Why NOT To Go to the Emergency Room

Hi, thanks for reading! My name is Dr. Jeff O'Boyle, and I am a board-certified family medicine doctor who owns his own clinic, Beyond Primary Care located in Ann Arbor Michigan. Like most family medicine doctors, our goal is to keep our patients healthy and out of emergency rooms if at all possible. My best friend is an emergency room doctor and I have the utmost respect for the care ER doctors provide and the role they serve in medicine. I have seen people in emergency rooms with life-or-death conditions such as chest pain and shortness of breath, and am grateful we have skilled providers in this area of medicine.

Why Not to Go to the ER

Yet, I meet a good number of people who utilize an emergency room like it’s a one-stop-shop for all their medical health. People going to emergency rooms for dental pain, refills on blood pressure medications, common colds, and various other complaints that have been manifesting themselves over the past 3 months. As a Direct Primary Care (DPC) family medicine clinic, I promote and encourage that longitudinal care with my patients to ask me for medical advise or treatment that can’t be achieved in emergency rooms. Here is some free advice why NOT to go the emergency room.

1) The ER doctor doesn’t know YOU

The trust that develops over time between a doctor and a patient (or family) is absent. It is also extremely helpful to have seen a sick individual or child when they were healthy, to know how far from their baseline they are.

2) You don’t know the ER doctor

Sick people are not happy people, and it’s hard to do a physical exam on someone stressing out. A familiar face causes less distress, and allows the doctor to do a better evaluation.

3) “Emergency” does not mean that you’ll be seen soon

 The ER team takes care of the sickest patients first. If you have a minor illness and a severely ill or injured person rolls in, you’ll be waiting a while.

4) It’s expensive

 Really expensive as noted here and here. It costs about $1,000 more to evaluate a minor illness in the ER than it does in an office setting–and that’s without any tests.

5) You will probably have tests

 This means needle sticks, radiation exposure, and increased cost. Often, a DPC doctor could do a thorough physical exam and schedule a follow-up the next day, all at no additional cost to you. But the ER gets one shot, and they can’t afford to miss something, so they tend to over-order imaging and labs.

6) The ER’s job is to figure out what you don’t have

 They are not tasked with figuring out exactly what is going on and solving every problem; the focus is on ruling out life-threatening conditions and deciding which patients need to be in the hospital. This often frustrates patient’s who come in wanting answers.

7) There are sick people there

 In the summer it may be vomiting or diarrhea. In the winter, it’s the flu. Emergency rooms do their best to keep things from spreading, but viruses haven’t survived this long by being bad at what they do. If you weren’t sick when you went in, you may be soon.

8) If the beds are full, really sick people can’t be seen

This is more altruistic, like vaccinating yourself so nobody else gets the flu–but it’s real. Every ER has a limited number of beds, and when they’re full, they’re full. If they’re full of relatively healthy people, the really sick ones sit in the waiting room until a bed opens up.

So What Should You Do?Find a Primary Care Doctor that you trust

This is the most important step, and it’s one that you should take when you are healthy. A good physician can identify diseases early, track a child’s growth and development, provide reassurance when that’s all you need, and handle the vast majority of acute illnesses. If–or rather, when–you get sick, your doctor has access to her records and history, avoiding expensive and unnecessary repeat testing. That doctor will understand your personality and perspectives, and you will be less scared of a familiar face. Look for a Direct Primary Care doctor, who routinely offers same-day sick visits, weekend hours, and phone availability even when the office if closed–a lot of ER visits can be avoided by talking through symptoms over the phone.