5 Ways To Survive An Unexpected Trip To The ER

Did you know that more than 250,000 deaths per year are due to medical errors in the U.S.? That’s according to a 2016 John Hopkins study published in The BJM. This figure, according to patient safety experts and now with consideration of COVID-19, is the fourth leading cause of death. Some may argue that this number is inflated and dependent on medical specialty and location in the United States, however, what cannot be disputed is that we have a very flawed health care system.

There are clear disparities in the quality of healthcare and access to treatment. Deep-seated historical racism, social injustice and implicit biases have significantly contributed to patients being misdiagnosed, under-treated and sometimes dissuaded people from coming into the emergency room in the first place.

My Dad, a retired serviceman, died in a local community hospital of a massive heart attack. I remember hearing chaos behind the glass windows when I went to visit him in the emergency room. Confusion, inattentiveness, poorly coordinated care, communication breakdown and lack of resources left a bad taste in my mouth. I truly believe if different steps were taken, and certain guard rails had been in place, he could still be here today.

My father’s passing is what led me to the path of wanting to become the best cardiac nurse in the world. I thought if I could just make changes in the healthcare system then I could prevent the next family from having the same experience. Talk about trying to move mountains!

So, my goal here is to raise your awareness as to what really happens, provide you with a realistic perspective on the emergency room and equip you with tangible ways to receive better treatment that can be the difference between life and death. In honor of National Minority Health Month, it is important to acknowledge and call out the systemic racism and broken processes people of color face in our current health system.

So why else should you care about any of this? About 2 in every 5 Americans will visit the ER each year. Some will be admitted, but a majority will be sent home. And while that sounds good, a Harvard Medical School study published in 2017, found that about 10,000 people die each year in that first week after being sent home from the ER.

So, here are five ways to protect yourself in the ER.

1. Keep a list of your medical history, medications and allergies.

It is important that you have a good understanding of any medical history, medications, and/or allergies you may have. I recommend keeping a small notebook with a running log of information that is easily accessible. This is also great if you have relatives who need help keeping track.

Going to the emergency room can be an overwhelming and oftentimes painful experience. You may not always be able to articulate or remember everything. Having this information available can help fast-track your treatment by prompting healthcare providers to consider certain medical conditions you may have or be predisposed to. Help understand your potential risk factors and be mindful of medications that may have contributed to your condition or contraindicated with medications they may consider giving you.

2. Focus on your biggest issue.

The goal of the emergency room is to treat your primary concern, patch you up, and then discharge you to follow up with your primary care provider (often referred to as “treat and street”) or admit you to the hospital, where another doctor will oversee your care. Providers in the ER only focus on your biggest issues, so instead of coming in with a laundry list of concerns and watering down the attention each problem will receive, focus on what is bothering you the most.

The goal of the emergency room is to stop a life-threatening problem so that you don’t die and can start the path of recovery elsewhere. By being very clear about your chief complaint — telling the doctor what is bothering you, describing how it feels, when it started and what, if anything, makes it better or worse — you can help expedite and eliminate unnecessary steps that can delay your treatment. For example, if you have a heart condition and have already taken three nitroglycerin tablets that didn’t help your chest pain (that’s now radiating down your arm and into your neck), us providers can draw some general conclusions about your issue, which will dictate response time and direct us towards specific diagnostic workups to rule in/rule out potential problems.

The sooner we can get to the root of your problem, the sooner we bring you some comfort and minimize any damage. This is critical for us healthcare providers because we need to work quickly to save your life and contain harm. After all, “time is tissue.”

3. Make sure someone knows that you’re at the hospital.

Whether it’s your neighbor, boss, family member, significant other and/or friends, someone should be with you or at least a phone call away. In the event that something happens, whether you become unconscious, are unable to communicate your concerns or are a poor historian, it is important that someone can reach you and we know who that person is. It is our job to act in your best interest, but having someone familiar with your health issues and personal wishes helps us make decisions that you are comfortable with.

