A hospital’s emergency department has equipment and resources no doctor’s office can match. If patients are sick enough that their condition cannot wait, or if they think waiting could cause serious problems for their health, there’s only one place for them to go.

If they know their problem isn’t an emergency, if they know it’s something routine that they’ve just not taken care of, they can likely be seen more quickly, more efficiently, and in a less costly fashion at their family doctor’s office.

Emergency Departments versus Family Practices

A friend of mine told me a story about having a urinary tract infection. It hurt when she peed. She waited three hours at a hospital emergency department, then looked in the phone book and found a nearby family practice clinic. An hour later, she was leaving the clinic with an antibiotic prescription.

Ambulances take patients to emergency departments for a reason. No physician is equipped to care for a heart attack in the office. Even the orthopedic specialists lack the ancillary personnel and specialized equipment needed to put a broken bone back into place. Most family practitioners, working in an office setting, can care for individuals with burning on urination.

What happens if the patient is not sure if that pain he is having is heartburn or a heart attack? Where does he go? Does he have an emergency medical condition?

EMTLA

The federal Emergency Medicine Treatment and Active Labor Act of 1986 (EMTALA) defined an emergency medical condition as “a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: (i) placing the health of the individual (or, with respect to a pregnant woman, the health of her unborn child) in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any bodily organ or part.”

The key is “reasonably be expected.” This means the patient does not need to know what he has. Of course, if he knew what he had, he would likely know whether it was an emergency.

Emergency Conditions

More modern thinking leads to the concept of “an emergency condition.”

A commonly accepted definition of “an emergency condition” is “any medical condition of recent onset and severity, including but not limited to severe pain, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of a bodily organ or part.

Patients should take the path of safety; that’s the reasonable thing to do. If they believe there’s a chance that failure to obtain emergency care may seriously harm them, then they need the resources of a hospital emergency department.

Myocardial infarction versus GERD?

More than one patient has had trouble deciding her gastroesophageal reflux disease (GERD) was acting up or she was suffering a heart problem. Even in the hospital, specialist emergency physicians and cardiologists may require hours, or days, with sophisticated testing to distinguish between the two. Sometimes the problem may be something different and unexpected.

Think of the potential consequences. If the patient went to the emergency department for an evaluation of chest pain, he is taking the path of greatest safety. If all he has heartburn, no foul. If he stays home and has a heart attack, you may be disabled or die.

Few of life’s decisions, including those regarding an individual’s healthcare, are always straightforward. For that reason, we must all try to use judgment. We all make potential life and death judgments on a routine basis. Can I swim in this current safely? Do I need to get my car’s tires replaced? Should I drive through this yellow light?

A patient’s prudent judgment should tell her where to go when she needs medical care, and always with an emphasis on safety.

Once in the emergency department, the patient has a right to expect that the care will be delivered according to the emergency medicine standards of care.