wanting to go to the ER. That certainly doesn't say much for the idea of emergency care, now does it?

Two weeks ago I took my neighbor to the ER. Her doctor told her to go. The way she was treated there by an arrogant, narcissistic, ego-maniac, god complex doctor brought her to tears and she left the ER. She walked to a pharmacy nearly a mile away and called me to come get her. She hadn't had any food all day and was in a great deal of pain. She was almost disoriented. She subsequently had gallbladder surgery.

I have lost respect for ER's due to horror stories I hear repeated from many sources about how people are treated while there. It seems that in general ER docs have acquired a hostile/aggressive position towards patients. Yes, I understand that some of this is job related actually as they become hardened to life and jaded in their emotional expression or lack there of but coming from the patients point of view it is reflected as hostility and indifference. The majority have lost their ear for listening and forsaken their oath of "do no harm"

Just my observations/experience.

On the flip side I am sure there are still many excellent ER docs out there providing great care. Too bad they are now cast in the shadow of those that do the harm. When patients fear doctor in the ER and doctors succumb to the god complex we are all at risk....if nothing else but from fear.

When I was a young adult (back in the good old days) ...your doctor called the ER and gave orders that were then acted on and followed. Now it seems that once you get to the ER they want to do everything all over again like you just walked right in off the street withOUT any directives.

There is something very wrong going on in ER today. It may be something as simple as corporations, schedules, management, contracts and of course money and insurance or lack there of.

JMHO which is subject to revision based on any new information which may be obtained.

[Altra, BSN, RN]

The last time I was in the ER was also a nightmare of major proportions. I wish to g-d I had not gone to that hospital. ER's are contract services operating under different rules. If they screw up they become invisible and that is all I am going to say about that.

Something that worries me is this: My PCP doesn't go to the hospital. He refers his patients out to specialists for particular needs of tx. If however you have an emergency he tells you to go to the ER. That scares me very much. I like my PCP...he is a jewel so changing docs hasn't even entered my mind.

I would most likely die from lack of treatment due to fear I acquired from the last trip to one.

I have to ask of the rest of you (not to those who are only embarrassed). There seems to be a general consensus about not wanting to go to the ER. That certainly doesn't say much for the idea of emergency care, now does it?

Two weeks ago I took my neighbor to the ER. Her doctor told her to go. The way she was treated there by an arrogant, narcissistic, ego-maniac, god complex doctor brought her to tears and she left the ER. She walked to a pharmacy nearly a mile away and called me to come get her. She hadn't had any food all day and was in a great deal of pain. She was almost disoriented. She subsequently had gallbladder surgery.

I have lost respect for ER's due to horror stories I hear repeated from many sources about how people are treated while there. It seems that in general ER docs have acquired a hostile/aggressive position towards patients. Yes, I understand that some of this is job related actually as they become hardened to life and jaded in their emotional expression or lack there of but coming from the patients point of view it is reflected as hostility and indifference. The majority have lost their ear for listening and forsaken their oath of "do no harm"

Just my observations/experience.

On the flip side I am sure there are still many excellent ER docs out there providing great care. Too bad they are now cast in the shadow of those that do the harm. When patients fear doctor in the ER and doctors succumb to the god complex we are all at risk....if nothing else but from fear.

When I was a young adult (back in the good old days) ...your doctor called the ER and gave orders that were then acted on and followed. Now it seems that once you get to the ER they want to do everything all over again like you just walked right in off the street withOUT any directives.

There is something very wrong going on in ER today. It may be something as simple as corporations, schedules, management, contracts and of course money and insurance or lack there of.

JMHO which is subject to revision based on any new information which may be obtained.

I'm sorry your neighbor had a negative experience in the ER and I hope she has recovered well after her cholecystectomy. I'm sorry that you had a negative experience also.

JMO, and I certainly don't want to presume to speak for all those who have posted, but I think the point of the thread was ... what type of truly emergent situation would bring you to the ER so as not to be "embarassed" as yet another non-emergent ER presentation.

I'm not labeling your ER visit or your neighbor's as non-emergent. But I'm willing to state that outside of trauma, stroke, respiratory distress & AMI, 80 out of 100 ER presentations are non-emergent.

