Despite the fact that most people will have had the misfortune of visiting the emergency department (ED) at some point in their life, I find that many folks do not really understand what happens in the ED.
1. Emergency medicine is a specialty. Yes, we actually did residency training to learn how to work in the ED. This training lasted three to four years after medical school and is sometimes followed by another one to three years of additional training for subspecialty certifications, like pediatric emergency medicine, toxicology, hyperbaric and undersea medicine to name a few.
In addition to being specialists in medical emergencies, we are trained to be the extension of all of the other specialists in medicine to figure out whether you have an emergency and how to best direct you from there because, unlike other specialists, we are available to see you 24 hours a day, seven days a week, 365 days a year.
2. We are efficient, but we can’t do everything from the ED. Not everything can be ordered and performed from the ED. Some tests, like MRIs, are of extremely limited availability, if at all, from the ED. We are trained for evaluating whether you have a medical emergency or issue that requires you to be admitted or have an urgent procedure. Once we have determined this, we need to pass your care along to the next provider to help you with your medical needs from there.
3. We are primarily there for emergencies. This means that even though almost 50 percent of medical care is provided in the ED in the U.S., not all of that care is emergent. Triage nurses are trained to help prioritize which people are most likely to be having a medical emergency over the people who are not. If you are not having a medical emergency, you may have to wait until we tend to those that are. This is frustrating, but you will appreciate it the day you or your loved one is the one with the emergency, and we drop everything to take care of you.
4. Your doctor may have sent you to the ED, but what we recommend may not be what they sent you for. People are sent to the ED because their problem cannot be adequately evaluated by phone. So even though your provider thought you might need lab work, an X-ray or in-person consultation with an orthopedist, they have not seen you. After we evaluate you, your needs may end up being very different.
5. We spend a lot of time sitting. We are required to enter a lot of electronic data. So, yes, you will see us sitting in front of the computer. A lot. We don’t like it any more than you do. We also do a lot of communicating with other providers all over the health care system, which means we are often talking to, waiting to talk to or trying to reach someone to talk to on the phone.This necessitates more sitting. This leads to our next ED truth …
6. ED staff get interrupted. A lot. We are used to multitasking because all of the staff are working to take care of multiple people at one time. A recent study showed that ED doctors are interrupted an average of 12.5 times/hour during a shift. We try our best to limit interruptions, but this is often not possible because of urgent patient needs, consultants calling back, urgent lab results needing attention, orders needing to be entered in the computer, etc. Please be patient if we get called away in the middle of tending to your needs. We honestly wouldn’t interrupt our time with you if we didn’t have to.
7. A lot of your care in the ED is dependent on forces outside of the ED. A high volume of people showing up at a given time or a person arriving who needs a lot of immediate attention can slow it down for everyone. We are also often at the mercy of what is happening in areas outside of the ED. If the hospital is full, the lab machine is down, or our transport staff is occupied moving another patient to their destination, you might spend extra time waiting in the ED.
8. Sometimes we seem unprofessional. The ER is one big open room by design. This is so we can keep a close eye on our patients for medical emergencies. As a result, you hear us in our work area. Sometimes something might be funny, or you may hear comments between staff. They aren’t talking about you. It’s staff taking some of the levity out of our sometimes gruesome, emotionally draining and difficult job. We try our best to be respectful of noise, but in an open space, sometimes the volume of our voices gets the best of us.
9. Sometimes it seems like we’re understaffed. And that’s because sometimes we are! EDs are staffed to the average volume, in general, so some days we are relatively understaffed because the volume is higher than normal. Everyone is taking care of multiple people at once, working on a “to do” list that never ends. We have to prioritize by what medically needs to happen first. This can make your wait longer, and sometimes this means you will be evaluated from the waiting room, in the hallway or moved around the ER. We do whatever we can to see as many people as we can as efficiently and effectively as we can. Days like this can mean no food or bathroom breaks for us … literally.
10. Every patient is a VIP. Treating people differently based on who they are or who they know is not in our genes. We work in the ED because we want to take care of everyone who comes in our front door to the best of our ability.
Those of us who work in the ED work there because we can’t imagine working anywhere else. Despite all of the challenges, we really love taking care of you in your time of need.
Author: Dr. Iren Tien Emergency Medicine