Why I Don't Go To My Local Hospital

[Brown]

About three years ago, I found myself in serious pain. The pain was so bad that I could not stand or walk. Desperate, I called a friend and asked if he could drive me to an emergency room. It was a Sunday.

We decided to go to our local hospital. Eventually I managed to move myself into the emergency room. Even though I was the only patient in the emergency room, the staff acted as though it couldn't be bothered to treat me. Eventually, a doctor came, asked a couple of questions, did no examination, prescribed some pills, and walked out.

The pills didn't do diddly. When I told my regular doctor about the prescription, he was appalled. The medicine that was prescribed was the wrong one. (Although I paid a pretty penny for non-existent medical treatment, I eventually just got better on my own.)

So I decided not to use the local hospital any more.

As if I needed yet another reason to avoid this hospital, I recently received a magazine that publishes stories about the suburb where I live, its people and its businesses. One of those profiled in this issue was the local hospital.

Here is how the article begins:The air is heavy with the intoxicating aromas of lilac, vanilla and honeydew.

The lighting is low and the sheets are down-soft.

Gentle harps, string and piano music sooth the senses, and the only other sound is the clock on the wall and the deep, meditative breathing of the Healing Touch volunteer, whose gentle methods bring on the sensation of floating that begins in the feet and drifts up through the body.

Welcome to the world of holistic healthcare....
...
"We all have energy stems," explains K*** M****, registered nurse and coordinator of the volunteer Healing Touch center.... "Those energies can get a little out of balance with surgery or with having a baby or chemo. This (treatment) balances the energies, thereby promoting self-healing."These passages--which use the word "explains" in a sense that is unfamiliar to me--are followed by more mumbo jumbo about the so-called "therapies" and when such "therapies" are recommended. Surprise, surprise, these "therapies" are recommended in a wide variety of cases.

Then the article gets scary: Every member of the nursing staff is "trained" in these "therapies." The article calls the staff "conservative, medical-based healing artists" and refers to their services as "elite health care."

What are those therapies? A separate feature lists them. They are Essential Oils ("Extracts of plants used to restore balance to the body through the sense of smell"); Guided Imagery ("Internal experiences of memories, dreams, inner perceptions and visions serve in connecting the mind-body-spirit"); Music Therapy ("...to ensure access to healing music that features spiritual and nature sounds"); Accupressure ("Bands are placed on the wrist. Small button used to stimulate specific pressure points between the two tendons on the arm"); and Healing Touch ("A light touch or passing over the body that focuses the body's natural energies").

Time was when nurses were trained in medicine, not this sort of quackery. But if you go to this hospital, you'll get a nurse who probably has some medical training, but who also probably has been trained to be a woo-woo.

[Eos of the Eons]

Is that a homeopath hospital?? This is what scares me about privatization. You make money on what sells. That is what private hospitals do...

In our province we are spending lots of money on this junk too, with the intention of introducing it to the hospitals here. There is a lot of talk about privatization...


http://www.camlawblog.com/hospital-policy-171-calgary-canada-leads-way-in-cam-research-and-clinical-training.htmlMount Royal College in Canada will open Canada's first post-secondary institute dedicated to advancing complementary and alternative health, together with a 24-hour phoneline to dispense information about 'scientifically proven alternative health options.'

CAM use in Canada is apparently higher than in the U.S. With the opening of this clinical training and research center for complementary therapies, Canada is moving the way forward for greater international consensus around law and policy pertaining to CAM use.


Well, considering the popular goverment folks around here consist of MPs that are chiros...I'm not surprised at this in the least.

What did they prescribe you Brown?

[CFLarsen]

Originally posted by Eos of the Eons
Is that a homeopath hospital?? This is what scares me about privatization. You make money on what sells. That is what private hospitals do...

Don't worry. Never forget the magic spell:

http://www.skepticreport.com/resources/smilies/engel1.gif "The market will take care of itself." http://www.skepticreport.com/resources/smilies/engel2.gif

After a pile of dead bodies and ruined lives, of course...

(Edited to spel rite.)

[Dr. Imago]

Brown,

What was the eventual correct diagnosis, if you don't mind me asking?

I mean, I feel horrible that you were treated so badly in the ER. But, sadly, the ER has become more of an overcrowded walk-in Family Practice clinic than a place to treat real emergencies. Honestly, a lot of ER docs are just so burned-out, jaded, and cynical that they don't care much to really get to the bottom of the problem. I've spent my fair share of time in the ER, and trust me it's not the best place for anyone to be - including the staff.

As for all the alt.med stuff going on at your local hospital, well... as Claus says, bullsh*t sells. It's easier to cater to public misconceptions than it is to actually fix real problems. I've actually (I believe) thought of a realistic a solution to the whole ER mess, but it would require a complete change of the concept of what an ER is as well as a fairly substantial upfront financial investment by hospitals that many are, quite frankly, just not willing to make. Instead, they promote this other quackery and silliness.

Glad your problem resolved itself. As someone once said (allowing me license to paraphrase), often doctors exist only to humor patients while they get better on their own.

