I’m about to tell you a deep dark secret of the medical world, so keep this on the D.L, deal? Ready? Ok. Here we go. (Deep breath.) Ok. (pause). Alright. For reals this time. Ready? Ok. 1, 2, 3, go!
Whether or not they are willing to admit it, almost every health care worker, no matter what age, what gender or what specialty, has an inferiority complex concerning emergency department folk. Even if we are happy in our own specialties, tending to premies in Newborn ICU or sullen teens at the STD clinic or emotionally-bereft family members of patients new to hospice, we all kinda secretly wish we could hop on top of the gurney and crack open the chest of a trauma patient. We want to wield that crash cart with ferocity, slam that first intraosseous needle into a veinless drug addict, and deploy enormous volumes of morphine with swagger. We want the badass ER nurses to accept us into their shit-talkin’ clique and the testosterone-pumped docs to meet us at the bar for a round of shots and dirty stories after our shift.
Of course, this is all part of a fantasy that doesn’t really exist. ED docs are not always manly, handsome superhumans–the best ED doc I know is a sweet, soft-spoken hispanic lady. And not all ED nurses are fiery redheads like my friend Lisa, although I have noticed that emergency nurses are, in general, bitchy and hilarious and a blast to hang out with. But many of them are cranky burnouts or sweet older ladies or hardworking fathers. There’s also techs and secretaries and paramedics and terrified students and lab people and pharmacists and transport guys and the people who restock the supplies and a few naked, disoriented patients from the other wards wandering around, too. But in reality, ED patients are not all gory traumas and massive MIs and outrageous injuries, and they are certainly not all quirky but lovable or touching characters. For the most part, ED patients at a big teaching hospital like ours are drunks, drug seekers, unfortunate people without insurance, and hysterical parents of children who have the sniffles. Now, I am not saying that our ER does not see some crazy shit. They have gunshot wounds and MVAs and hanta virus and bones sticking out of limbs and blown valves and all kinds of stuff. But these cases are relatively few compared to the constant onslaught of non-emergency cases and substance abusers. And this type of inappropriate usage of the ED is one of the reasons why ER waiting rooms become a holding cell for desperate people who have been waiting 6, 10, sometimes 14 hours just to see a doctor. It’s a shitty situation, and nobody’s happy. And that’s the real reality, the reality that keeps most health care workers out of the ED, mindful that the fantasy isn’t worth the stress of a system in peril.
Inappropriate usage of the emergency department is a complex problem with multiple etiologies. Many people without access to insurance are forced to use the ED for primary care. Other people cannot wait 2 months for an appointment with their own primary care provider. Plenty of people do end up going to their primary care provider’s office, at which point they are sent directly to the ER by a nervous provider who would rather take extra precautions than be sued. Plenty of people are just unaware of alternatives like urgent care. People with avoidable chronic illnesses such as diabetes or heart disease have scary flare-ups that send them to the ER on an annoyingly regular basis. And other people just don’t know that a cough and a runny nose are not life-threatening, since health education leaves much to be desired in this country. Social services also leave much to be desired in this country, which means emergency rooms get to babysit people who would be better off in a comfortable shelter or a treatment program.
All this overflow adds up to a miserable experience for people who really are experiencing severe, urgent or life-threatening problems. It adds up to waste and burnout. Even if people receive excellent medical care at the ER, they leave pissed and dissatisfied because of long waiting times, poor customer service, and high out-of-pocket expenses.
If you are unfortunate enough to wind up in a busy ER, make sure you pack a blanket and a pillow. Bring your iPod and some snacks. If you have a laptop, bring that too, since most ERs now have wireless internet and you can use the time to google your symptoms and diagnose yourself. Unless your guts are spilling out all over the place, don’t expect to be seen right away. My apologies for that. The thought of people waiting stresses me out, and that’s one of the toughest realities that ER people must constantly confront.
Even given what a hot mess the emergency department is, I still cling to the fantasy of hot doctors and kickass nurses and crazy medical cases. The reality of the situation makes these people even more remarkable, since they deal not only with the ugliest medical disasters, but also with the ugliest snags in the health care system. It’s quite a burden to shoulder, and some shoulder it more gracefully than others. In either event, I hope that political, social, cultural and economic factors eventually converge to help ease the load and restore the ER to its rightful place among the medical specialties: emergency medicine.