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When It’s Urgent

Howard Rohleder

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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