Category: the business of health care

Call 911, it’s an emergency! or is it?

To patients, an emergency is any medical condition which 

is new, unexpected, worse than usual, uncontrolled, of unknown origin, not responding to treatment, not going away and interrupts normal life.

However, to physicians and other health care personnel, the definition of an emergency is specific.

An emergent medical condition is one that

  • Threatens life
  • Threatens one or more limbs
  • Threatens vision/hearing/speech/mental function/ function of any major internal organ or organ system
  • Has the potential, if not treated promptly, to cause death or long term and/or permanent harm.
Minutes matter with heart emergencies
Minutes matter with heart emergencies

Some examples of conditions that meet this definition are

  • Acute changes in heart function, like a myocardial infarction (heart attack), arrhythmia (abnormal heart rate or rhythm) or congestive failure (poor pumping capacity)
  • Acute brain conditions including stroke, head trauma, seizure, psychosis
  • Pulmonary (lung) dysfunction including pulmonary embolus (blood clot), severe pneumonia, asthma or COPD
  • Multiple trauma , including large burns or trauma to any major organ
  • Significant changes in components of the blood; for example high blood sugar, low blood potassium, low platelets
  • Severe depression

When should you suspect any of these conditions?

The SYMPTOMS of an emergency  include

  • Shortness of breath, or difficulty breathing, especially if not associated with exertion
  • Uncontrollable bleeding
  • A seizure, especially in a person with no previous diagnosis of seizures
  • Sudden or severe loss or difficulty with vision, hearing , speech, or other functions such as swallowing, thinking, walking, passing urine or stool
  • Fainting, passing out, loss of consciousness
  • Hallucinations, confusion, thoughts or threats of harm to self or others
  • In a pregnant woman- any of the above plus loss of fetal movement

You notice that I did not list PAIN and FEVER. Even though these are symptoms that concern patients the most, BY THEMSELVES they do not define an  emergent condition. However, if they occur with any of the other symptoms, or are severe, then it is reasonable to call it an emergency.

The COVID-19 pandemic presented some unique challenges in emergency room use, I discuss those in this article.

Chest pain must always be taken seriously, even if mild.

Although in persons under 40 years old it is less likely due to a heart attack, there are other life threatening conditions that can occur in this age group. Again, especially if it is associated with any of the other symptoms, it is emergent.

While on a mission trip to Panama, my husband had a near emergency when a board flew into his leg causing a deep gash; our medical team members took care of the injury right on the clinic site, and he recovered without permanent damage
While on a mission trip to Panama, my husband had a near emergency when a board flew into his leg causing a deep gash; a local surgeon was working with our medical team , and with their help he sutured the wound at the small rural church where we were holding clinic; his leg has healed well, just a scar to remind us of the adventure.

So assuming it is an emergency, what do you do now? You do not call your doctor’s office or answering service, your mother, your best friend, or post a question on social media (which I have seen done!)

IN AN EMERGENCY  CALL 911!

Helicopters transport of emergency patients can make the difference between life and death.

If it’s not an emergency but is urgent, then the next best options are calling your doctor’s office or going to an urgent care clinic. Posting on social media is still a bad choice. Do you really want your “friends” giving you medical advice about something they know nothing about?

Now, some doctors may disagree with this- but I think it is acceptable to go to an emergency room for problems that are serious but not emergencies. Since an emergency center is staffed 24/7, it should be utilized; there’s no reason to waste our health care resources. And sometimes it may be your only choice- if your doctor’s office is closed or the schedule full, if you are away from home, or you don’t have a primary care physician.

Just be aware if you go to an emergency room instead of an office, clinic or urgent care facility you may

Hospital sign- 5 miles to help.

That brings me to my final point. There are

10 Things to Know Before Your Next Visit to the Emergency Department

that Dr. Kristin Prentiss Ott and I want you to know. She is an emergency physician who knows exactly what an emergency is . In my career I have worked in ERs so I can attest to the accuracy of what she writes. I hope you never need to go to an emergency room, but if you do, keep her advice in mind.

Helicopter landing at a hospital to deliver a critically ill person.

exploring the HEART of emergency medical care

Dr. Aletha

Life, Liberty and the Pursuit of Health Care

As far back as the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system has evolved into the current military health care system which covers service members and the Veterans’ Administration system for veterans.

You may continue reading here, or follow this link to an updated version of this post.

The Patient Protection and Affordable Care Act (ACA) was enacted by the United States Congress in 2010 to guarantee basic health insurance to all citizens.  People who object to the ACA ,aka Obama Care, dislike or even fear government involvement in medical care; they consider it interference, control, or even nationalization of the United States healthcare system.

I think many people, even physicians, don’t realize or forget, how involved the government already is in healthcare. As far back as the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system has evolved into the current military health care system which covers service members and the Veterans’ Administration system for veterans.

a Veterans Administration clinic
a Veterans Administration clinic (photo by Dr. Aletha )
American soldiers serving in Afghanistan
American soldiers serving in Afghanistan

The year 2015 marked the 50th anniversary of two other government healthcare programs- Medicare and Medicaid. The Journal of the American Medical Association, (JAMA), devoted an  entire issue  to them,the ACA and the implications for the future of healthcare in the United States.

Medicaid provides insurance coverage for adults and children who are unemployed or low income.

Medicare covers disabled children and adults  and persons 65 years and older.

The numbers are rather staggering.

  • Together these programs cover at least 30% of Americans.
  • Together they comprise 25% of all federal spending.
  • Together they pay 40% of total U.S. health care spending.

An infographic from the Kaiser Family Foundation and JAMA explains this further.

Disabled children and adults may qualify for Medicare.
Disabled children and adults may qualify for Medicare.
Children may be eligible for Medicaid if their families cannot obtain health insurance for them.
Children may be eligible for Medicaid if their families cannot obtain health insurance for them.

You may not be eligible for either of these programs now, but chances are eventually you or someone close to you will.

  • Anyone can become disabled from a serious illness or freak accident.
  • You or your spouse may lose your job and your employer sponsored health insurance.
  • Your child may have a disability that will prevent them from working when they grow up.
  • We may all live long enough to qualify for Medicare on the basis of age alone.  Your parents or grandparents are near or already at Medicare age.
Senior adults age 65 and older use Medicare.
Senior adults age 65 and older use Medicare.

It’s important to understand how Medicare works, since it’s not automatic; even if you qualify, you need to sign up to be covered (with a few exceptions). The rules are summarized here. Or consider an easy to understand book here. 

photos courtesy of volunteer photographers at Pixabay