Are You "Emergency Room Happy"?

[pezheadmeg]

No--but I grew up the daughter of a nurse. She's the firm believer of you can see the doctor in the morning.

My father sliced his finger down to the bone, she waited for me to come home from class for 2 hours to take him. Lose sleep for stitches? Nope he wasn't hemorraing yet.

The last time I went, I was working and injured my ankle. Dear Mom told me I was over reacting and it was just a twist. That if I was still bad come Monday, I could go see a podiatrist. After she was told that my foot was perpendicular to my leg did she agree that I needed to go to the ER.

But around here, the urgent care centers aren't open past 10 or so at night. So it really isn't an option for the middler of the night issues.

 

[Liberty Belle]

As a woman (but not a mother), I am the same way!

The last time I went to the doctor (other than the dentist for cleanings, and dermatologist for a mole removal) was last summer, at 1am when the pain of my strep throat was more than I could handle. Before that, I hadn't been to the doctor since I was 12. I am 27 now!

So far, nature has cured all of my colds just fine... along with tea and honey, hot toddies, and OTC cold meds!

Your doctor is open at 1 am?! No wonder you don't find the emergency room necessary.

 

[NEVERENOUGHWDW]

The "Ugh Stop Telling Me How To Parent" thread got me thinking about people who go to the emergency room for every little thing.

IMO, unless you are going to die or there are NO clinics around, you don't need the emergency room. Even if it's broken, the clinic can mend it. Last time I was at the clinic at 1am for strep throat, there were TWO kids getting casts on broken arms!

I have a friend whos DD woke up with a painful boil-type cyst on her butt. Her mom drove her 20 minutes to the hospital emergency room, passing MANY clinics on the way.

The day we moved into our house, my mom fell and somehow split open her hand. It was NOT in need of stitches, the bleeding stopped after about a minute, but FOR that minute, my MIL shouted, "Oh my God, oh my God, I can drive you to the emergency room NOW!" Um... but even if she NEEDED stitches, WHY would we pay for an emergency room when the clinic can stitch it up for her $20 co-pay!

Using your own example.....if she truly hit her head I think it unwise to decide if she has a concussion or not.

As far as stitches if it's a place that is seen such as my face I would go to the ER & have a plastic surgeon stitch NOT a doc in the box.

 

[swkmom]

Around here our clinics are open 9am-9pm and the ER is the only choice after that. We are not emergency room happy and haven't been to the ER in years but in the past week we've had to go twice.

Tuesday night my son fell down our stairs (14 hardwood) and I didn't see the fall, he was very banged up and favoring his arm, I didn't know if he hit his head. We went to the ER and he ended up being fine just very bruised but he could have had a head injury. When we went for the follow up with our family dr. he said we did the right thing by going to the ER.

Then very early this morning, about 3am I still could not sleep because I was so short of breath. I have not needed meds for asthma in at least 2 years. When I got to the ER they didn't even ask me to fill out forms the attack was so bad, I was hooked up to a monitor and started on a breathing treatment within 10 minutes. I did not realize the attack was so bad until I got there. After 2 breathing treatments and a steroid injected into the port on my hand I was ok to be released. So, to me that classifies as an emergency.

We used to have a 24 hour urgent care but do not anymore. It would be much more convenient if they brought one back into our area.

 

[AKL_Megs]

Your doctor is open at 1 am?! No wonder you don't find the emergency room necessary.

No, the doctor at the urgent care... he also happens to have an adjacent PCP facility with partners... but he is NOT my doctor, however I could make him mine!

Using your own example.....if she truly hit her head I think it unwise to decide if she has a concussion or not.

As far as stitches if it's a place that is seen such as my face I would go to the ER & have a plastic surgeon stitch NOT a doc in the box.

Her HAND... not head!

 

[Acklander]

I definitely don't go to the ER for a cold, flu or earache, but then again I don't go to the Dr. for these things either.
Where I'm living now, there's an urgent care that has decent hrs (10-10) and I've gone there a few times.