Some people dislike their ER care because the ER environment is stressful. Yes, I feel badly when a little old lady is unnerved because the room next to hers contains a belligerent junkie & his accompanying police officers having a *discussion* about appropriate language & behavior. I also feel badly when a grieving family is in close proximity to another patient/family who do not yet know their diagnosis or planned disposition. Others don't know what to expect in the ER and seem shocked that they need to be undressed, they can't eat or drink until after diagnostic testing, there will almost certainly be an IV and there may be a need for other procedures as well. Pain is, in & of itself, not necessarily an emergency. But if a pt. comes to the ER because they want pain relieved immediately, I need to start an IV to do it. (I left my magic wand at home today) And then there is the view of the ER as the one-stop-don't-need-to-make-an-appointment-shop. I won't go there ... it's been discussed at length.

As for PCPs calling in "orders" to the ER ... if they know they want tests done, why not schedule them on an outpatient basis ... or if they are nearly certain the patient will require admission, why not directly admit them, at least for 23-hr. observation? Why send them to the ER at all? ER MDs have every right and responsibility to examine & evaluate pts. who present to them as they see fit.

Just food for thought.

[RN1263]

i was having left sided numbness and tonic spasms, i was home alone and decided to drive (since my right side wasn't affected....real smart...uuhhh). i refused to go to the e.r. i was a tech at, so i went to a different hospital....

WELL, the P.A. that worked in my e.r. dept. was getting in extra hours at this other hospital....ugh. he was greatly concerned though and called in the BEST neurologist (instead of a resident!). i won't bore you w/ all the tests, but i was admitted and told days later that i had multiple sclerosis, of course confirmed by a second opinion!

sometimes it pays to know someone in the e.r., because they make sure you get the best care....

[smk1, LPN]

hmm, not a nurse yet, have been to the ER twice that I can remember and once that I "sort" of remember. It is hazy but when i was really little I ate a thing of mothballs (don't ask why) and had to have my stomach pumped. When I was about 16 I got E. Coli in a famous outbreak at a local lake, and was hospitalized overnight with for dehydration. (the stomach pain was on par to early dilation labor pains, painful and not a whole lot of relief). When i was pregnant I fell at 20 weeks and had immediate contractions and had to go to the ER, was observed for 8 hours and sent home on bed rest for 2 weeks. Oh! and I was running with a oencil when I was about 4 and fell and got it stuck in my eye and had to go the hospital. Amazingly there is no sight damage or trace of any trauma! As a nursing student now with some healthcare knowledge, I couldn't imagine how sick I would have to be to sit for hours on end with weirdos and other sick people to be seen...

[christinemj]

About 2 years ago, kidney stones sent me to the ER. Dilaudid is a beautiful thing. :)

The previous ER visit had been about 15 years ago when I managed to fall down a flight of concrete stairs, break both arms, and seriously lacerate my head. That time, I didn't even want to go, but security for the building that I was in, insisted. I guess it was a good thing... I only thought I had a little "scrape" on my head, and my arms felt a little "bruised." Bystanders can be pretty logical, sometimes. :)

[Jennifer, RN]

ER stands for EMERGENCY ROOM. If you are not about to die, you probably do not need to come the the ER. Sometimes, pain will make you feel like you are about to die, so in those circumstances, yes, you probably should be in the ER. If you are not truely in pain (ER nurses and doctors CAN tell what 10/10 pain is), then you need to go to your PCP. If your PCP sends you to the ER for tx, you need to find a new PCP.

[Arkansas RN]

While I have gone in to my own ER "off the record" so to speak just to get a prescription for a UTI or something like that, I am not sure of anything short of coding that would get me in there offically. I have even told my husband that if I code at home to drag my body outside BEFORE calling the ambulance since I know all of them too and my house might not be clean enough!:wink2:

[Little Flower]

I'm sorry your neighbor had a negative experience in the ER and I hope she has recovered well after her cholecystectomy. I'm sorry that you had a negative experience also.

JMO, and I certainly don't want to presume to speak for all those who have posted, but I think the point of the thread was ... what type of truly emergent situation would bring you to the ER so as not to be "embarassed" as yet another non-emergent ER presentation.

