Using the emergency room as a GP?

SlavOz on 21/09/2020 - 11:53
Last edited 23/09/2020 - 13:20

As someone with poor health who's prone to unexpected trips to the ER quite often, I've always noticed that there are way too many people who are not in an emergency. Most are there because their baby won't stop drooling or sneezed a couple of times prompting a panic attack. Others are just there doing general GP stuff - getting prescription, checking test results, etc.

This has always been a big problem and now even more so due the pandemic. Why do it?

EDIT so it seems most people condone going to the ER anytime you are worried because that's what triage is for. Please note that filling the waiting room with non emergencies increases the time it takes for a nurse to triage a real emergency, or could even contribute to the ongoing stress of these people. To each their own but I dont condone this.

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Comments

          • MessyG on 23/09/2020 - 19:09

            @SlavOz: Ah so you're THAT Ozbargain armchair doctor who sends the young girl home whose just a bit short of breath when she walks who plays on her phone in the waiting room. To die. Of an undiagnosed PE.

            Bonus points for when you send the young man home with a 'bit of a headache' whose been playing on his phone in the waiting room. To die. Of an undiagnosed brain tumour. Jolly good work Dr Nick!

      • [Deactivated] on 23/09/2020 - 17:19
        +3

        If you can walk into the ER and sit around causally waiting while playing with your phone, you're not on an emergency.

        I had a patient call me from the ED to cancel a cosmetic surgical procedure because they were waiting in ED after having a confirmed heart attack.

        My dad had a heart attack and waited patiently in ED. He had a quintuple bypass later that week.

        Emergency usually presents severe signs that would affect behaviour.

        I had screaming patients because they had a migraine, opioid withdrawal, dislocated limb… Not urgent stuff.

        Pain or of the lack thereof isn't an indicator or excluder of an emergency.

        (It does make some hospital staff eager to see them and get rid of them sooner though.)

  • eek on 23/09/2020 - 16:09

    The few times I've entered the emergency department I've been admitted almost instantly after triage. Collapsed lung and on the verge of cardiac arrest. The other time I came off a mountain bike, had internal bleeding and didn't go into the ER until 8hrs after the incident as I kept urinating blood.

    • [Deactivated] on 23/09/2020 - 17:38
      +1

      How many times did you urine blood before you went into the ED?!

      • eek on 24/09/2020 - 09:45

        6-8? It crashed a downhill bike maybe 7am, had a BBQ at a friend's place afterwards for brunch/lunch. Didn't get into ED by about 9pm. Nurses/docs weren't impressed I didn't go in earlier. Turns out I had internal bleeding in bladder, kidney. Wasn't able to empty bladder fully so had a catheter for a while. My other incident with the collapsed lung was about as bad. Ended up staying in hospital for 2+ weeks.

        • [Deactivated] on 24/09/2020 - 09:48
          +3

          Lol. just a suggestion, don't take my word for it but the correct number of times to pee blood is zero.

          If you pee blood once, go to the ED dude.

  • MessyG on 23/09/2020 - 19:07
    +1

    Medical triage, armchair Ozbargain style. Complete with intimate experience of a babies health record and parental mindset and sweeping definitions of what GP work is.

    Keep up the good work, I'm sure you'll have everyone agreeing with you in no time!

  • BartholemewH on 23/09/2020 - 20:31
    +3

    My one year old was refusing to eat / drink and was seen at ED at night but sent straight home. Went to GP next day and expressed serious concerns. GP said give it a day. Went back to GP first thing next day. GP rang ED. 4 - 5 days in hospital. A shit show all round.

    P.S. Not all babies that look ok at ED are actually ok.

    • [Deactivated] on 23/09/2020 - 23:52
      -1

      By your own admission, the GP wasn't concerned until day 3 either.

  • bmerigan on 23/09/2020 - 21:50

    Agree with you fully. It's not a GP service.

    • Jaystea on 24/09/2020 - 00:02
      +2

      You're right, it's not.

      BUT it is OP's insinuation that the bulk of people who go there are simple/minor/non-issues as well as his blatant lack of due respect to nursing staff and their qualifications that earns him a contender for OzBargain's shitshow of the year award.

      • SlavOz on 24/09/2020 - 07:59
        -1

        If you have stage 3 liver cancer, do you talk to a nurse for advice, or do you rely on the specialised knowledge of a surgeon?

        Liver surgeon you say? Oh my God why do you hate nurses so much you nursephobe!!

        • Jaystea on 24/09/2020 - 09:08
          +3

          If I showed up to the ED, still the nurse first. If I didn’t, it’d be the GP. you actually can’t get to a hepatobiliary surgeon on your own accord - good try though. You continually demonstrate how little social interaction, cognitive understanding, and lack of a life you have.