While I try to avoid the ER as much as possible (horrible long waits!!!) I'm well aware that there are many who don't have insurance, so they wouldn't be able to get into see a "regular" doctor for their healthcare and only have the ER to rely on. Maybe the Doctor's in the OP's area are different, but here, if you try to make an appt. they will ask for your insurance info over the phone, and if you don't have insurance, you don't get an appointment. Therefore, I try not to judge others that I see waiting in the ER. There situation may warrant a different criteria for going to the ER.

 

[lemondog]

The "Ugh Stop Telling Me How To Parent" thread got me thinking about people who go to the emergency room for every little thing.

IMO, unless you are going to die or there are NO clinics around, you don't need the emergency room. Even if it's broken, the clinic can mend it. Last time I was at the clinic at 1am for strep throat, there were TWO kids getting casts on broken arms!

I have a friend whos DD woke up with a painful boil-type cyst on her butt. Her mom drove her 20 minutes to the hospital emergency room, passing MANY clinics on the way.

The day we moved into our house, my mom fell and somehow split open her hand. It was NOT in need of stitches, the bleeding stopped after about a minute, but FOR that minute, my MIL shouted, "Oh my God, oh my God, I can drive you to the emergency room NOW!" Um... but even if she NEEDED stitches, WHY would we pay for an emergency room when the clinic can stitch it up for her $20 co-pay!

I feel the same way!!! I can count on one hand the number of times I have gone to the ER, and in almost every case it involved the doctor TELLING me to go there.

What really kills me is people who take their kids to the ER for a high fever. My friend is a pediatrician. He said you would not believe the number of parents who bring their kids in with a 101-104 temp and have not even tried giving them Tylenol or Motrin!!! He said the only time a temp is a true emergency is if it is OVER 105 (meaning 106+) or if it occurs in an infant under 4 months of age.

My ER visits with my kids were for an open fracture, stitches to the face, and when my preemie was 3 weeks old with a possible UTI, in which case her pedi called me and told me in no uncertain terms to get the ER immediately. Luckily, the test was a false positive and she did not have a UTI, but we still had to endure 48+ hours in the hospital on IV antibiotics as a precaution.

 

[NEVERENOUGHWDW]

No, the doctor at the urgent care... he also happens to have an adjacent PCP facility with partners... but he is NOT my doctor, however I could make him mine!

Her HAND... not head!

Again any place that's seen...plastics not doc in a box.

 

[Liberty Belle]

No, the doctor at the urgent care... he also happens to have an adjacent PCP facility with partners... but he is NOT my doctor, however I could make him mine!

Her HAND... not head!

Our urgent treatment centers close at 8pm. So, unless it's something that can wait, if you need care, you need to go to the ER.

 

[AKL_Megs]

Again any place that's seen...plastics not doc in a box.

I wouldn't pay a plastic surgeon to stitch up a cut on my palm, no way! But everyone is different.

 

[GAGirlInVA]

I would avoid goign to an ER unless I truly thought I was in a life ro death situation.

Go for an earache...nope. It can wait till morning unless my ear falls off. Even then I mighy consider putting it on ice and waiting till morning.

Reminds me of something we saw back home. We were in the doctors office that also has a large amount of walk in business. A guy walks in with his ball cap on and a bandage on his ear. I didn't think twice. He didn't appear to be in a large amount of pain.

They called him up and he explained to the front desk what happened. Doc came out from the back and took a quick look and said "I can't reattach your ear.. go across the street to the ER, tell them I sent you."

The guys ear was literally HANGING by a thread. How on earth he bandaged it and put a ball cap on and drove himself to the urgent care and then sat there in pain, I'll never know.

 

[minkydog]

WHY would we pay for an emergency room when the clinic can stitch it up for her $20 co-pay!

BEcause there is no clinic available. I grant you, a lot of people go to the ER for ridiculous reasons. As a nurse, I have heard it all--"I have to work in the morning,so I need to come to the ER at 5am so I can get a doctor's note to stay home with my sore throat" "My 10yo has a 101 fever..." aaaannd? "My neighbor's child has chicken pox and I've never had them." idiot. I think people just panic in the moment and don't think it through.

