TRADITIONAL PRACTICE:

  1. See “My Chest Hurts." Check in at the ER, giving a detailed medical history of your past medical problems (from memory, which may not be good, depending on the reason you are in the ER or if someone else brought you and is giving the history).  This history includes:
    a. medications
    b. allergies
    c.  surgeries
    d. procedures
    e. medical problems
    f. any recent test results
  2. The doctor takes a history of your problem, usually without any knowledge of care you have gotten by your PCP or specialists.
  3. Tests are ordered based on your symptoms, often not aware of any tests that have recently been done by other doctors.
  4. Your immediate problems are addressed.  Since the primary question for all ER physicians is, “does this person need to be hospitalized?” you may not have questions answered or symptoms treated.
  5. Since the ER physician doesn’t have much past history, they are far less likely to understand the context of symptoms for complicated patients with multiple problems.  Again, their job is to simply decide if someone needs to be hospitalized, not to figure out what is going on, so complex patients are often not satisfied with ER visits. 
  6. Owing to the legal climate in the US, as well as the fact that they have no chance for follow-up, ER physicians are much more likely to order tests and give prescriptions that a patient’s regular physician or specialist would not. 
  7. Upon leaving the ER, medication changes and test results are usually sent to the PCP (but usually not any specialists).  This means you must notify all of your doctors about any changes to these medications and pass on test results if you can remember them.  This is usually done when you go to your next visit to each doctor.

MY PRACTICE:

  • Since communication is so much easier (and I am not overwhelmed with work), I expect my patients to contact me (or my office) if they are going to the ER (if possible or practical).
  • Since you are known to me, I may be able to prevent the visit altogether.  If not, I can send pertinent information to the ER to avoid duplicate testing.
  • If needed, I will speak to the ER physician, giving some background information.
  • Since you will have an accurate list of your medical history (in your personal health record), you can print out a copy of it and give it to the ER physician, assuring accurate information.
  • An accurate medical history will also let the ER physician make better decisions based on better information.  It will also cut down on unnecessary testing.
  • After going to the ER, you should notify (via patient portal or a phone call) about what happened.  We can do follow-up as needed based on the problem. Updating the personal health record based on what happens in the ER will assure you can easily communicate important details to any of your physicians.

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