-TT

[Brown]

Originally posted by Eos of the Eons
Is that a homeopath hospital?? This is what scares me about privatization. You make money on what sells. That is what private hospitals do... I don't know whether the hospital pushes homeopathy or not. As far as I can tell, it is an otherwise ordinary community hospital, with a maternity ward, ICU, an emergency room, and so forth. I was hesitant to identify the hospital, because my source was purportedly not affiliated with the hospital. The hospital's own web site (http://www.woodwinds.org/Care/Integrative.cfm), however, touts these "Integrative Therapies." I could not find anything about homeopathy on the web site.Originally posted by Eos of the Eons
What did they prescribe you Brown? The events in question took place about three years ago, so I can't remember many specifics. Basically, my lower back started hurting so much that any motion was very painful. Walking was a challenge, and even sitting was uncomfortable. I believe (but I'm not 100% sure) that the ER doctor prescribed a muscle relaxant. When I followed up with my own doctor, he was shocked, and said that such a medication wouldn't do any good. I confirmed he was right about this; it didn't work. My doctor then prescribed something else--possibly an anti-inflammatory--and this brought the pain under control.

[Brown]

Originally posted by ThirdTwin
Brown,

What was the eventual correct diagnosis, if you don't mind me asking?

I mean, I feel horrible that you were treated so badly in the ER. But, sadly, the ER has become more of an overcrowded walk-in Family Practice clinic than a place to treat real emergencies. Honestly, a lot of ER docs are just so burned-out, jaded, and cynical that they don't care much to really get to the bottom of the problem. I've spent my fair share of time in the ER, and trust me it's not the best place for anyone to be - including the staff.This ER was not overcrowded. In fact, it was virtually deserted. I was the only patient. No one there was overworked, at least not while I was there. And this wasn't the middle of the night, either, but about 9:00 in the morning.

I've been to the ER of other hospitals (as a patient) three other times in my life. In the first, the ER was most certainly overcrowded (it was a Denver hospital) and every resource seemed to be stretched thin. As you say, many patients who were there were not emergency cases in the conventional sense, and they were drawing the resources of the staff. Also, I wasn't bleeding (I was coming down with mono), so my case wasn't a priority. I was disappointed, but not surprised, that I got poor care there.

My second ER visit involved me taking a cab to a hospital, walking into the ER, and saying that I thought I might have appendicitis (it turned out that I did). This ER wasn't crowded and I was seen immediately. The sad part about that experience was that I needed to be admitted to the hospital, but the hospital didn't have any available beds. So I was stuck in an ER treatment room for a few hours while the staff arranged for surgery and a hospital room. Otherwise, they treated me all right.

My third ER visit was as a part of my "Clinton Syndrome," which turned out to be due to medication side effects and not a heart problem. In that case, there didn't seem to be quite enough staff on duty, so everybody was a little harried. My care there was pretty good.

[Dr. Imago]

Originally posted by Brown
The events in question took place about three years ago, so I can't remember many specifics. Basically, my lower back started hurting so much that any motion was very painful. Walking was a challenge, and even sitting was uncomfortable. I believe (but I'm not 100% sure) that the ER doctor prescribed a muscle relaxant. When I followed up with my own doctor, he was shocked, and said that such a medication wouldn't do any good. I confirmed he was right about this; it didn't work. My doctor then prescribed something else--possibly an anti-inflammatory--and this brought the pain under control.

[DEVIL'S ADVOCATE]

Why did you go to the ER in the first place? Did the pain come on suddenly and inexplicably? Was it truly an "emergency"? Why didn't you call your regular doctor first?

[/DEVIL'S ADVOCATE]

A lot of ER docs (and I'm not making a value judgment nor am I speaking for all of them) are very frustrated with people coming to the ER in the absence of a "real" emergency. This is not to diminish the pain that people are suffering or the inconvenience that, say, a low-grade fever may be causing someone at 3 A.M. when you have to be at work the next day, but many of these physicians feel that their training and resources as an emergency physician are being exploited. It's kind of like dialing 911 to report when the garbage man doesn't come to pick up the trash on time.

If you have a regular doctor (and everyone should) and are having a problem, you should call him/her first unless it is a true emergency. After all, that's what they are there for. If after you call them they feel you need to go to the ER, they will call the ER to report that you are coming and/or meet you there.

If you are truly having an emergency, which includes (but is not limited to) the following...

- New or worsening chest pain
- Shortness of breath or inability to catch one's breath
- Prolonged uncontrollable vomiting
- Trauma
- Sudden, voluminous bleeding from any orifice
- Loss of vision
- The "worst headache of your life"
- Onset of inexplicable excrutiating and debilitating pain anywhere in your body
- Loss of consciousness
- Sudden confusion or inability to speak
- Weakness in a body part
- Serious bites, poisonings, or overdoses (e.g. accidental, intentional, or venomous bites)

You should always trust your instincts if you really think you need to see a doctor immediately. If you're not sure, call your own private doctor first. They don't mind. :) The ER is not, contrary to the apparently prevailing opinion among the general public, the best place to be evaluated and treated for most things.

Not trying to be preachy, Brown. Just illustrating some of the frustrations from the other side.

-TT

[Dr. Imago]

I see you answered while I was posting...

You got burned by the "ER burn-out". The irony is, sometimes the less patients there are the less motivated people are to work.

-TT

[PixyMisa]

Originally posted by ThirdTwin
- New or worsening chest pain
- Shortness of breath or inability to catch one's breath
- Prolonged uncontrollable vomiting
- Trauma
- Sudden, voluminous bleeding from any orifice
- Loss of vision
- The "worst headache of your life"
- Onset of inexplicable excrutiating and debilitating pain anywhere in your body
- Loss of consciousness
- Sudden confusion or inability to speak
- Weakness in a body part
- Serious bites, poisonings, or overdoses (e.g. accidental, intentional, or venomous bites)
What, all at once? I can see how that could be inconvenient.