I agree with you that the ER should be reserved for serious stuff, but to say that you shouldn't go unless your life is threatened is a little much. In my area we have children's urgent care centers. These centers can treat minor illness and injury, but if your child has a broken bone they will not cast it.Why? Because the liability insurance is sky high. They will put a splint on and either send you to the hospital for setting(if it's a complicated fracture) or send you to the orthopedist the next day(for simple fracture.) Sometimes they will put in sutures, sometimes they won't, depending on the age and cooperativeness of the child. Therefore, if it's an under 5yo, we will almost always recommend the children's ER where they are better set up for sedation and immobilization. Similarly, any kind of MVA that involves speeds of 35mph or more should be evaled in the ER, where there is access to CT scan. Sometimes you can't tell from looking at someone if they are bleeding internally.

My personal rule of thumb for choosing the ER versus my own nurse's bag-o-tricks is: is it gushing blood? is the wound gaping open like a smile? is there an altered level of consciousness? are they smiling and talkative or are they having a hard time following conversation and obeying commands? is it a first seizure or a seizure that is prolonged(over 5 minutes)? Is there chest pain or difficulty breathing? is there a blistered burn that covers more than 3 inches of skin? There may be more, but those are the basics.

I rarely take family members to the ER. I can cure about 90% of illnesses and injuries with benedryl, advil, tylenol, mucinex, ice packs and bandages. the rest either go to Urgent Care or ER depending on the severity. But I'll tell you this, when we go to the ER we almost *always* go to the head of the line because of the acuity of the situation. Being the sickest one in the ER is not the kind of accomplishment you want to have.

 

[AKL_Megs]

Our urgent treatment centers close at 8pm. So, unless it's something that can wait, if you need care, you need to go to the ER.

But I am not talking about situations like that, that is what you aren't understanding. I am talking about the broken baby toes, the colds, the boils, the things-that-can-wait-for-tomorrow's and the things-that-can-wait-till-the-doctor-can-see-you's.

I already said if it's bleeding, not breathing, or breaking through the skin, the emergency room is necessary.

 

[lillygator]

our clinics take payment up front or you aren't seen. our ER would like to be able to collect but we have to see you regardless if you have money or not.

 

[Liberty Belle]

But I am not talking about situations like that, that is what you aren't understanding. I am talking about the broken baby toes, the colds, the boils, the things-that-can-wait-for-tomorrow's and the things-that-can-wait-till-the-doctor-can-see-you's.

I already said if it's bleeding, not breathing, or breaking through the skin, the emergency room is necessary.

I guess I missed that and was just going by your "unless you're dying, etc". I suppose I mostly agree with you, then.

 

[AKL_Megs]

I guess I missed that and was just going by your "unless you're dying, etc". I suppose I mostly agree with you, then.

And I also learned something today. I thought ALL places had 24-hour Urgent Care. It must be that, here in Detroit, with the Big 3 and all of the factories, there are urgent care facilities every other mile in each direction, and they treat pretty much everything. All day and all night.

 

[Pea-n-Me]

We were actually told that by the triage person at the local kid's hospital. DS was 6 months old and had just smashed his mouth into a table at a restaurant; first time sitting in a highchair, he was tired, and just as I was about to take him out the food arrived and I felt it was safer to keep him in the chair with hot food being put down. A few minutes later, blam, one brand new tooth, lost.

His healthcare provider (who called me back even though it was late into the evening, yay her) said a dentist wasn't needed, so we were just going to go home. Then the tooth, which had been hanging on by a "thread", disappeared, and I just didn't know if that was cause for worry. So we went up the hill to Mary Bridge hospital, mind you this was mid-December, waited, and we were finally seen by the triage person. She said it would pass or dissolve, and to go home b/c there were "sick people here". I liked her.

DS has been there two more times...once he got burned on his chest, and the emergency people who responded to our 911 call (the flip chart I got from a kid fundraising said to call if it's a 2nd degree burn or higher) said they didn't want to charge us for an ambulance ride (it's not covered in our taxes here) but we should take him up...felt it was prudent since we'd already alerted people. They did nothing but bandage up his chest. Went there in an ambulance after he fell and hit his head on a metal clothing rack base at Target, and sure he was bleeding but it was his mental state that caused me to call 911. He was totally fine, came out of his haze while in the ambulance, but it was the same ER doc AND nurse (both were lovely especially given our alternative healthcare beliefs, YAY) and it was good to know they felt he was OK.


