General

The misconceptions of the Emergency Department

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3 Aug 2016 - General
 

Emergency medicine is the medical specialty dedicated to the diagnosis and treatment of unforeseen illness or injury. It encompasses a unique body of knowledge. The emergency physician has the tools needed to begin the management of any acute medical condition or injury. They will manage sick patients every day and have a major impact on their lives and will have the opportunity to perform many procedures, both routine and life-saving. I would love to hear from doctors and other allied health professionals who are working or have worked in ER and what your experience was like. Recently in Queensland, Australia they shared this infographic to spread the message that emergency departments are there for emergencies. The ER is designed to provide emergent care to make sure you are safe, healthy, and comfortable. It is not an in-and-out clinic or a primary care office. They then suggested to call 13HEALTH, a medical help line available 24 hours a day where you are able to speak to registered nurses. From what I have heard from patients, the feedback they gave on this service was not all positve. Many said the nurses advised them to go to emergency most of the time. They would also make it quite difficult to advise due to legalities - Is the patient beside you? Can they speak? If they cannot speak for themselves I will require them to give verbal authorisation that you can speak on their behalf. Most of the time, people using this kind of service would believe it an emergency situation and the patient most likely wouldn't be coherent. Also, how well can one diagnose or offer solid advice from the phone? It is a risky situation. So in my opinion, it would seem there are a few flaws in this type of service. I wonder if Singapore or other countries have this kind of service and has it been successful? 

Theekshana Abayawickrama : It really isn't sensible but it is the problem we face here. Our ERs turn into OPDs when the OPD closes at 5 PM. This is the case for the majority of the hospitals here in the Philippines but not necessarily all. It is my first time to hear the term PCU actually. Also it was only last year, when I was in the US, when I learned that there is something called Urgent Care. Our nurses he...
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@anchau Regarding your concerns, there are services like this in Singapore that i know of. And a lot of it has a limit to the care that they can provide over the phone. Having a good, trained Registered nurse with experience in identifying illnesses over the phone is essential to provide the best care over the phone and also to quickly identify obvious traumatic or symptoms that should be alarming, and brought up to the necessary party. This service is used just an alternative for cases with per...
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Jennifer Winter Hmmm I see. But I still don't understand how sensible it is to allow patients to admit themselves to the emergency room. I have worked in the Primary Care Unit (PCU) which in my setup is similar to your ER except only cases that are identified as acute emergencies by the OPD doctor are admitted there. I remember there were times when the PCU was so busy with a couple of emergency cases at a ti...
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Theekshana Abayawickrama : In the Philippines the patient decides on their severity of their illness and when they come to the emergency room they need to be treated there. Of course if their cases are benign we try and course them to the OPD or to the doctor's clinics but quite a few refuse to because, as mentioned earlier, they don't like the long lines. It is true that they don't want to be there as...
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In your hospitals, are patients allowed to judge the severity of their illness by themselves and just walk into the Emergency Department? Do you guys manage every patient that comes to the emergency room whether it be an acute condition or not? In my hospital setting, we have an out patient department, a primary care unit and an accident service. Things like trauma, fractures, burns and head injury are sent there. All the other patients are seen at the outpatient department (OPD). OPD doctors as...
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In the Philippines, emergency room cases are really in the extremes. It can be full of toxic cases some days while others will be full of cases that are appropriate for outpatient consult. There has been quite a few cases where the patient or relatives acknowledge using the emergency room to avoid queue in their doctor's office. Regardless of the severity of the case, I firmly believe that there should be no room for bias in the management approach. The patients in the emergency room who hav...
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One thing that pisses ER doctors a lot is the sickness, "Medical Certificat-itis". Most people, especially on a monday, takes a visit to the ER for non emergent needs. Like a throat pain for 3 days with no difficulty of breathing and can tolerate eating, AGE with no signs of dehydration and can eat as well, or anything really that could make them get out of work, they will make an effort to visit the ER.

Another thing that they thought ER is for, is the fast service. Not a lot...
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