The Danger of Discouraging ER Visits

EVERY FEW MONTHS I see this video pop up on the social media feeds of doctor friends, mainly emergency physicians, with some approving caption along the lines of, “This is my life.” The video depicts, in overly dramatized and satiric fashion, patients presenting to the ED with various non-life-threatening conditions, among them an ingrown toenail and nasal congestion. The message: Don’t come to the emergency room if it’s not absolutely necessary.

The video is a product of the government of Queensland, Australia, and is one of several that it has released in an attempt to stem the flow of patients into its emergency departments. Each video implores patients to exercise restraint and consider alternatives to emergency care, such as walk-in clinics, health hotlines, or their PCP.

I can sympathize with emergency physicians’ impulse to purge their practice of the mundane, low-acuity problems that are more appropriately addressed in an outpatient office. But public service announcements like these are dangerous. Appealing to patients’ common sense places the burden of triage in their hands, rather than relying on the judgment of an experienced medical professional. Asking a patient to decide what constitutes an emergency is problematic because not every acute health condition presents dramatically. Not all heart attacks manifest as crushing chest pain, and though most chest pain is not cardiac, I would argue that any patient with chest pain should go to the ED immediately to be evaluated by a doctor.

Not too long ago I had a patient in the hospital who had waited two days from the onset of stroke symptoms—slurred speech, right-sided facial droop and arm and leg weakness—to present to the hospital. When I asked her why she waited, she explained that when she first noticed something was wrong, she went next door and asked her neighbor, who had had a stroke before, if she thought her symptoms could represent a stroke. The neighbor’s response: No, because her own stroke had been left-sided, and she’d never heard of anybody having a right-sided stroke before. So the patient stayed home.

I’m not making fun of this patient. This is the level of health literacy in the community I work in and in many communities like it. What if my patient had seen an advertisement on TV advising her to stay away from the emergency room? She might never have sought help, figuring that she would be received with annoyance and disdain for wasting the doctor’s time.

Discouraging patients from seeking medical attention in the ED is counterproductive. Emergency care is special in that it welcomes all comers, from minor headaches to grisly trauma, and it is the crucial task of the doctors to decide what needs attention and what can wait. Sure, there will always be those who abuse the system. But most people come to the ED genuinely worried that what they are experiencing could be serious, and they want the peace of mind of a thorough medical assessment. Diagnosing an acute ailment is just as important as reassuring a patient that there is nothing wrong with him, and that he can go home.

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