For example, our goal is to keep you alive, but if there are certain treatments that you disagree with or will impact your quality of life, it is important that we know what your boundaries are and how we should proceed. It is always helpful to have an advocate with you, just in case the hospital system or provider is delayed or not attentive to your issues. This is someone who can speak up for you when you may not feel empowered to. And if anything, you should have someone there for moral support.

4. Honesty is the best policy.

This is the time to speak your truth, especially if you want to stay alive and feel better. The healthcare team works for you, you are the boss. This is not the time to be embarrassed or shy. You must speak up, be forthcoming and honest. There is nothing you can say that we haven’t heard or seen.

You do not want to be misdiagnosed or your treatment delayed because you neglected to mention details about what you took, behaviors you were engaged in or watered down what you are feeling. For example, if you took some kind of recreational drug and don’t communicate that, we may eliminate certain relevant causes or differential diagnoses or administer you medication that can cause a negative reaction, possibly resulting in harm and worsening your condition.

It’s also important to ask the ER providers to be straightforward and honest with you and not leave anything out. Because ER providers have limited time with and knowledge about you, and by nature of the name itself, the emergency room is not the place where you will receive comprehensive care.

If you’re feeling short of breath, the ER provider may order a chest x-ray, some labs and a breathing treatment to improve your symptoms as the workup is done. If the chest x-ray shows a mass or fluids in the lungs but your symptoms have improved and you’re stable enough to go home, they will suggest you follow up with your primary provider for further care. But ask the doctor to be very honest. What could it be? Is this an urgent matter? Did my tests reveal anything else I should be concerned about?

Too many times I’ve seen patients leave the ER with improved symptoms but with test results suggestive of a serious diagnosis — like cancer or heart failure — yet, the information isn’t conveyed with gravitas to the patient.

And more often than not, a fair amount of ER users don’t even have a primary care provider. Either they don’t have health insurance or, if they do, they haven’t established a relationship with a primary care provider yet. Let your ER doctor know that. Establishing a doctor-patient relationship will take time and you may not have that kind of time to wait, which may result in the ER doctor admitting you instead because your problem could worsen during the time you’re trying to get an appointment.

And never assume that no news is good news. The truth is the ER providers are very busy and, again, they’re focused on your priority complaint. They aren’t going to do your full cancer or cardiac workup — and they’re not checking you for everything. They will check only necessary things based on your complaints and stabilize you so you can follow up with your primary provider and insurance plan.

5. Don’t delay coming to the ER due to fear of costs.

Emergency care is the one service where you do not get to choose your options off of a menu with prices listed prior to service. It is not until after you’ve been treated, near the very end of your stay, that you receive your bill with the breakdown of costs. We understand that medical bills are the number one reason why most people file for bankruptcy in the United States. Credit is important to us in the Black community and, historically, it hasn’t been our strong suit. Adding the element of medical debts often causes the plight of the Black person.

Poor healthcare, fewer facilities, even fewer primary doctors in our neighborhoods, fear and mistrust are all factors that lead to us delaying seeking help. But something that could have been treated if caught earlier can become a major life-threatening issue if you wait. When it comes to your life, what value do you place on it? Remember, these costs can be forgiven and/or written off. Those who love you would rather be on a payment plan for a medical bill than for a funeral.

I carry the weight of my father’s legacy. I want to improve patient outcomes. I also want to eliminate the health disparities within our healthcare system. Early screening, early detection and prevention methods can help you avoid a trip to the emergency room in the first place. But if you do find yourself heading to the emergency room, remember these steps to help you have a successful experience.

I, on the other hand, will continue to fight the good fight and work with my colleagues to change the culture — eliminate implicit bias, promote cultural competency amongst providers, promote a culture of safety, and work to remove historical racism and social injustice so Black and brown people are treated with quality healthcare, dignity and respect.

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“Nurse Alice” Benjamin is a nurse practitioner, speaker, educator, author and mom.