The patient gets to the hospital’s emergency department (ER) and looks around. Every bed is filled, the staff is disheveled, the doctors and nurses are running around, there’s urine on the floor, and the place has a bad odor. Very bad signs. Would you stay in a doctor’s office that had those conditions or at any other healthcare facility?

It might not even be the fault of the doctors and nurses; they might just not have enough staff. But does that matter? Not to the patient, he has a smaller chance of getting the care he might need if the place is short staffed, and the resources are stretched.

If your food doesn’t reach you in the restaurant because the waiter has too many tables, does it matter to you why he has too many tables? He might be the best waiter in the world, and the chef might be superb, but if the food doesn’t get to you or, in an ER, if the personnel can’t get to the patient, it doesn’t do him any good.

Believe it or not, it is possible to walk out. Even call a cab. The patient is in a hospital, not a prison. The staff may ask him to stay, but if they’re really overwhelmed and understaffed, they are, more likely than not, simply “covering” themselves in case he has a problem after leaving. If he is capable of leaving in a cab, fine. It’s way, way cheaper than a private ambulance, which he might or might not be able to get.

If the place isn’t cleaned, there’s a greater chance of infection. If he is a patient there, he is presumably sick, and he is therefore at a greater chance of catching whatever might be there. If the staff takes hours and hours to provide care, it’s a bad sign. If he thinks he is sick enough to need care right away, he might still have to wait for other patients who are deemed to be sicker than him. That’s normal. Still, if his wait is really absurd, like hours, he should consider where else he might want to go.

Some hospitals also have specialized care that is not advertised. Hand specialists can be found, but there are hospitals which are “hand centers.” The patient may find out, for example, where fingers are re-implanted. It means they have a high degree of expertise at that hospital.

Sometimes a patient can bypass the ER if he requires admission simply with a phone call or two. A physician I know had a child with a burn injury for which he was caring. He needed consultation. He called the local pediatric burn center and spoke with the burn specialist. It was an easy phone call. Burn centers are great for caring for burns, and they generally want to see as many burn patients as possible.

The child was then a “direct admit,” walking right past the four-hour wait in the ER. A patient can do that too.

Dr. Dean Dobkin

Dean Dobkin, M.D., is a practicing emergency physician who has been certified and recertified three times, as a specialist in Emergency Medicine by the American Board of Emergency Medicine. He has experience acting as faculty for an emergency medicine residency program, has held academic appointments at two Philadelphia medical colleges, and acted as an emergency department director at a variety of different hospital emergency departments. He has been honored by being named a Life Fellow of the American College of Emergency Physicians (ACEP), after serving with distinction for that organization. He testifies as an expert witness for Med League.

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