[EdipisReks]

i hate to derail the thread, but i want to relate my ER experience. this past september i had a seizure and suffered from dysphasia for an hour. after finally reaching my GP (after i could speak and recognize numbers again), i was told to go to the emergecy room for a CT scan, as it might be a brain aneurysm (it was a "just to be sure" kinda thing, i think). the place wasn't crowded, and i sat in the waiting room for 2 hours before i was finally taken in. personally, i think the possibility of a brain aneurysm is an emergency and should have been processed more quickly, especially since it wasn't busy. by this point i wasn't suffering from from my original symptoms, and i was told that it was probably an "anomalous migraine". i do suffer from migraines, and i've been seeing a neurologist since the incident, but this diagnosis kind of stuck me as "we have no idea what the hell happened to you". that was a bit unnerving, but they gave me a prescription for vicodin, which i didn't need and never asked for. at least they prescribed something that would have gotten rid of any pain i had. unfortunately, they didn't give me anything for the nausea and dizziness i suffered from for the next week (and which i was suffering from at the ER). oh well, i lived.

[EdipisReks]

Originally posted by ThirdTwin

If you are truly having an emergency, which includes (but is not limited to) the following...

- New or worsening chest pain
- Shortness of breath or inability to catch one's breath
- Prolonged uncontrollable vomiting
- Trauma
- Sudden, voluminous bleeding from any orifice
- Loss of vision
- The "worst headache of your life"
- Onset of inexplicable excrutiating and debilitating pain anywhere in your body
- Loss of consciousness
- Sudden confusion or inability to speak
- Weakness in a body part
- Serious bites, poisonings, or overdoses (e.g. accidental, intentional, or venomous bites)


i had the "worst headache of my life" during my epiode. when it happened it felt like my brain was on fire. my GP told me to use that exact language when i got to the ER. if using that specific language was supposed to cause some kind of quick action, however, it failed.

[Barbrae]

As someone once said (allowing me license to paraphrase), often doctors exist only to humor patients while they get better on their own.

costs a pretty penny to "humor" a patient while they get better on their own.

[Mojo]

Originally posted by Barbrae
As someone once said (allowing me license to paraphrase), often doctors exist only to humor patients while they get better on their own.Well...

Was it the word that was in place of "doctors" you have paraphrased, by any chance?

[EdipisReks]

Originally posted by Barbrae
As someone once said (allowing me license to paraphrase), often doctors exist only to humor patients while they get better on their own.

costs a pretty penny to "humor" a patient while they get better on their own.
:i:

[jimlintott]

I remember one trip to the emrgency room where I received swift and immediate attention simply by uttering the words " I got sodium hydroxide in my eyes". Next thing I know I'm having my eyes flushed and had a swarm of busy people around me. They worried about filling out forms and such after.

That was a bad day and it hurt, a lot. Don't ever get that stuff in you eyes. Trust me.

[joesixpack]

-Onset of inexplicable excrutiating and debilitating pain anywhere in your body If Brown's back pain was anything like my first episode of lower back pain, then that quote is the best way to describe it. If you've never experienced it before, it's very frightning and it does feel like an emergency.

[Dr. Imago]

Originally posted by joesixpack
If Brown's back pain was anything like my first episode of lower back pain, then that quote is the best way to describe it. If you've never experienced it before, it's very frightning and it does feel like an emergency.

I meant to imply sudden, not gradual. For example, if you get a pain just below your ribcage on the right side of your body that doubles you over (and, perhaps, you even vomit), then you should go to the hospital. Lower back pain that gets gradually worse over a few days (and I see this ALL the time in the ER) is not a reason to visit your local emergency room. That is a perfect time to call your primary doctor.

Originally posted by EdipisReks
i had the "worst headache of my life" during my epiode. when it happened it felt like my brain was on fire. my GP told me to use that exact language when i got to the ER. if using that specific language was supposed to cause some kind of quick action, however, it failed.

Well, this is definitely a "buzz phrase" that, if the brief history-taking that ensues elicits the proper responses, will get quick action in the ER. The concern here is mainly about a subarachnoid bleed, such as would be caused by a ruptured aneurysm.

The problem with showing up and getting, say, an immediate CT scan may be that of scheduling. Sometimes it's about authorization (e.g., certain insurance carriers have to approve tests or the hospital doesn't get reimbursed for them). Who knows what specifically happened in your case? Could be any number of things, but I'm certainly not defending the way ERs are run in the U.S. Again, I think we need major changes and a revolutionary new way to look at ERs. Until administrators are willing to make the financial investment in doing this (i.e., it somehow becomes cost effective in the grand scheme of things), things will pretty much continue the way they are now.

Long story short: try to avoid the ER at all costs unless you absolutely, positively have to go there. It's not a place to take your sniffles or earaches or low-grade fevers or chronic lower back pain. If you do this, you will wait a long, long, LONG time to be seen - even if you are the only one sitting in the waiting room. If you are TRULY having an emergency, you'll be amazed at how fast things move. (That triage nurse you talk to out front has more power than many people realize.)

-TT

[joesixpack]

I meant to imply sudden, not gradual. That's what I was talking about. I had bent over to pick up a magazine of the floor and the pain hit so fast and so hard that I was on my hands and knees and almost unable to breathe or speak. I had never had any back pain before in my entire life. Lower back pain that gets gradually worse over a few days You've obviously never had it. My case wasn't exceptional as I have spoken with a number of people who've had the same experience.

