Lehigh Valley Healthcare
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By Paul Goldfinger, MD, FACC. Blogfinger.net, Ocean Grove, NJ, USA
If you try to call a doctor’s office after hours you will get the message, “If this is a true medical emergency, hang up and call 911.”
Then you are stuck with a conundrum. You must decide if you fit into that description (“a true medical emergency.”) And should you make that call?
Sometimes your situation is so severe that you and your family know that you must get help immediately. So you dial 911 without delay. And of course, circumstances might lead you to consider calling 911 even if the message is not in play.
So with or without the message, you might be tempted to delay, but you don’t want to make a fatal mistake and stay home.
You need to know what is meant by a “true medical emergency,” and that terminology may confuse your decision.
Here is one definition: “A true medical emergency is a medical condition of such severity that a prudent person with average knowledge of health and medicine would seek immediate medical attention.”
Obvious situations include severe problems such as stroke, heart attack, head injury, hemorrhage, and broken bones. And in certain situations, as in heart attacks and stroke, time is of the essence to save a life, so if it seems clear or likely that you are in serious trouble, make the call.
But what if you are not sure: Maybe you aren’t so sick or maybe you believe you can wait till later or tomorrow. Then the imagery of dialing 911 pops into your head–it will mean opening the door to mayhem.
Vehicles arrive with lights flashing, and EMT’s rush into your room to take charge. They buzz around doing tasks and scaring the wits out of you and your family.
Once the 911 crew arrives, they rarely let you stay home. But in some cases, perhaps in 10%, the patients may turn out to not require emergency care–in retrospect. In other words, the trip to the hospital was actually unnecessary.
And then you arrive at the ER and you may find yourself in the midst of chaos due to a crowded set-up with many patients and inadequate facilities and personnel, as I ran into at JSUMC one night when I arrived to their ER which was impossibly out of control.
Calling for 911 help is a big deal. It utilizes considerable personnel, complexity, and cost. Corporations which provide emergency care have been studying how to improve such care for their patients and their bottom line.
ER’s are supposed to take care of the sickest and most threatened cases, so alternative sources of care should be sought out if possible such as doctors’ offices, doctors on-call by phone or telemedicine, or urgent care if available. But can you figure out which way to go?
Hippocrates told doctors to always place the patient’s best interest first. But healthcare these days is often run by corporations, and doctors’ best judgements may be stifled and some physicians will admit that if you corner them in a candid discussion. For example there are Robert Wood Johnson Barnabas and Hackensack-Meridian in this area.
The personnel component of ER care includes “mid-level” professionals such as nurse practitioners and physician assistants who are being inserted into care scenarios including ER’s, and the AMA and I will tell you that they cannot replace physicians even though they are often presented that way. And I have run into that juggernaut myself. Patients may be baffled by all the unidentified white coats running around.
There have been studies which show that some sort of triage can save patients from going the 911 route.. In my day, we always had one of our group on call after hours. And if you called the office at any time, as long as you are not having signs of imminent danger, a board certified cardiologist would call you right back and perhaps give you advice that would save you that 3 digit ticket to chaos. But that coverage method seems to be breaking down. I had a situation recently at midnight, and the covering doctor never called back.
There are many cases in the everyday practice of medicine where a doctor, picking up a phone to speak to the patient, could stifle the panic and turn a situation around. Unfortunately doctors don’t often call right back or at all.
And if you call the office, you may get a person who answers the phone and who might insist on a medical history, and that is practicing medicine without a license because who trained her in triage? So sometimes you are forced to call 911 or go to the ER because you have nowhere else to turn.
One idea that is proving to be tempting by planners is to establish panels of registered triage nurses who would take initial urgent phone calls and advise the patient whether to call 911 or not. Nurses are well qualified to perform triage.
This is a promising idea, but some say that it is not safe.
They say: If there are any concerns go straight to the ER, but there are places which have already implemented the concept or are considering it.
But would such nurses make mistakes regarding 911 decisions? —Well it could happen. The system could work on that.
KELLI O’HARA. From Nice Work if You Can Get It.