          • bmerigan on 24/09/2020 - 21:23

            @Jaystea: People don't usually turn up to the emergency dept for cancer treatment.

            • [Deactivated] on 25/09/2020 - 08:26

              @bmerigan: Well not for subsequent treatments, but yes the ED is a pretty common place for people to present the first time, or throughout their treatment for all the complications.

              Also adding to the "do I talk to a nurse" bit, yes in a lot of oncology and Haematology departments we have specialised nurses who are your primary contact throughout your treatment. You don't tend to just phone up a specialist doctor.

        • HelpMeiCantSee on 27/09/2020 - 09:43

          If you actually had cancer, you’d know the answer to your question. The nurses are the most invaluable resource you can have access to. Stage 4 here, so (profanity) you.

  • redslert on 24/09/2020 - 01:00

    Wife had a fish bone stuck in her throat and had to wait 3hrs in the ED to be seen and to get it out.
    It is not life threatening but where else do you suggest for her to go after seeing a family doctor who directed her to the hospital?
    How do you know people were only there to refill a prescription?

    Why are you the only person who has bad health who can visit a hospital?

    If you are visiting the ED and needing to wait, it can only mean that your health issues are not that serious!

    • HelpMeiCantSee on 27/09/2020 - 09:45

      This highlights the need for urgent care. Whilst not an emergency, it will still require specialised skills and equipment to deal with. So yes, appropriate presenting to ED.

  • Orpheon on 24/09/2020 - 09:32
    +3

    Mum had some pretty bad shoulder pain that got worse over a 5 hour peroid, by midnight it was unbearable - her eyes were droopy and she was constantly moaning. I made the call to go straight to Emergency.

    We took her to ER. It was filled with people with broken/fractured limbs, some constantly throwing up, and others anxiously waiting their turn.

    Upon presenting the ER nurse was surprised why we came at all with just shoulder pain, and calmly asked mum directly where the pain was. She said "shoulders, chest - near the heart."

    That was all, she was rushed inside for an urgent ECG and treatment ahead of everyone else - turned out to be a mild heart attack. Triage nurses are trained to look for the red flags, they're not always obvious.

  • m0b1liz3 on 24/09/2020 - 11:49

    Such an echo chamber of unknowledgeable people with anecdotal comments. As someone who works in emerg, the OP is correct. Emergency departments are clogged with unnecessary presentations that could have been easily dealt with by a GP. I would also be frustrated as a sick patient with an actual urgent medical issue.

    https://www1.racgp.org.au/newsgp/professional/eds-continue-t…

    • Jaystea on 24/09/2020 - 13:47
      +1

      Are you a health professional? There literally are multiple doctors and nurses who have voiced their professional opinion against OP's tirade.

      Further, as I mentioned here, it's not so much about people presenting with non-urgent, non-serious issues. Nevertheless, would you be willing to take the fall for the multitude of seemingly "non-urgent" or "non-actual" medical issues that turn out to be severe conditions that on the surface present innocuously?

      • m0b1liz3 on 24/09/2020 - 15:27
        +1

        If you read the article, it actually underestimates the non urgent emergency presentations. At least 1/3 could be dealt with by a GP or walk in clinic.
        I don't really care about anecdotal stories by nurses. The data supports the fact that a significant number of emerg presentations are unnecessary. There are multiple studies out there that confirm this. If you are only interested in stories, I have plenty about patients going to emerg asking to get their ear wax syringed, showing up with a runny nose etc.

        This is an important issue because it clogs up emerg and potentially delays more urgent patients from being seen quickly. A triage system can fail if all of the beds and cubicles are filled. This is why you hear stories of ambulance patients being cued in the hallway.

      • [Deactivated] on 24/09/2020 - 22:27

        There are doctors and nurses who have differing opinions. I reckon it's about 50/50.

        Popular concensus will typically be in favour of liberal use of the ED.

        People who work into he ED tend to be split down the middle.

        Those who have administrative roles or are sensitive to efficient use of tax payer resource would advocate for conservative use of the ED.

        would you be willing to take the fall for the multitude of seemingly "non-urgent" or "non-actual" medical issues that turn out to be severe conditions that on the surface present innocuously?

        At some point, some level of assumption has to be made. If resources were infinite, it would be grand to have an all welcoming ED but alas, that would be impossible. The more money we put into ED, the less goes to other departments.

        The advice to "go to the ED" is becoming like "may contain ingredients known to cause cancer in the state of California" or "may contain traces of peanuts". Without scrutiny, the use of emergency services will become more frivolous.