EDIT: It's not a place to take your ...chronic lower back pain. Yes, I agree. There's not a thing that anyone can do for you. It generally goes away on it's own after a few weeks.

[Dr. Imago]

Originally posted by joesixpack
That's what I was talking about. I had bent over to pick up a magazine of the floor and the pain hit so fast and so hard that I was on my hands and knees and almost unable to breathe or speak. I had never had any back pain before in my entire life.

Then, this is a case, as I describe in more detail below, where you have to use some common sense (no offense intended).

Originally posted by joesixpack
You've obviously never had it. My case wasn't exceptional as I have spoken with a number of people who've had the same experience.

Yeah, you're right. I've never personally had back pain like that. But, it sounds like you just moved wrong and wrenched something (to be non-technically... I can be if you want me to, though, but that would require talking about a list of different possibilities that may have caused this, absolutely none of which are life threatening, and only one of which is a potential medical emergency, given the way you describe it - but is SO rare that for all practical purposes it is only considered after everything else has been ruled out... and still would likely be missed by your average, run-of-the-mill ER doc).

The question is: what does a patient, in general, hope to accomplish by going to the ER in this situation? It's not meant to be a nasty, demeaning rhetorical question. I'm being completely serious. Do you hope to get the problem fixed? Do you want it specifically diagnosed and treated there? Do you just want to get pain medication to make it stop?

These are pertinent questions that, I think, can help to better describe the "gestalt" of the ER, which is something that a lot of people just don't get. That's the disconnect I'm talking about (and, in my opinion, what needs major fixing from our end).

Originally posted by joesixpack
EDIT: Yes, I agree. There's not a thing that anyone can do for you. It generally goes away on it's own after a few weeks.

Well, there are things you can do, actually. You can lose weight, you can do strengthining exercises to improve the muscle tone and development in your paraspinal muscles and abdomen, you can buy a better mattress to sleep on (which is the source of a LOT of "chronic" back pain), you can be evaluated by a pain management specialist who may be able to pinpoint the problem (if it is spinal in origin), or you may be a candidate for surgery.

The key is to talk to the right people about the problem. You're just not going to accomplish much by going to the ER at 3:00 AM and talk to someone who doesn't have much expertise in lower back pain and is, quite frankly, probably not all that interested especially when they've got other truly sick patients to see.

-TT

[joesixpack]

The question is: what does a patient, in general, hope to accomplish by going to the ER in this situation? Well, I didn't go to the ER, but I'm not surprised that someone would. As I said, it's very frightning to have such a sudden onset of so debilitating a pain. The fear is that sometning is terribly wrong and will only get worse. And, you're desperate to make it stop hurting. Most people (myself included) don't have enough medical education to understand that the condition is temporary, or that there's nothing that can be done in most cases.Well, there are things you can do, actually. You can lose weight, you can do strengthining exercises to improve the muscle tone and development in your paraspinal muscles and abdomen, you can buy a better mattress to sleep on (which is the source of a LOT of "chronic" back pain), Well, all of this I know now, but only after speaking with a competent medical authority. None of that is intuitivly obvious to a guy (or girl) with no medical education and doubled over by debiliting pain.

Sometimes people will end up in the ER who don't need to be there simply because the average person isn't able to accurately diagnose themselves. There's no way around that. I can understand that if the ER staff is overworked they don't have time for non-emergencies, but when no one else is there, they could at least have given Brown a bit more compassion. It's not like he needed the staff to stop administering CPR to another patient so he could have his runny nose looked at.

[Pragmatist]

Originally posted by ThirdTwin
The question is: what does a patient, in general, hope to accomplish by going to the ER in this situation? It's not meant to be a nasty, demeaning rhetorical question. I'm being completely serious. Do you hope to get the problem fixed? Do you want it specifically diagnosed and treated there? Do you just want to get pain medication to make it stop?

What you need to take into account, is that during an acute episode of sudden debilitating back pain, the patient is in no rational frame of mind to coolly evaluate the situation. I've had the same experience as joesixpack, and in that situation, you are struggling to breathe, the slightest movement is agony - and that is assuming any significant movement is even possible - the muscle spasm can be so intense that you are effectively paralysed in a fetal position. Given the anxiety that generates, all rational thought goes out the window.

And in that situation all anyone wants is help. All you want is for the pain to stop and to be able to move/breathe. You don't care how that is achieved or who does it. In my case the only time it happened and a friend took me to an ER, the problem was enormously and quickly helped by an injection of muscle relaxant. So the mileage varies depending on the specific nature of the complaint.

And although I'm not a medical person, I'm not convinced that such a situation is not potentially life-threatening or at least dangerous. The intense muscle spasm can pull the joints and increase pressure on the affected (or other) nerves - is there a chance of permanent nerve damage from prolonged severe compression? Not to mention that it can also affect the circulation and I would imagine that it could cause some extremeties to be deprived of blood for some time with consequent possible damage. I may of course be wrong, but is it worth taking the risk?

[Checkmite]

Emergency rooms these days tend to double as Primary Care centers for the indigent. Families with no insurance and no money will use the emergency room when their kids have colds or what have you. The reason is that emergency rooms are legally required to provide care to everybody who walks in, whether they have insurance or money or not. It makes sense that an emergency doctor would get burned out quickly on non-emergencies. He didn't want to be a GP, but here he has to be one regularly. It's not the job he wanted, therefore he is miserable.

