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EVEN THOUGH I’M NOT a doctor, I’ve been around medicine all my life. My father was a general practitioner and I spent my career in hospital administration. I had administrative oversight over three emergency departments of varying sizes. Based on my experience, here are 10 recommendations that may improve your experience should you need to visit an emergency room:
1. If you use the emergency room (ER) for a non-acute medical condition, bring a book. The ER prioritizes based on the severity of the health issue, not on who arrives first. You’d want the same if you were there for a heart attack.
2. Tell the truth. No matter how embarrassing your condition or the circumstances surrounding your accident, the ER staff has heard it all. By knowing the background, the doctors and nurses will be better able to help.
3. Any medical history you can bring will be useful. Arriving with a list of medications, current medical problems, past surgeries and the names of your physicians will speed things along. The longer the list, the more important the information is. If you have advance directives, bring those as well. If all your health care is provided within the same health care system, the ER might have access to your electronic medical records, but don’t count on it.
4. Visit the ER that’s in-network for your health insurance unless it’s a life-or-death situation. Showing up at an out-of-network ER has “major hassle” and “hefty bill” written all over it, though it may be necessary if you’re traveling. When picking health insurance, think about the emergency room you’re most likely to use.
5. The ER physician and staff don’t know how your insurance works and they don’t care. There are innumerable health plans out there, and each has its own network and limitations. By going to an ER, you’re conveying that you have an acute medical condition. They’re there to solve that problem, regardless of cost.
6. Surprise medical bills are real, but they can sometimes be avoided. The ER physician may refer a given condition to X hospital because it’s 15 minutes closer than Y hospital, which is equally capable. If X hospital isn’t in your network, speak up if you’re able. The same goes for surgeons or other specialists who drop by to consult. To find in-network providers, you might call the number on the back of your insurance card or use your phone to go to your insurance company’s website.
7. Helicopters are wildly expensive and a huge source of billing surprises. When necessary, they save lives, but understand that they may come with a significant out-of-pocket cost. If a helicopter is proposed, it’s reasonable to ask whether using slower ground transport is too medically risky.
8. The ER staff isn’t necessarily there to provide a definitive diagnosis. Their job is to determine whether your condition will kill you, and then prevent that from happening. If you arrive with chest pains, that might suggest five or so fatal conditions. Once those are ruled out, you’re safe to go home or to an inpatient floor for a follow-up to determine if you have, say, chronic indigestion. Medical problems on TV may be resolved in an hour, commercials included, but the real world often doesn’t work that way.
9. Despite the convenience of 24/7 availability, an emergency room should not be a substitute for your primary care physician. There’s value to your ongoing relationship with your primary care doctor that’s lost in the ER. An ER doctor may head down a diagnostic path that makes sense based on what she sees, but wouldn’t make sense if she had the background your doctor has.
10. We live in a world where we can review ratings for many products and services, and this is starting to be the case for physicians. You don’t have a choice of which doctor you’ll see in the ER. Still, evaluating them by previous patients’ reviews may be shortsighted.
In the 1980s, hospitals started doing patient satisfaction surveys. I decided to share the physician-specific comments we received on our ER survey with each of our ER doctors. One consistently had the lowest satisfaction ratings. As I explored the reasons, I came to understand that he was very introverted and wasn’t one for small talk.
No one ever said he was mean or inappropriate. Meanwhile, the ER nursing director rated him the highest for his medical skills. The other members of the medical staff all said they hoped he would be the one on duty if they arrived with a heart attack.
Hospital administrators would love to only have doctors who are highly skilled and highly personable. Just remember, if your ER physician doesn’t bubble the way you think he should, his previous case may have necessitated telling a family that a child just died. Cut him some slack.
Howard Rohleder, a former chief executive of a community hospital, retired early after more than 30 years in hospital administration. In retirement, he enjoys serving on several nonprofit boards, exploring walking paths with his wife Susan, and visiting their six grandchildren. A little-known fact: In May 1994, Howard was featured—along with five others—on the cover of Kiplinger’s Personal Finance for an article titled “Secrets of My Investment Success.” Check out his previous articles.
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Thank you for sharing your insights for health care!
Excellent post. I am shocked at how many patients come to my hospital’s E.R. to get their medicines when they have not gotten a refill in time.
Seems like an expensive way to get a refill given the high copays for ER visits that most insurance plans have. Why not choose the automatic refill option that most pharmacies offer? We’ve been doing it for years.
This may be a useful article, but a far more useful one would be how to get in network care when you need it. For instance, the article mentions going to a doctor after getting released because a condition isn’t an emergency. Then the next appointment available is in six weeks…
Good article, and really most medical issues can often wait for an outpatient visit with their physician. For those medical issues that cannot wait, only take exception to bringing a book to the emergency room because if you really belong there, there is no way you will focus on a book…been there and casual reading is the last thing you’d want to do.
I’m surprised you did not mention that almost all ER physicians are out of network, regardless of the hospital status. That started in the late 2000’s and now is close to 100%.
The new No Surprises Act seeks to fix this issue, I believe.
Thanks for the article … I love reading the insights from a former healthcare administration insider.
The title should be “When It’s Emergent”. Our health insurance companies should update their smartphone apps to use geo-location to determine whether facilities/providers are in-network or not. My wife recently had ankle surgery at an in-network hospital using an in-network orthopedic surgeon. But are the radiologists and anesthesiologist in-network? One never meets the radiologist(s), and the anesthesia doc pops in at the last minute. Healthcare is complicated, even for those of use who think we are going through all of the right steps.