But anyway, we aren't ER addicts at all, and my husband got good care at the Urgent Care place, but I have not. Not at all.

Just realized that one of my stories was from the "family doctor" side of the Urgent Care building, so that's not fair to the UC people.

But my other story was when I dropped a table on my bare toe. Did awful awful unspeakable things to it, was bleeding profusely. Called the ex to drive me (it was HIS table I was trying to return to him), called the close-by one. They were open but their xray machine was broken, told us to go to the other. Didn't stop to think why I needed an xray of a TOE as they wouldn't do much anyway, but hey, I was fainty from the bleeding.

Got there. The nurses spent at least half an hour trying to get xrays of my toe. Touching my foot repeatedly. I was bleeding all over the film case. Oh, and the nurses NEVER put on gloves. Isn't that awesome?

Then the doctor came in, looked at my toe, and said...."ew".



Bandaged it up, gave me no info about what the nail might do (thankfully I'd had a similar injury at the age of 11, to my finger, and had a good idea what I was in for), gave me a prescription for vicodin (turns out that stuff doesn't work on me), didn't tell me to come back for aftercare with anyone, sent me home.





Anyway, i don't even know if the Urgent Care here is 24/7, but that experience is just seared into my brain and I have very little faith...

Your "triage person" was likely a Triage Nurse.

The person filming your toe that you refer to as a "nurse" was likely a Radiology Tech.

 

[Acklander]

But I am not talking about situations like that, that is what you aren't understanding. I am talking about the broken baby toes, the colds, the boils, the things-that-can-wait-for-tomorrow's and the things-that-can-wait-till-the-doctor-can-see-you's.

I already said if it's bleeding, not breathing, or breaking through the skin, the emergency room is necessary.

I'm sure we all know someone or has witnessed someone who has abused the ER, and it's a shame that they would waste resources like that, however when I see someone sitting in the ER, I'm only seeing a small portion of their issues. So what looks like a minor problem to me, might be something different for them. It's not my job to judge.

I remember one time I had to go to the ER for a 101 fever. And if you had been in the ER at that time and heard me talking to the triage nurse explaining that my temp had just started to go up about an hour ago, but before that it was normal, you might of thought I was a nut case for being there. To the casual observer it would definitely look like a case of overkill and if you had heard that I'd been to the ER 4 different times for the same problem you might think that I was abusing the ER. But the reality was, I was being treated for MRSA and whenever my temp started to rise I was instructed to race back to the ER, so they could get me started on the IV antibiotics and admit me to the hospital.

 

[Tweevil]

In my experience people are utilizing ER's instead of a PCP due to being non insured. Doc's offices usually do not offer state charity care or other programs. Hospitals do and if you are unemployed or under employed you can get financial assistance. Due to the no turn away or EMTALA laws we have to treat before we can even ask about insurance or other information. Some hospitals have fast tracks that try to aleviate the non threatening issues but it does not pay them to keep those open with insurances wanting to pay a traige level of care ($45 per visit) than a ER level of care which is case rated and much higher. To staff an urgent care or fast track the professionals are paid at a higher rate and the reimbursement and facility overhead isn't being met.

I have seen my share of emergencies and always opt to go to my physician but there is a problem as well. You can't just get into a doc's office the next day a lot of times. My doc has a set number of emergency appointments and if he is overloaded he advises to go to the ER as well. I haven't been to an ER as a patient in years, neither has my son but that is us.

The economy plays a huge role and I am seeing our payer mix shift with an increasing large number of patients becoming un-insured. Those patients use the ER as they do not have a doc anymore that will take self pay patients.

It really is a terrible situation but before anyone gets ripped at the facilities - keep this in mind.

Just my two cents....

 

[CF'er]

It's the people in the ER at 2AM with the rash that they've had for 3 weeks. And yes I agree with a PP who said Sunday night ppl in ER looking for Dr's notes to get out of work Monday.

I don't go to the ER because I have insurance and can't afford it. I'm sure those who abuse it are looking at it as primary care because they have no ins.

I did drive home from work (hospital) last weekend pretty sick. It's only about a 10 min drive... rural area. The whole way I was thinking about getting DH to drive me back to the ER. lol Turns out my port is infected and I was having symptoms related to that.