Another thing to keep in mind is that emergency rooms are also exploited for another reason. In Brown's case, the triage nurse saw somebody walk in unassisted, then sit down and complain that the pain is so bad he could barely move. Brown, I'll be willing to bet that although you may have gotten very agitated, you weren't particularly vocal about it - which is natural, of course. You'll sit there and stew, getting more pissed off, but still wanting to be polite. The triage nurse may have concluded that you were a druggie who wanted a painkiller fix. Staff can get jaded that way.

[Dr. Imago]

Originally posted by Pragmatist
The intense muscle spasm can pull the joints and increase pressure on the affected (or other) nerves - is there a chance of permanent nerve damage from prolonged severe compression? Not to mention that it can also affect the circulation and I would imagine that it could cause some extremeties to be deprived of blood for some time with consequent possible damage. I may of course be wrong, but is it worth taking the risk?

Not really, this doesn't happen, and depends.

The one situation that I alluded to that is a true medical emergency is when a vertebral artery is somehow severed. But, in the case of the mechanism of injury that joesixpack describes, the likelihood of this happening is so remotely small... I'm not even personally aware of an actual case report (althought there may be one out there somewhere). Of course, if such a patient were to be in a car wreck or fell off of a latter, that'd be an entirely different story.

I hear your point about going to the ER in this case. And, I'm not completely nor necessarily disagreeing with you. Quite the contrary. I think medicine needs to better cater to the patient in most instances. An interesting seminar (and I call it that because it wasn't truly a medical conference although it was about medicine) I went to one time put it to the audience of doctors and nurses this way by using a simple word game that went like this...

One of the doctors was invited on stage to read a case report. It was pretty standard stuff... "The patient is a 28-year-old female who comes to the clinic with a 3 day history of earache. The patient reports having a similar episdode last year... (etc.)"

When he was done, the audience was casually polled about what they thought. Most were not terribly impressed or excited with what was a relatively boring, standard case report of an otherwise straightforward problem. Many had a "what was the point of that" look on their faces.

Then, the lecturer handed a second piece of paper to the same doctor and asked him to read it... "The customer is a 28-year-old female who comes to the clinic with a 3 day history of earache. The customer reports having a similar episdode last year..."

The "aha" of the crowd attending the lecture was palpable.

That's the big problem with the current medical paradigm, especially in the ER where ER docs, quite frankly, have to deal with a lot of B.S. that has nothing to do with what they were trained to treat. Any "back pain" patient suddenly becomes a potential drug-seeker. Any grouchy, antagonistic mom toting a three-year-old with a temperature of 99.1 demanding antibiotics becomes a reason for them to question why they went into medicine in the first place.

I don't think doctors expect people to diagnose themselves. Certainly, back pain as you describe itcould, at the very least, be treated with pain killers in the ER that you couldn't otherwise get. But, I'm still not convinced that this is the best use of the ER's resources, and clearly the full reasons why a back pain will always get to spend time in the waiting room is multifaceted, including far more than those I've mentioned here. Right or wrong? You be the judge. I'm just trying to illustrate a few of the reasons behind the reality. And, I know that most of the time a better alternative is to pick up the phone and call your private doctor, someone with whom you already have a rapport, if you're not sure you're truly having an emergency. You might just get faster service anyway (e.g., a call-in prescription, a same-day appointment in his/her office, etc.) and be able to avoid the additional heartache of being treated in the ER. Finally, if you don't have a private doctor, you should get one.

-TT

[Dr. Imago]

Originally posted by Joshua Korosi
Emergency rooms these days tend to double as Primary Care centers for the indigent. Families with no insurance and no money will use the emergency room when their kids have colds or what have you. The reason is that emergency rooms are legally required to provide care to everybody who walks in, whether they have insurance or money or not. It makes sense that an emergency doctor would get burned out quickly on non-emergencies. He didn't want to be a GP, but here he has to be one regularly. It's not the job he wanted, therefore he is miserable.

Another thing to keep in mind is that emergency rooms are also exploited for another reason. In Brown's case, the triage nurse saw somebody walk in unassisted, then sit down and complain that the pain is so bad he could barely move. Brown, I'll be willing to bet that although you may have gotten very agitated, you weren't particularly vocal about it - which is natural, of course. You'll sit there and stew, getting more pissed off, but still wanting to be polite. The triage nurse may have concluded that you were a druggie who wanted a painkiller fix. Staff can get jaded that way.

Read this after I responded. Glad to see you touched on a few similar points. This is why I would completely remodel and restaff the emergency. The question is whether or not the hospital would be willing to take a slight financial hit to better serve their patients. Unfortunately, I think I already know the answer to that. But, things like this (http://www.ehealthconnection.com/regions/toledo/content/30_minute_Home.asp) give me some hope. However, we need to see outcomes measures to ensure that we are not actually comprimising care in order to speed time to treatment.

-TT

[Pragmatist]

Originally posted by ThirdTwin
Not really, this doesn't happen, and depends.

The one situation that I alluded to that is a true medical emergency is when a vertebral artery is somehow severed. But, in the case of the mechanism of injury that joesixpack describes, the likelihood of this happening is so remotely small... I'm not even personally aware of an actual case report (althought there may be one out there somewhere). Of course, if such a patient were to be in a car wreck or fell off of a latter, that'd be an entirely different story.

I hear your point about going to the ER in this case. And, I'm not completely nor necessarily disagreeing with you. Quite the contrary. I think medicine needs to better cater to the patient in most instances. An interesting seminar (and I call it that because it wasn't truly a medical conference although it was about medicine) I went to one time put it to the audience of doctors and nurses this way by using a simple word game that went like this...

