Staying Home from the ER

If it’s a cold, it’s a cold.

I have been complaining for months about the state of our emergency departments and hospitals and about the absence of news coverage of the issue. I do feel rather vindicated now. Apparently it is a problem because now the news outlets have picked it up. (You’re welcome NBC, CBS, ABC, Fox, CNN, etc. I’ll eagerly await my check… for warning you.)

As I have said on many occasions, the problem of hospital capacity is multifactorial. I don’t intend to revisit those issues today.

I have also, over the past months, offered suggestions on things that individuals can do to keep safe, and to protect their loved ones as healthcare becomes less available and the system more stressed.

However, as I’ve worked lately and watched as ambulances line up and patients stackup, as the waiting room fills and the frustrations grow, I have another thought.

Stay home if you can.

Now, I don’t mean everyone. But here’s a good example. Let’s say a family of five comes to the ER. Mom, dad, and three kids, age 8, 10 and 12. ‘We all have a cough and fever; it started four days ago. We were at Thanksgiving and we found out one of our relatives had the flu but didn’t know it yet. No, we aren’t vomiting or short of breath. But we thought we’d just get tested!’ Nobody is in distress. Kids are bored but well. Mom is chilled, dad is coughing a little.

So the thing is, it doesn’t matter if they find out. Even if the family wants Tamiflu it is of questionable benefit and isn’t very useful after about three days of sickness. Even if they were there on day one, waiting in the ER for possibly five or six hours, exposing others to their illness, being exposed to other illnesses, it probably wouldn’t have been worth it.

Sometimes our desire for absolute knowledge of a thing, our desire as a culture for a ‘diagnosis,’ for something to call the thing we have, well all of it just makes things more complicated and costly.

In the old days, most of the things we diagnose with costly visits and tests would have been called ‘a cold,’ or ‘a virus’ (neither actually incorrect) and the family sent packing from their family physician’s office with instructions to take tylenol (or aspirin…OK that was a mistake) and ‘feed a fever starve a cold,’ or some such.

Grandma would have made soup for the kids, mom and dad might have had bourbon with honey and lemon at bedtime. And in a few days, everyone would have been back on course.

Now it seems that there is this general idea that an ER visit is necessary, ‘just to be on the safe side.’ I see kids, diagnosed the day before with RSV, or with Covid, whose mothers bring the to the emergency department. ‘Well, the urgent care didn’t check for step and I figure, better safe than sorry!’

It’s much like the women who tell me, ‘I had ten negative pregnancy tests at home but I just want to be sure.’ To which I am likely to respond, ‘well, you aren’t pregnant.’

Certainly, some people really need to go to the ER for that cough and fever. They are confused, vomiting, short of breath or passing out. They are immunocompromised from cancer or immune suppressing drugs taken for auto-immune diseases. They are frail and old, or have lung or heart disease. They are young, weak and vulnerable with immature immune systems and lungs. Bring ’em on!

But when it feels like a cold, and it’s an inconvenience, and the lines are long, the waits are endless, maybe it’s best to avoid using an overburdened system.

I once saw a young, healthy man who quite literally called an ambulance for a cold. He was sent directly to the waiting room, a look of disappointment on his face. And yet somehow, this is the culture modern medicine has created. Just call that ambulance, because ‘I’ll be seen faster and better safe than sorry!’ Never mind that while it’s bringing in the otherwise healthy cold, a septic patient waits longer, a car crash victim lies wounded.

We’ve done a great job with stroke and heart attack, with warning signs and guidance.

We’ve done a terrible job with ‘sounds like you’ll be fine, don’t worry about it.’

But if the system is going to survive (and I’m not at all sure it can), we’ll have to learn to start saying that again. And start testing less, stoking less fear and using what few resources we have in the most rational and reasonable ways that we can.

Because a lot of our patients are ridiculously complex and critically ill.

And a whole lot of others just aren’t.

But the waiting room is full of both.

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