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Navigating the ER


Published Jan 1, 2008 8:00 AM

Copyright © Illustration by Anders Wenngren

By Dr. Andrew W. Seefeld '00 and Dr. Adam Landman

Recently, an elderly patient came to our Emergency Department (ED) complaining of nausea, vomiting and weakness. She told the physician that she had "high sugar and heart problems." She takes medications for these conditions but didn't remember their names. All she knew was that she takes one white pill in the morning and a blue pill at night.

Her physical exam and electrocardiogram told the physician that a dangerously slow heart rate was the cause for her symptoms. The ED physician was concerned that her slow heart rate was precipitated by an accidental overdose of one of her "colored pills." Unfortunately, the ED physician didn't know which one. So he was forced to treat a patient with a life-threatening condition with an incomplete medical history. Regrettably, that's the rule, not the exception, in today's health-care system.

Eventually, after this patient was stabilized and the lab results came back, it was discovered that she had taken too much of a cardiac medication called digoxin. There is an antidote for this overdose. Had the physician known what she took initially, he could have helped her much sooner. And it wasn't just a question of expedited treatment — at high serum concentrations, digoxin could have easily resulted in her death.

So what prescription medications do you take? Do you know their dosages and how often you take them? How many surgeries have you had? Can you list your medical problems?

Most Americans are familiar down to the last decimal point with their investment portfolios and bank account balances, but few are as knowledgeable about their own medical histories. For example, a 2003 Yale University study of 94 underserved patients found that only 42 percent could accurately cite their medication names, 13 percent knew their medication doses and 29 percent were able to identify their medication frequencies. But knowing those critical facts could make an enormous difference in medical care and outcome, particularly in an emergency situation.

Part of the problem is that patients today routinely visit multiple specialists (orthopedics, dermatology, gastroenterology and so forth), sometimes in completely different health-care facilities. This makes it difficult to ensure that any single provider has access to a patient's complete medical record, including clinical notes, lab results for such things as blood work, or imaging results such as X-rays. A universal electronic medical record would help, but that's years, if not decades, away from becoming a reality.

That means, for now, it's up to the patients themselves to make sure their doctors have all the information they need. Whether you're visiting a local clinic or entering a nearby Emergency Department, the ability to communicate accurate knowledge of your medications, medical/surgical history, allergies and much more is invaluable to any health-care provider.

Here are five tips you can use to make sure that when an emergency strikes, you can partner with your doctor to quickly and effectively treat the problem. Because "I take 0.25 mg of digoxin daily for my congestive heart failure" will make you well a lot quicker than "I take one white pill in the morning."

Be Clear.

Concisely articulate the primary reason for your visit to the ED and whether you discussed your situation with another physician (i.e., urgent care/clinic physician, primary care physician) prior to your arrival at the hospital.

Have Facts on Hand

Provide an updated abridged medical record including previous medical and surgical problems, allergies and medications (including their doses and frequency), as well as the names/phone numbers of all your physicians (such as your primary care physician, cardiologist, etc.).

Be a Patient Patient

Understand that with the growing number of patients requiring medical care and the decreasing availability of primary care physicians, your waiting time to be seen and cared for in the ED may be longer than you thought, so please be patient and courteous to all of the Emergency Department staff.

Ask Questions

Remember to ask questions to your ED nurses and physicians as to what is being done to diagnose your medical condition, including what blood and imaging tests are being conducted as well as which medications are being administered to you.

Know Your Rights

Under federal law, all patients, regardless of health insurance status, are legally entitled to be medically screened and stabilized in the Emergency Department. If you lack health insurance or your insurance will not pay for admission to the hospital, you may be transferred (at your discretion) to another facility to avoid excessive medical bills, as long as your medical condition is deemed stable by the ED physician.