One of the doctors was invited on stage to read a case report. It was pretty standard stuff... "The patient is a 28-year-old female who comes to the clinic with a 3 day history of earache. The patient reports having a similar episdode last year... (etc.)"

When he was done, the audience was casually polled about what they thought. Most were not terribly impressed or excited with what was a relatively boring, standard case report of an otherwise straightforward problem. Many had a "what was the point of that" look on their faces.

Then, the lecturer handed a second piece of paper to the same doctor and asked him to read it... "The customer is a 28-year-old female who comes to the clinic with a 3 day history of earache. The customer reports having a similar episdode last year..."

The "aha" of the crowd attending the lecture was palpable.

That's the big problem with the current medical paradigm, especially in the ER where ER docs, quite frankly, have to deal with a lot of B.S. that has nothing to do with what they were trained to treat. Any "back pain" patient suddenly becomes a potential drug-seeker. Any grouchy, antagonistic mom toting a three-year-old with a temperature of 99.1 demanding antibiotics becomes a reason for them to question why they went into medicine in the first place.

I don't think doctors expect people to diagnose themselves. Certainly, back pain as you describe itcould, at the very least, be treated with pain killers in the ER that you couldn't otherwise get. But, I'm still not convinced that this is the best use of the ER's resources, and clearly the full reasons why a back pain will always get to spend time in the waiting room is multifaceted, including far more than those I've mentioned here. Right or wrong? You be the judge. I'm just trying to illustrate a few of the reasons behind the reality. And, I know that most of the time a better alternative is to pick up the phone and call your private doctor, someone with whom you already have a rapport, if you're not sure you're truly having an emergency. You might just get faster service anyway (e.g., a call-in prescription, a same-day appointment in his/her office, etc.) and be able to avoid the additional heartache of being treated in the ER. Finally, if you don't have a private doctor, you should get one.

-TT

Thanks for the clarifications. And I also agree with your viewpoint as well, I have been in several ER's in several different countries and it was much the same situation everywhere. Medical staff run ragged trying to deal with drunks, drug addicts, whiners etc. But amongst all that, some genuinely suffering people.

Personally, I think a lot of it could be improved with more efficient triage. Not everyone needs to see a fully qualified surgeon. A good nurse should be able to deal with cuts and abrasions and put in simple stitches - although of course I realise for liability's sake they need an exam first - and that seems to be part of the problem. At the same time, although more cases could be handled by lower qualified staff, maybe the situation could be helped by more qualified triage staff. Which sounds like a contradiction in terms, but what I mean is that there is clearly an optimum balance between triage and treatment - maybe juggling that balance a bit might help. I realise there's a potential risk at having someone assessed and treated solely by lower grade personnel, but at the same time, it doesn't help the situation to have the most qualified staff exhausted, wasting time with trivialities and leaving other cases waiting.

It would also make a difference if the drunks etc., were filtered out and sent to a separate area on arrival. Maybe cases like that could be primarily handled by security staff with some paramedic training.

One aspect I ought to mention, obviously the situation changes in different countries. In some countries it's extremely difficult to get a doctor to attend on demand - especially out of hours, even private ones. In those situations the ER is really the only choice if the problem seems to be urgent.

Perhaps another solution would be more simple community medical centres with 24/7 quasi-emergency facilities, i.e. not the facilities of a full hospital, but enough to deal with stitching up the odd wound, giving essential jabs etc.

[Jas]

Here they have a really good service, where you call a local phone number, and get to speak with an RN. I think the main reason for this is to keep people from going to the emergency room thinking they have meningitis, when really they just slept with their neck in a funny position. They'll let you know if it can wait until the next day, or if/when you should go see the doctor.

[Pragmatist]

Originally posted by Jas
Here they have a really good service, where you call a local phone number, and get to speak with an RN. I think the main reason for this is to keep people from going to the emergency room thinking they have meningitis, when really they just slept with their neck in a funny position. They'll let you know if it can wait until the next day, or if/when you should go see the doctor.

Good point - information. And funny you should mention that. I once had to take the son of a friend to an ER in the middle of the night because we suspected possible meningitis. The kid had woken up screaming in the night, he was disoriented, had a high fever, was vomiting and complaining of intense headache and stiffness of the neck. We phoned his doctor who basically said, (I'm paraphrasing of course) "How the heck would I know if it's meningitis? Take him to the ER". So we did. And since we didn't know how serious it was we decided fast would be better, so I ended up driving 10 miles at 3 a.m. and even ran a couple of red lights on the way - luckily there wasn't much traffic about at that time.

The good thing was that there was a very competent doctor at the ER who quickly checked his vitals, asked some very specific questions and then informed us not to panic because it was a common bug going round and he'd seen a dozen similar cases in the last week that superficially looked like meningitis but which was really quite transient and mostly harmless. He was right of course.

But we would have been saved a lot of trouble and worry, and so would the doctor at the ER, if that kind of information (about a common bug doing the rounds) had been easily available.

So yes, that helpline sounds like a great idea.

[Dr. Imago]

Originally posted by Pragmatist
Good point - information. And funny you should mention that. I once had to take the son of a friend to an ER in the middle of the night because we suspected possible meningitis. The kid had woken up screaming in the night, he was disoriented, had a high fever, was vomiting and complaining of intense headache and stiffness of the neck. We phoned his doctor who basically said, (I'm paraphrasing of course) "How the heck would I know if it's meningitis? Take him to the ER". So we did. And since we didn't know how serious it was we decided fast would be better, so I ended up driving 10 miles at 3 a.m. and even ran a couple of red lights on the way - luckily there wasn't much traffic about at that time.