A recent innovation that I like is the “virtual visit”. I have used this feature successfully recently, no extra fee! My healthcare thinking nowadays for a new condition — try a virtual visit first, then primary care doc, urgent care, then ER. Of course, see the primary care doc for an annual visit.
Very helpful. Thanks for the post.
My doctor son, doctor daughter in law and semi adopted physician assistant “daughter” all have done a lot of time as ER docs. I’ve also been to ER’s as a patient and as a parent of an injured kid. Absolutely the ER is the last place you should go if you aren’t in danger of dying, they have bigger fish to fry. Now you can just go to an urgent care clinic or your own doctor if it’s not life threatening and get faster attention and leave space at the ER for the truly ill or injured or indigent folks with no other option. Nice overview of the considerations people should take. Many hospitals in the US are now outsourcing the ER to a contracting company. That’s the case in our town.
Could also consider an Urgent Care office instead of an ER. I did wind up in the ER last year, but only after I called an Urgent Care office and they told me they didn’t have the equipment for the test they thought I needed. (And it was a looong wait for the test, which was needed.)
Good advice. Thanks for sharing.
I can relate to your article. For the first time since I was a kid 60 years, I went to ER 5 times last Fall due to severe abdominal pain. I found the ER docs to be competent, thorough and caring in their treatment. I was often told after a battery of tests that they could tell me what I did not have but not what I had. I had followups a couple of times with my PCP and he did not know either. My pain was so intense that even morphine did not always relieve the pain.
Shortly thereafter I had my annual urology checkup. My urologist immediately discovered that I had a urology infection which he treated with antibiotics and no more pain.
My only complaint is that no doc, including my pcp, suggested I be checked by a urologist. You would think, given the location of my pain, that one of them would have suggested I see a urologist.
ER was not a great place to be last Fall due to Covid, but I was impressed with how organized they were and the competency and professionalism of the staff.
Just to be clear, in each of the 5 ER visits I had, I called the triage nurse at my PCP’s practice. Based on my symptoms, each time they recommended that I go to ER. By the 5th time, I knew they would not determine what my problem was, but I hoped they would relieve my pain with medication.
I’ve gone a couple of times to an ER for issues that were not acute. I would be very reluctant to go again unless I was dealing with a life or death issue.
95% accurate and good insights.
As far as seeing the most acute first, since the 1970’s, stats are basically unchanged showing that 80% or so of people get discharged, and 20% or more need no testing or only one test – like a rapid strep, Covid, etc..
So most well-run ED’s don’t make those patients wait 4 hours. They have an entirely different team (or for the big ED’s several teams) just taking care of lower acuity people to get them in and out quickly and keep them from entering deeper into the ED where the sicker patients are.
Other ED’s have a provider in triage getting testing started within minutes of arrival so by the time they see a physician or advanced practice provider (NP, PA) the results are ready and the patient can be rapidly treated and discharged.
As far as out-of-network bills, congress recently passed the No Surprises act which has significantly altered the landscape of emergency medicine billing.
I believe the No Surprises Act only applies to in-network hospitals. Before the act, a patient would go to an in-network hospital and sometimes an out-of-network physician or other medical professional would see the patient and bill separately. (Often called “balance billing”.) There was no way for the patient to distinguish who was in-network and out-of-network. However, in the example given in the article above, if the patient were going to an out-of-network hospital, then they could reasonably assume all charges would be out-of-network.
Perhaps I should not have used the word “surprise” in item 6 since that suggests situations covered by the new legislation. If you expect your visit will be covered except for a $100 copay at an in network ER and you go to a out of network ER, you might be “surprised” to find you are paying more than $100 for the visit. Same if you are transferred to a non-network hospital. You are still obligated to know your insurance network and you will pay more if you use an out of network facility. This doesn’t have to do with what the hospital charges, but with what your insurance covers.
I agree that most ERs have made provisions as you outlined for the non-acute cases. Understand that smaller ERs may only have one team in place to handle all cases at least some of the time. Also, the non-acute teams can also be overwhelmed and, again, acuity will determine the order patients are seen.
4 out of the 10 tips relate to $$ , the cost of medical care. Still astounding to us non Americans every time we read this kind of stuff. What’s the purpose of gov’t if not to pay for services for their citizens?
I’m pretty sure your tax rate would astound many Americans. Our system, with all of it’s flaws, emphasizes individual freedom over big brother government.
I’ll take the system that has better outcomes, approx 50% of the cost per capita, universal coverage, & no pushback on treatment options from insurance companies, but thanks anyway. And despite what you claim, overall tax burden is roughly the same between the 2 countries. & there is no “big brother govt involvement” …Drs submit their bills to the Govt for payment ….that’s it. Govt has no say in type or quantity of medical care. Unlike the US, if a Dr wants to do 50 tests, the Dr does 50 tests …they don’t need approval or permission from anyone.
It’s worth remembering that there are different types of freedom. The U.S. system may theoretically give an individual some freedom of choice on healthcare insurer and the ability to comparison shop different plans, but its accompanying patchwork of in/out of network providers and varying plan terms can cause ER patients to either A) fret over billing when they should be focused on properly addressing an acute health concern, or B) face the stress of large medical bills later. In a gov’t based health insurance system like what OP alluded to, you might not have the freedom to choose insurer/plan/premium rate, but you might gain the freedom to just go to whichever ER is best for your healthcare without worrying about billing issues or even the potential for medical bankruptcy.
When you add state taxes to federal taxes the US rates don’t look so good. And what is the good of lower taxes if medical costs bankrupt you? What is the use of “freedom” if you die/become incapacitated for lack of medical care? Medical care should be a right, not a privilege, and every industrialized country aside from the US manages that.
Great post and insight. Thank you!