Should you present in the ER with squeaky wheel syndrome?

CNN Money has an interesting piece (How to get help in a hurry in the ER) on tactics to reduce one’s wait in the emergency room. The author describes the experience of a house guest who had an allergic reaction, then asks four ER physicians what they would do to get a loved one seen faster.

The suggestions include:

  • Telling the triage nurse the patient’s condition is worsening or that the patient has “an emergency medical condition that should be evaluated right away”
  • Drop the name of a hospital big shot (that’s what the house guest does and what one of the ER docs recommends)
  • Page the patient advocate or hospital administrator

I’m not that comfortable with these suggestions. In particular, if everyone acted this way it would make things much, much worse than they already are. The first suggestion is especially troublesome if it means exaggerating the patient’s condition. On the other hand, I know the helpless feeling of being in an emergency room and not feeling like your making any progress moving toward the front of the line. Some of the comments on the CNN article are from triage nurses who basically say, “trust us,” but I’m not really buying that either.

In my experience, the best option is to try to avoid going to the emergency room unless it can’t be avoided. If possible, that means going to see one’s own doctor or meeting him or her at the hospital. Not every doctor can or will do it, and it won’t always work, but it’s worth a try. Although I’m not a big fan of concierge medicine, this is the type of situation where it could be worth it for the patient.

In some communities –though not where I live– urgent care clinics or MinuteClinics are a realistic alternative and a better experience. Finally, some hospitals’ emergency rooms are less busy than others. Sometimes those are found in community hospitals rather than big academic medical centers. If it’s going to be a 3 or 4 hour wait, driving an extra 15 or 20 minutes for a better experience can easily be worth it.

When I visited Singapore, some hospitals were putting video cameras in their emergency room waiting areas so people could see for themselves what the crowding was like before coming in.

June 30, 2009

2 thoughts on “Should you present in the ER with squeaky wheel syndrome?”

  1. I’ve never had to go to an emergency room for myself. I’ve gone with my Dad when he was taken in after a heart attack or a seizure, but he was going in an ambulance.

    I still think it’s awful to lie about the state of a condition. If everyone did that, nobody would believe anyone.

    Mount Auburn and Newton Wellesley in Waltham do have urgent care clinics. At BIDMC, if your a patient of Health Care Associates, there is a doctor of the practice on call who will confirm with you that you should be going to the ER. S/he will then contact the ER docs to let them know that you’re coming. That makes the process much smoother.

    I don’t know if other hospitals have a similar set up.

  2. There are many possible solutions for overcrowding in Emergency Rooms, but the solutions in many cases cost too much to implement. Overcrowding can result in spreading illnesses, increased medical errors, law suits, and death. As much as possible, ERs should rely on support staff to do work that does not have to be handled by nurses and doctors.

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