SmalltownERdoc

A question that comes up when working in the ER is a simple thing that should be easy to answer. What should we call ourselves? An Emergency Room (ER) or an Emergency Department (ED). Of course, the follow up to this is, what difference does it make?

When the first emergency treatment areas of hospitals were initiated they were literally a single room with a few beds separated by curtains. Thus, they were initially called the emergency room. These were areas meant for only a few patients to come in to be quickly seen by their primary care doctors on their way to being admitted to the hospital. Patients rarely stared in the emergency room for more than an hour and there was no need for specific doctors or nurses to be assigned to the emergency room of the hospital. Times sure have changed over the past 60 years. The emergency area of the hospital is now the busiest part of most hospitals and is staffed 24/7 with a multitude of doctors, nurses and mid-level providers.

About 30 year’s ago there was a bit of an upheaval in the emergency world and the leaders of the various emergency physician societies decided that the best way to get more of a say in the running of the hospital would be to upgrade their Emergency Room to an Emergency Department. Afterall, a department sounds much important than a room. Along with this renaming came the attempt to lose the term ER and replace it with ED. Unfortunately, around this same time came the immensely popular television series named ER, with the irresistible George Clooney (among others) saving lives in the ER every week. Soon after, Viagra came on the market giving a whole new meaning to the term ED.

Personally, I refer to myself as an ER doctor when asked what I do for a living. People seem to understand what this means and they realize that the ER is more than a room now. Unfortunately, the naming controversy does go on, especially in the academic world, so don’t be surprised when you speak to someone who identifies the self as an ED doctor who has never prescribed Viagra.

It was the usual Saturday night in the ER. A few people in with various injuries and illnesses were in their rooms awaiting the typical lab tests and X-rays needed to take care of their problems. Everything seems to be under control. There were only a few people in the waiting room and I thought this might turn out to be a pretty good night.

I picked up the next chart and the patient, Mary (not her real name) was concerned that she was pregnant and having some bleeding and cramping. She stated that  she was 4 weeks pregnant and had been having mild vaginal bleeding for the past few hours.

This is a pretty standard ER problem of evaluating a pregnant woman with bleeding early in her pregnancy. There is a usual process involved including blood tests , urine tests and possibly an ultrasound. As I went to see this young lady, I was going through this process in my mind and the only thing that was a little odd was that the pt stated she was 4 weeks pregnant. We generally measure the dates of a pregnancy from the time of the last menstrual period. In this case, being 4 weeks pregnant means the woman’s last period was 4 weeks ago. Hmmm, usually women have periods about every 4 weeks and most of the time woman don’t get too concerned about being pregnant until it has been more than 4 weeks since their last period. As I entered Mary’s room, this was going through my mind.

Mary was sitting comfortably in the ER bed texting on her phone as I introduced myself. I asked her about her symptoms and she reiterated the story she had told the triage nurse regarding mild vaginal bleeding and cramping for the past few hours. She confirmed that her last period had started 30 days ago and she said she usually had a period once a month and that her periods were pretty regular. She said she had never been pregnant before but she had been sexually active so she was concerned that she might be pregnant. Then she added that she had been a little nauseated the past few mornings and she knew this was a sign that she might be pregnant. Because of these symptoms she stated she had checked a home pregnancy test and it was positive. Next, she stated that she had repeated her home pregnancy test 6 more times and it was positive every time.

Suddenly, warning bells were going off in my head. Who buys 7 home pregnancy tests and tests themselves over and over in the course of one day? As an ER doctor I have developed a certain radar detection system that helps me to sort through patients who have real medical issues from those who mainly need information, education and reassurance. I realized this young woman was so concerned that she might be pregnant that she was able to convince herself that her symptoms had to all be related to being pregnant. As I continued speaking with her and did her physical examination I tried to figure out how to tell this young woman that she was not pregnant and was just starting her normal period. After her exam (which was normal), I advised her that we would check her pregnancy test and some blood work and then I went through the possible causes of her problem, including the fact that this may just be the start of a normal period. Mary just looked at me and nodded as I spoke and it was difficult to read what she was thinking.

Needless to say, her pregnancy tests, both urine and blood , were negative. When I spoke with her about her results, Mary was quite attentive and seemed to be absorbing the information. When I finished I asked Mary if she had any questions. There was some hesitation and then she spoke and thanked me for my help. She stated she was relieved that she was not pregnant and she was happy that she had not told her family that she was pregnant. I was also feeling some relief. Sometimes people have odd reactions when you inform them that their preconceived notion of what is wrong with them is mistaken, but Mary was taking this quite well. My stellar bedside manner and thorough explanation had worked to make this an educational encounter for Mary. As I got ready to leave the room, though, my bubble was burst by Mary’s final comment to me. She said that everything went so well during her visit that she would definitely return to get another pregnancy test if she ever suspected she was pregnant in the future.

Unfortunately, the story of Mary and other patients like her, is indicative of one of the problems we face in the ER. The ER is not meant to be a walk in clinic for every imaginable medical question or concern. For instance, the ER is not the place to come to for a pregnancy test. I feel most people know this but it bears repeating. The ER is for medical emergencies, hence the name EMERGENCY room. Finding out whether or not you are pregnant is not a medical emergency. This is one of those real life ER issues that we deal with everyday. It is not sexy or glamorous and won’t be featured on any TV shows about the ER, but it is real.

This is the official launch of my new blog, smalltownERdoc. As you might have guessed from the title, I am an ER doctor in a small town. I have been working in small town ER’s for the past 18 years and it is amazing how many interesting stories and experiences I have had over that period of time. My goal is to share some of my thoughts and observations to try to help my readers to avoid some of the problems I have encountered over the years.

First off, let me tell you what this blog is and what it is not. It is a place for me to share information about care in the emergency department and how to best optimize your visit there. I will try to do this through examples of good encounters and bad encounters I and my colleagues have had over the years. By letting you know how ER doctors think and how things work in an ER, I can help you have a better ER experience. Hopefully, I can also save you unnecessary trips to the ER which should save you time and money.

Now, for what this blog is not. It is not a place to get cutting edge medical information. I will not really be discussing new drugs or new treatments for diseases unless they are particularly pertinent to the ER. I will try to provide some basic medical information that I expect to be helpful to everyone and if there are questions pertaining to what I have written, I will be happy to try to answer them.

I plan to try to update this blog two to three times per week so keep coming back to check out the new information available as it goes up on the site

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