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Things You Should Know About the ER

Why the Emergency Room Is Not Always the Best Option

By

Updated May 31, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

The emergency room (ER) is the first -- and sometimes only -- place many Americans go for their healthcare. These days it's often referred to as the emergency department, but that never did sound right to me. The ER has become an entry point for patients of all types, but it may not be the right place for some patients to go.

If you've gone to the ER when somewhere else might have been a better choice, you're not alone. Indeed, private physicians afraid of lawsuits are quick to point to the ER doors when you call the office. They don't want you to sue them if you're told to wait a couple days for an appointment and turn out to have some rare condition that's life-threatening. I'm afraid some doctors even use the ER as an overflow when they can't handle their own patient loads.

Since the ER might not be exactly what you thought it was. Here are a few things everybody should know about the ER:

The ER is for Emergencies

Despite the fact that everyone in the ER waiting room seems to have the sniffles and a cough, the ER is really supposed to be for emergencies (hence the name: Emergency Room). The whole system is built around the idea that at any minute a heart attack patient could come through those sliding doors; not to mention a shooting victim, a stroke patient, nectrotizing fasciitis or a woman having a baby right now.

If a bus full of hemophiliacs careens off the interstate and sends 30 bleeding victims to the ER, the staff would have to push aside those poor coughing souls in the waiting room to make room for honest to goodness emergencies. It happens -- not the bus full of hemophiliacs, per se, but real emergencies regularly displace all those folks who waited until Friday afternoon or Saturday to try to get medical care for a week old sore throat.

The ER is Not First-Come, First-Served

See above: It doesn't really matter if you're the first person in the waiting room. If everyone coming in after you has more of a need for medical care than you do, you'll have to wait.

The ER can be a conveniant way to get medical care -- or maybe your only way -- but that doesn't mean they'll see folks in the order they come through the door. Some ER systems are doing more to reduce the wait, including a huge change in the order folks are getting seen.

It's common today for ER staff to see the most dire emergencies first as well as quickly taking care of people who are least sick. That means the people with moderate medical needs end up waiting the longest.

The ER Doctor Knows a Little About a Lot

Emergency physicians are the medical equivalent of a Jack-of-all-Trades. As an ER doc, you never know what's coming through the ambulance bay at any given moment. You have to be as equally competent with massive chest trauma as you are with urinary tract infections. If the injury or illness is life-threatening, you'd better know how to get things stabilized and where to go for help after that.

ER doctors are like any other craftsmen: they get really good at doing what they do most. An emergency physician can run circles around any other type of doctor -- including a cardiologist -- when treating a cardiac arrest. They can stitch wounds in one room and decompress collapsed lungs in another. ER docs can prescribe antibiotics for the 25 or so most common infections by memory.

What an ER doc is not good for is taking care of -- or even recognizing -- rare diseases and conditions. You don't go to an emergency doc hoping she'll diagnose MS or cancer. It happens sometimes or, more to the point, they sometimes will identify a problem and send you to a specialist.

Most importantly, ER docs do spot-check medicine. They take snapshots of a person's medical history and make quick decisions about what to do. ER docs aren't in a good position to notice trends or do long term medicine. Most of these doctors chose this path specifically because at the end of the day they want to pack up and go home. They're here to save your life -- or treat your cough -- and move on to the next patient.

The ER Waiting Room is a Hotbed of Germs

In case you didn't notice, there are some sick folks sitting in there. They cough on each other and sneeze all over the place. It's not like an obstetrician's office, where everyone is mostly healthy and just coming in for a monthly check-up.

Not only that, but the cleaning crew doesn't get much time in the waiting room. Around the country ER's are filling up throughout the day leaving little opportunity for the chairs, floors and walls to get a good scrubbing. If you weren't sick when you walk into an ER waiting room, you might be before you leave it.

The ER is Not Always the Best Option

As you may have noticed, I'm not exactly selling the ER for your garden variety sniffle. The ER is a wonderful innovation and they save thousands of lives every year, but as a starting point for minor illness the ER leaves a lot to be desired.

If you think you have an emergency, by all means call an ambulance or get yourself to the emergency room. You never want to go to a doctor's office for chest pain or sudden weakness on one side. Those are the types of things an emergency doc is well prepared to handle. On the other hand, seeing ten different ER physicians for the same complaint on ten different occasions is not likely to help you diagnose what's wrong.

Try to save the ER for emergencies, you'll be healthier in the long run.

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