    • gimme on 24/09/2020 - 16:07

      Your first sentence should be the Ozbargain tagline (minus a handful).

  • evocable on 24/09/2020 - 12:35

    It's not always as it seems. My partner was instructed to attend the ED for follow up checks after pregnancy complications (HELLP syndrome) requiring an emergency c section. She had to wait in the queue with everyone else while perfectly healthy. We were told they look after her for 6 weeks following the procedure after which she reverts back to seeing her GP.

    Saying that I do agree that people should always attend a GP if they aren't in need of urgent care unless otherwise instructed!

  • EFC94 on 24/09/2020 - 12:35

    OP if you don't like the way the system is run you're more than welcome to pay for private health insurance or otherwise employ your own personal doctor. You have no authority to tell someone else how to live their life.

  • Tehcookiemonsta on 24/09/2020 - 14:05
    +1

    I had a Serum potassium level of 6.5 that was picked up during a pre-admission. A Surgeon called me and told me to goto the ER urgently to be retested.

    For you it might seem like i'm just there for a bloodtest but in reality i waz there for a potentially life threatning situation.

    Moral being you don't always know what is really going on behind the scenes…

    • HelpMeiCantSee on 27/09/2020 - 09:46

      Your ecg would’ve been peaky. Nice!

      • Tehcookiemonsta on 27/09/2020 - 11:21

        Lol… Thankfully it was just the potassium leaking from the cells…

        Retested levels were 5.6. However I have CKD and other medical conditions so it could of potentially been possible that my potassium was quite high.

        • HelpMeiCantSee on 28/09/2020 - 21:15

          Yeah. Potassium should be inside your cells lol. Renal disease will do it! Poor lad. That must suck!

          Usually 6-6.5 is where you see ecg changes. And not much higher it can throw you into dysrhythmias. Can get quite complex to sort out, so don’t take it lightly!!!

  • nephilim on 24/09/2020 - 14:06

    I took someone to emergency for a serious thing years ago, waited 3 hours then was taken in, 2 hours later I asked if could go check on them. Only then did 2 male doctors around 25 know what was going on.
    Ambulance and nurse reports didn't explain it right, kinda blew my mind. It was a elderly gentleman who kept throwing up constantly, he wanted to sleep but was very sick. was worried he may die in his death. Took him 2 weeks to be released, yes it was serious.

  • SydStrand on 24/09/2020 - 15:22
    +2

    EDIT so it seems most people condone going to the ER anytime you are worried because that's what triage is for.

    Yes. That's exactly what the ED is for. You go when you have a perceived emergency, and it's the staff's job to determine how urgently you need to be seen.

    Please note that filling the waiting room with non emergencies increases the time it takes for a nurse to triage a real emergency, or could even contribute to the ongoing stress of these people. To each their own but I dont condone this.

    I've explained how triage takes 1-5 minutes and is performed on arrival, and how it does not affect your treatment time at all, a concept you can't seem to grasp. I also asked you to find a single report of someone dying while waiting in an Australian ED even during the COVID crisis and you haven't delivered, because it doesn't happen. Let's call this what it really is: SlavOz is annoyed he has to wait a little longer because someone who he thinks is non-critical gets seen first. The end.

    • SlavOz on 24/09/2020 - 19:25
      -3

      I've explained how triage takes 1-5 minutes and is performed on arrival

      Triage cannot be done in a minute, don't be silly.

      A few minutes taking down details at the reception, perhaps a few minutes until that case reaches the nurse, then a few minutes for the nurse to discuss problems or administer pain relief. You're looking at at least 10 minutes per triage. If just 6 people followed your silly advice that's an hour taken away from checking the vital signs of a real emergency. No thanks.

      I also asked you to find a single report of someone dying while waiting in an Australian ED

      Nice try shifting the goal posts. My complaint isn't about people dying in the ED, it's about too many trivial cases coming in. There have already been sources provided to confirm this. My claim has been proven. You're just ignoring the data and insisting on using the internet to pretend to have a clue about anything in life. We all know you dont.

      • tarb on 24/09/2020 - 21:15
        +2

        Just want to make sure you know that your opinions still suck! The only reason you've stopped getting downvotes is that we've already ran out downvoting your previous terrible comments 👍

      • HelpMeiCantSee on 27/09/2020 - 09:51
        +1

        Triage can be done in seconds. A differential diagnosis can be made in a few more. Testing confirms or denies the diagnosis.

        Experienced clinicians can triage on sight, reasonably accurately. Often it’s the quiet ones that are the concern.

        Obviously some exceptions to the rule, but man you are so far off base. Just stop.

