What happened to the old ER?

It’s still called the ER by most people, but those of us who work there like to think of it as a department, not a room. Thus the term Emergency Department (ED) is what is used by those of us “in the know.” In years past, the ED was a place where you would go with an emergency and you might see some lackey just out of medical school, with very little training, taking care of real patients. So, ERs got a bad rap. The quality of care you were about to receive was a crap shoot. And, sometimes the dice were cold…

Times have changed for the good. In most EDs, especially in larger cities, you get your care from an emergency physician who has done 3-4 years of specialty training to be able to stabilize whatever emergencies show up at the front door. Mostly we care for the walking wounded and those with all ranges of illnesses, some mild, some severe, and everything in between. Health care has evolved to the point that the ED is quite the safety net for access to medical treatment. Doctor’s offices get booked up. Sometimes they want a little coin before they’ll see you. Or, you might be too ill for what they can handle in their office.

Regardless of one’s ability to pay, the time of day, or the number of other people seeking treatment, walk into an emergency department, and you will be taken care of. At least for your urgent or emergent medical needs. The sicker you are, the better we are. Crushing chest pain, sweating, trouble breathing? We’ll probably shine. Just wanting to get “checked out” for that nagging groin pain that has been there for 10 weeks? We’re not that full of awesome. Wanting a 2nd (or 5th) opinion for the itching teeth the Mayo Clinic, Cleveland Clinic, and Dr. House himself couldn’t diagnose? We’re probably going to disappoint you.

Sometimes a person just needs some relief from his symptoms. Not necessarily  a diagnosis. Often, we can help with that. We can provide some pain relief, reprieve from your nausea, fluids for dehydration. While we’re easing your suffering, our number one job is to make sure you don’t have an emergency that is life threatening. Often, we’re better at telling you what’s not causing your symptoms than what is. Because, simply put, we rule out badness. I may not know what is making your chest hurt today, but I’m going to do my best to make certain it’s not a heart attack or a blood clot in your lungs. When I discharge you with belly pain, I have tried to rule out that you had a process going on that requires surgery on an emergency basis. And, I’ll send you home with some instructions of things to look for that should bring you back. Try as I might, I sometimes miss what’s going on. For that, there are return instructions. If you were discharged for undiagnosed chest pain, and later are sweaty, have an elephant sitting on your chest and you can’t breath, go back! Sometimes we’re…how should I say this? Wrong.

So, the next time you’re plagued with an illness or injury that requires a trip to the ED, understand that you’re being cared for by a specialist. If you’re hurting, we’ll try to make you better. We’ll try to rule out horrible things that you really don’t want to have. And, we’ll try to direct you to your next best stop on your road to recovery.

On a personal note, how have you seen your local ED change over the past 10-20 years?