Should an ED doctor go to the ED for a knee injury?

As an emergency department physician, I’ve personally been a patient in a hospital emergency department only twice in my life. Once I was admitted for a gallbladder attack (leaving three days later, without a gallbladder.) The second time I arrived by ambulance. A speeding truck pulverized my car while I was at a red light. Fortunately, the car accident caused no permanent damage. (Yes, I was wearing my seat belt.)

I have three teenager children, fraternal twins, age 19, and their older brother, 21. I brought the oldest to the ED twice. Each visit he had one or more broken bones. I brought his younger sister there one Sunday when I thought she might have broken her finger and needed an x-ray.

I bypassed the emergency department when my youngest son had a burn. I called the closest pediatric burn center and spoke with the physician director, and arranged for his care without a visit to their ED.

A few years ago, I walked down the steps and tripped on my cat. He was far too trusting I would not step on him, and I’m a bit too clumsy. I did, after all, have “right of way.” He ran, and didn’t have to give up even one of his nine lives. I landed hard on my flexed left leg two steps below him.

I can’t begin to describe how much pain I had. My prior broken bones and my gallbladder pain were hangnails by comparison. My wife came to see why the cat ran from the stairs like a bullet and why a variety of unpleasant sounds came from the point of my impact. She helped me to a chair. (Did you know that the common housecat is able to run 30 mph?)

An hour after my fall, ice wasn’t preventing swelling and was doing little for the pain. I could barely walk, and couldn’t put weight on my left leg. An hour after that, I cleared my schedule for the next three days, calling out of work “sick” for the first time in seven years.

The Doctor Does Not go the Emergency Department

I did not go to an emergency department. I think most people would have gone, and I certainly had an injury serious enough to warrant a visit. So, why didn’t I go? My self-assessment told me I didn’t break a bone, and my working diagnosis is – and has been – either a severe sprain, or possibly a torn muscle or ligament. (Doctors are not supposed to diagnose themselves, but most of us will.)

What I needed for diagnosis is an MRI, a test I wouldn’t have in the ED. I didn’t think an x-ray would show anything. The emergency visit would have provided pain medication and an orthopedic referral – something I can arrange myself.

Like many of you, I feared a ten-hour visit. I considered going to the ED a little more strongly at 4 a.m., when I awoke when my pain medication wore off. My best chance of avoiding a long wait would be near that time of morning.

I did some things that are not generally an option for the general public. I determined I didn’t have a broken bone but arranged an orthopedic visit on an expedited basis. This is not usually an option for non-physicians. I also know enough medicine to be able to predict that another emergency physician would have similar considerations for my diagnosis and treatment. Someone who is not an ED doctor would not be able to come to that conclusion.

Would an ED visit have been a good decision? Yes and no.

Yes, it would have reduced my wife’s anxiety, no question. I try not to reflect on how often I’ve seen patients seriously ill who came to the hospital only because their spouse insisted.

No, if I had gone to the ED, I would have been at risk for getting the wrong medication, the wrong treatment, or an infection transmitted by the hands of the staff.

As medical malpractice attorneys know, there are risks you take when you walk in the door of the ED, and risks you avoid when you walk in.

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