  • GourmetFoodie on 24/09/2020 - 20:42

    Whenever I've gone to the ED (and unfortunately I've been quite a few times) i've rarely seen kids or babies.

    Honestly, most of the time I've seen people who look like they should be there.

    I have definitely heard there are people who go for non serious reasons but I think they are probably the minority. Everyone I know who has ever been to the ED (myself included) seriously debates whether it is worth going because we know how long the wait time will be and how disgusting it is waiting with 100 other people around you who are sick. Hence if it can wait for a GP appointment, we wait.

  • digitalbath on 24/09/2020 - 20:43
    +1

    Why are you allowed to go so much? But no-one else is?

  • kaleidoscope on 25/09/2020 - 10:28
    +2

    I wouldn’t complain about kids and babies being in ED any time because their health can go down south very quickly.
    As someone who had attended once to the ED at RMH I can say that op’s onto something. I was in unbelievable agony by a urine infection which escalated in a matter of half an hour or so. No GP was open at the time as it was around 11pm on a Saturday. I was in so much pain and I kid you not I waited till 7am next day without a sleep and in pain and even by then I was still waiting at triage and the nurse still could not say when they can take me in. I left ED without any help being offered and my GP’s clinic was opening in an hour at 8am.
    All of this because it was filled with people that showed no emergency and some were even sound asleep on chairs… I completely lost my faith in ed at rmh this day. Next time i’m going to call an ambo as these patients get straight or escalated medical attention.

    • [Deactivated] on 25/09/2020 - 21:19
      +1

      By OP's logic you shouldn't have been at ED because while the infection sounded painful, you were hardly in danger of dying.

  • djones145 on 25/09/2020 - 12:01

    i was thinking the compliant was some guy using an emergency or panic room in some office as a GP

    boring!

  • capslock janitor on 25/09/2020 - 14:16

    A little story instead when we used the GP as Emergency.

    When I was a kid had a freaken painful ear infection discharging yellow liquid nonstop.
    Slept on me mum's lap crying and soothing myself in the waiting room for hours.

    Never again. Bloody shit doctors there too, was our first clinic in Melb.

    Edit - mum was young and new to Australia, those GP's should've at least asked and advised us to ER. We didn't even know of such a thing existed!

  • CalmLemons on 25/09/2020 - 14:19

    A lot of the time people are handballed to the ED by the GP.

    Often the only way to get into the hospital is via the ED.

    I would think people normally wouldn't want to wait for hours on end just for a sniffle.

    Most of the kids emergencies go to the children's hospitals.

    There is unfortunately no way to jduge 100% whether someone should or shouldn't be allowed in the emergency room, no health professional is a god.

    Therefore, sometimes, people who go there may not need to, but this happens everyday in society with many things.

    As long as you do the right thing yourself, that is the best way.

    I hardly think people, during covid, choose to go to the ED on purpose.

  • gstfree on 25/09/2020 - 17:41

    Set up a couple of GP clinics within the ER. Triage can direct non urgent cases to GP.

  • lonewolf on 25/09/2020 - 18:50
    +2

    Actually it is known by people who work in ED that a lot of people are going to ED when they should be going to the GP / medical centre. And this has been on the rise as people either feel the wait times at GPs are now getting annoying plus then for tests / xrays / ultrasounds you then have to go else where and on another day while through ED they will do it the same day. And this does affect everyone and this can be a topic for people to discuss because it is using tax payers money. It is something that needs to be looked at as a lot of the ED staff feel overwhelmed at times and are usually short staffed as it is to cater for a lot of cases that just dont need to be there.

    • ssquid on 25/09/2020 - 20:45

      Right, if you get tests/scans done at a public hospital there's no out-of-pocket costs vs. being referred to a clinic by a GP. But either way the taxpayers still pay the same amount via medicare, the private places just charge the patient extra on top (which is fair enough since they own the equipment rather than the public).

      • lonewolf on 25/09/2020 - 20:52

        It depends, most scanning places / clinics bulk bill for x-rays and ultrasounds. Its just that you have to drive from the GP to the other place and some busier places want an appointment although usually you can get the scans done on the same day or within a couple of days. But with the hospital its a one stop shop in a way.

  • OldBugger on 25/09/2020 - 21:01
    +1

    It's not only the non emergency cough and cold cases clogging up the system (which I personally don't see a problem with it it's serious), it's the ones coming in with drug and alcohol problems that are completely self inflicted.

    Worse yet, they often are using up other essential resources such as police and ambulance.

    If they are violent and abusive, there is even more resources taken up by hospital security, seclusion rooms and triage nurses being forced to make way for them over others just to get them out of the waiting room.

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