The good thing was that there was a very competent doctor at the ER who quickly checked his vitals, asked some very specific questions and then informed us not to panic because it was a common bug going round and he'd seen a dozen similar cases in the last week that superficially looked like meningitis but which was really quite transient and mostly harmless. He was right of course.

But we would have been saved a lot of trouble and worry, and so would the doctor at the ER, if that kind of information (about a common bug doing the rounds) had been easily available.

So yes, that helpline sounds like a great idea.

Haha. Now, this is interesting because, in that instance and had you called me, I would have clearly sent him to the ER too. But, this has probably as much to do with the litigious nature of medical practice in the U.S. as well as the fact that there's truly is, of course, no real way to know over the phone whether or not that is meningitis - even IF there is a common bug going around. Most doctors wouldn't have the guts to take the risk that it was "nothing to worry about" in that instance, and would do exactly what the doctor you called did. And, I'm sure that in most cases you would get prompt attention in the vast majority of ERs, especially if you presented with a child (as you did) in such a condition.

But, still you called the doctor and did the right thing. And, I'm not sure if you were aware of this or whether or not he told you, but I'm sure that he called ahead and let the ER know you were coming. This also can almost magically open a lot of doors.

-TT

[Brown]

Originally posted by Joshua Korosi
Another thing to keep in mind is that emergency rooms are also exploited for another reason. In Brown's case, the triage nurse saw somebody walk in unassisted, then sit down and complain that the pain is so bad he could barely move.Um, no, that's not the way it was. It was agony for me to get in my friend's car for the drive to the hospital, and when we arrived, I could not get out. My friend went inside and procured a wheelchair for me, and the triage nurse watched as I extracted myself from the car with great difficulty, and seated myself in the wheelchair.

I'd had back pain before, but never like this. I'd had a few times when my back went "out," so that I could not walk for a few hours. But this was different. This was not only incapacitating, it was horribly painful. In addition, there was no known cause for it (no fall, no strain, no heavy lifting, etc.) I am perfectly satisfied that this was a legitimate emergency.

As for my own doctor, there was no way to call him on a Sunday. If you call his office number, you get a message: "If this is an emergency, call 9-1-1."

[pgwenthold]

Originally posted by ThirdTwin
Long story short: try to avoid the ER at all costs unless you absolutely, positively have to go there. It's not a place to take your sniffles or earaches or low-grade fevers or chronic lower back pain. If you do this, you will wait a long, long, LONG time to be seen - even if you are the only one sitting in the waiting room. If you are TRULY having an emergency, you'll be amazed at how fast things move. (That triage nurse you talk to out front has more power than many people realize.)

-TT

I think this last comment is very relevent. If it is a true emergency, things will happen. If you are sitting there for two hours in Emergency ward, it is likely because they determined that you could. And never assume that because things don't look busy in front doesn't mean they aren't busy in the back.

I know it's hard to not get worked up about things, when they happen to you. I remember how when my wife went through her thyroid testing that I was getting hot and bothered by the lack of response from the hospital regarding her tests. Of course, it wasn't an emergency, so it wasn't something that had to be known right away, but still I was very anxious (of course, it didn't help that they told us the results would be available on Thursday but we didn't get them until the next Tuesday). However, despite that extra 5 days, no one was in danger or anything.

Contrast that with the activity that happened when she went in for her appendix. PCP got her in right away, got the exams completed, and took radiographs. Referred her to the hospital for ultrasound, which took place immediately and we got the answer right away. When the condition was actually threatening, they did the job without delay.

[a_unique_person]

Having been a patient in a critical care unit, all I can say is that anything that takes away the incredibly depressing atmosphere a hospital can have has to be good. There are people in serious trouble there, some of them dying in front of you. The neat and clinical look is efficient, but not much of a lift when you need it.

[jambo372]

Our local hospital (Monklands General) is a joke, so are the doctors who run it.

This is what happened a few weeks ago.

My four year old cousin (actually second cousin) hadn't been well all day. His mum (my cousin) took him to the hospital. He was repeatedly coughing and his temperature was sky high. The doctor barely even glanced at the toddler, said he had a chest infection and wrote a prescription for Calpol and Amoxil. They left the hospital.

Later on at 11pm that night he started to turn blue and was wheezing terribly. His parents panicked and took him back up to the hospital straight away. They waited 30 minutes to see a doctor. The doctor just looked at the child and looked up google on the internet for information ! He then printed information on croup and told his mum to read it and was about to send them home. Then a nurse came in and said " You can't send him home in that state you eejit". My cousin asked her if they were keeping him in over night - the nurse said " We don't have a paediatric ward here, we don't even have a paediatrician". The nurse dialled an ambulance to take him to Wishaw General. My cousin asked if she could just drive him by car - they said they couldn't risk him stopping breathing in the car without oxygen. They waited for an hour and a guy came in from an ambulance, he told the receptionist he'd been poked in the eye in a fight. The receptionist went mental with him and started shouting " You phoned an ambulance cos you got poked in the eye, is that what you call a ****in' emergency ? I've got a wean in that waiting room half choked to death needing an ambulance to take him to Wishaw and you phoned one just cos somebody poked your eye. I need a drink to calm down." They waited another hour and the receptionist eventually had to say it was a blue light case just so they could get an ambulance on time. He was hallucinating with fever.