I'm not labeling your ER visit or your neighbor's as non-emergent. But I'm willing to state that outside of trauma, stroke, respiratory distress & AMI, 80 out of 100 ER presentations are non-emergent.

Some people dislike their ER care because the ER environment is stressful. Yes, I feel badly when a little old lady is unnerved because the room next to hers contains a belligerent junkie & his accompanying police officers having a *discussion* about appropriate language & behavior. I also feel badly when a grieving family is in close proximity to another patient/family who do not yet know their diagnosis or planned disposition. Others don't know what to expect in the ER and seem shocked that they need to be undressed, they can't eat or drink until after diagnostic testing, there will almost certainly be an IV and there may be a need for other procedures as well. Pain is, in & of itself, not necessarily an emergency. But if a pt. comes to the ER because they want pain relieved immediately, I need to start an IV to do it. (I left my magic wand at home today) And then there is the view of the ER as the one-stop-don't-need-to-make-an-appointment-shop. I won't go there ... it's been discussed at length.

As for PCPs calling in "orders" to the ER ... if they know they want tests done, why not schedule them on an outpatient basis ... or if they are nearly certain the patient will require admission, why not directly admit them, at least for 23-hr. observation? Why send them to the ER at all? ER MDs have every right and responsibility to examine & evaluate pts. who present to them as they see fit.

Just food for thought.

In all fairness to truth and to answer your question... I agree with you on this statement. I thought it extremely odd that this wasn't done. Sometimes I just wonder in awe at the whole thing....especially after the next morning when her doc called her at home and blasted her off about how medically nescessary it was for her to go to the ER...that's why he sent her there. ER's are run differently today then in the past is all I can tell you and it seems that there is MORE lack of proper communication between the ER and the private docs. JMHO.

As to the other part of my post I think seizure is good enough to be angry about an ER....especially when nothing was done at all which consequently caused a second seizure. When I say nothing was done I mean nothing to evaluate. Why you ask? ....because of the next statement. However, the drug panel was all 100% clean as was the social history.

My beef with ER's is that everybody going there is drug-seeking. You have to prove your innocence up front first on that degree. Today it is a given that all patients are drug seeking if they go to the ER. Some docs make the ER's where they work hell holes of negativism and distrust of patients. True there are many who do go there seeking drugs (see thread about the funniest things that happen in the ER...all 90 something pages) but what about all the rest of the patients? Attitude towards the patient is what sets the tone of either a good ER or not so good one. Attitude is everything.

As to "what type of emergent situation would bring you to the ER so as not to be embarrassed as another non-emergent presentation"....the average person without medical education has no way of knowing or defining this. Even educated people sometimes get this skewed. Disgust, indifference and bad attitude from the ER staff then sets the tone for their fear experience conditioning. Not everyone has an insurance company with an oncall nurse line to pre-evaluate for the patient. Sometimes things happen to patients out in the field whereby they are delivered to ER's by ambulance without even wanting to go there in the first place......and all they are thinking about is how fast they can get out of there.

When on the other hand you arrive at an ER with a truly emergent situation only to have it mis-diagnosed and dismissed out of hand.....now THAT is one situation that could fall into the stated category but it certainly isn't the patients fault. You must remember there are many variables at play in a presentation. Automatic assumption is wrong and dangerous. It is a value judgement first and logical confirmation somewhere down on the list at maybe 9th out of 10. Bias IS contagous.

Temperance from the staff is paramount to patient relations. When an ER nurse or doctor loses there ability to maintain temperance and collar their personal feelings or disgust for the very people that allow for the payment of their income and are their source from which their livelihood is derived...then it is time to leave emergency medicine and take a sabbatical.

Or of course, you can do what lots of ER docs do when they make mistakes and just transfer to another state.

Not all ER's are the same. Some in big cities see more drug-seeking patients. Some in more rural old time communities see less. Ruling out drug-seeking behavior seems to be the gold standard of care first now which doesn't say much for our present society.

But,

A person's ability to judge their own situation as to whether or not it is emergent or not should not be contingent upon them not being made the laughing stock or blunt of the jokes in anybody's ER.

What happened to professionalism?

JMHO