They got to Wishaw General and he was given steroid tablets and kept in to be assessed. They eventually let them go home in the early hours of the morning. They said that if he took a relapse they had to go directly back to Wishaw General because the Monklands was so inadequate.

Firstly a glaringly obvious misdiagnosis and then this rigmarole ...

From previous knowledge of the Monklands half of the nurses can't even change an IV saline solution drip. I heard that recently in the Monklands a girl died because it took her 2 hours to get an ambulance to a paediatric ward at a different hospital and get an injection.

[Dr. Imago]

Originally posted by jambo372
Our local hospital (Monklands General) is a joke, so are the doctors who run it.

Quite a story, jambo. Things here are certainly not like you describe them as a rule. We have a commission called JCAHO that would effectively shut such a hospital down if it were to operate in the manner you relate.

The main hospital I train in has a pediatric emergency room. This makes a world of difference, not the least of which is the fact that the kiddies are segregated from the adults and they get specialist (i.e., true pediatric) care.

-TT

[Rolfe]

You, however, are not located in the Twin Cities of the Plain.

Rolfe.

[jambo372]

Originally posted by ThirdTwin
Quite a story, jambo. Things here are certainly not like you describe them as a rule. We have a commission called JCAHO that would effectively shut such a hospital down if it were to operate in the manner you relate.

The main hospital I train in has a pediatric emergency room. This makes a world of difference, not the least of which is the fact that the kiddies are segregated from the adults and they get specialist (i.e., true pediatric) care.

-TT

It definitely happened, it took 2 hours to get him an ambulance and he was turning blue.

[Rolfe]

Originally posted by jambo372
It definitely happened, it took 2 hours to get him an ambulance and he was turning blue. This is one story of Jambo's I have very little difficulty in believing. Sitting as I am at my desk about a mile from Wishaw General.

Rolfe.

[jambo372]

Originally posted by Rolfe
This is one story of Jambo's I have very little difficulty in believing. Sitting as I am at my desk about a mile from Wishaw General.

Rolfe.

Why ?
The Monklands is famous for it's poor record.
If that nurse hadn't came in when she did that stupid, lazy foreign doctor would have sent my cousin home dying of croup, screaming, wheezing and hallucinating with nothing but Paracetamol . He never even explained what was wrong he just gave her a printout, FROM THE INTERNET ! As if she couldn't have did that herself at home. If he takes another attack ( they say it's likely ), they'll have to drive all the way from Townhead to Wishaw as opposed to just a mile or so to the Monklands because they can't let them have Corticosteroid tablets in the house for self-administration as the dose has to be tailored to the severity of an individual wheezing episode.

They had to wait 2 hours for an ambulance even after the receptionist declared the case an emergency blue-light.

They don't even have a resident padiatrician anymore never mind a paediatric ward. It was also recently in the paper that Monklands General was sued for gross misconduct after a young girl died of pneumococcal meningitis because it also took her hours to get an ambulance and they didn't even give empirical antibiotic therapy whilst awaiting the ambulance despite their clinical diagnosis of acute bacterial meningitis and having taken CSF samples via lumbar puncture for microbiological examination which were cloudy. Apparently she'd probably have survived had the case been correctly dealt with.

Here's another TRUE horror story regarding Monklands General.
A man went in complaining of chest pains, the doctor ( incidentally one of my own GPs ) who assessed him said he would be fine and sent him home. He collapsed dead with a massive heart attack on the train home.

My gran attends this same doctor ( I won't name him ), on a regular basis. She is diabetic with angina and takes no less than 20 tablets a day for her various problems. She went in to see him one morning and he asked her if she was diabetic after she issued him with her list of medication and he checked her records. Wouldn't this be obvious ... she sees him all the time for her problems, her record should mention diabetes and her list of medication had Insulin and Gliclazide written on it. Incidentally he cut a mole off my cousin's boob and said it would leave no scar ... the scar was huge. He can't differentiate between acne and impetigo.

The monklands is also quite dirty and has high rates of nosocomial infection such as MRSA/GISA and GAS Necrotising Fascitis.

Where exactly do you live that's a mile from Wishaw General ?

[Rolfe]

Originally posted by jambo372
Why ?
The Monklands is famous for it's poor record.Read what I typed, you raving woo! I said I believed you!!!Originally posted by jambo372

Where exactly do you live that's a mile from Wishaw General ? That, sweetheart, would be telling.

Rolfe. :c1:

[Skeptic Ginger]

I found the website for the hospital in the OP very disturbing. On the one hand, it does look like a regular hospital and on the other hand it looks like an alternative medicine clinic. They don't seem to claim a marriage of the two practices nor to be a hospital where one can get alternative care if requested.

I wonder if they are accredited?

On the other issue, of quality of care, that can vary widely from hospital to hospital and from doctor to doctor. I have worked in about 25 different hospitals during my career, (regular jobs and as an ICU agency nurse), and now continue to interact with all of the area emergency departments. I have horror stories from most of the hospitals yet I know they save a lot of lives and do a good job most of the time.

There are 3 hospitals in the Seattle area I would not go to if asked. All of them are small community hospitals. And, there is supporting evidence one gets better care in big city hospitals. (I'm sure there are exceptions.)

My philosophy is buyer beware. The more informed you are about your health, and the health care providers in your community, the better health care you will get. It is worthwhile learning a little about the facilities around you before you need to use them.

[Dr. Imago]

Originally posted by skeptigirl
I wonder if they are accredited?

Yes, they are.

http://www.jcaho.org/qualitycheck/directry/qualityreport.aspx?hcoid=309747

-TT