Reliable keys to identify a medical emergency

A larged medical insurance company received criticism for its handling of some emergency room (ER) claims recently. If, after review of an ER visit the company determines the condition was not a true emergency, it will deny payment for the visit, making the patient responsible for the full amount.

Critics, including patients, doctors, and hospital administrators fear this endangers patients , who may be harmed by avoiding  emergency room care for financial reasons.

You may consider an  emergency to be any medical condition which 

  • is new , sudden, and/or unexpected,
  • worse than usual or uncontrolled,
  • of unknown origin,
  • not responding to treatment,
  • not improving or resolving,
  • interrupts normal life.

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

An emergent medical condition is one that, if not treated promptly 

  • Threatens life
  • Threatens one or more limbs
  • Threatens vision/hearing/speech/mental function/ function of any major internal organ or organ system
  • Threatens long term and/or permanent bodily harm
Minutes matter with heart emergencies
Minutes matter with heart emergencies

In the United States, a federal law known as EMTALA defines a medical emergency as

“a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”

Examples of emergent conditions include 

  • Sudden or new  changes in heart function, like a myocardial infarction (heart attack), arrhythmia (abnormal heart rate or rhythm) or congestive failure (poor pumping capacity)
  • Brain conditions including stroke, head trauma, seizure, psychosis
  • Pulmonary (breathing) dysfunction including pulmonary embolus (blood clot), severe pneumonia, asthma or COPD
  • Multiple trauma, including extensive burns , multiple fractures, or trauma to any major organ like the liver or kidneys
  • Chemical changes in the blood; for example high /low blood sugar, low blood potassium, low platelets,
  • Severe depression and/or anxiety
  • Drug and alcohol overdoses
a person having blood pressure measured

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, severe dizziness
  • Hallucinations, confusion, thoughts or threats of harm to self or others
  • In a pregnant woman- any of the above plus loss of fetal movement
  • Persistent/severe nausea/vomiting/diarrhea
  • Severe pain, especially if it prevents or inhibits body function

Certain groups of people are more at risk of significant illness with any of these symptoms, so emergency care should be sought sooner than later. They include

  • infants up to age 2
  • elderly-most medical references still call this over age 65
  • pregnant women
  • people with suppressed immune systems as from cancer chemotherapy, HIV, malnutrition, other drugs

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.

Learn more about common heart diseases at this previous post

Exploring -when HEARTS break

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.

IN AN EMERGENCY  CALL 911!

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

You should 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!)

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?

We doctors don’t expect you to diagnose your condition before coming to the ER or the office, and insurance companies either. With using the above guidelines, if you even suspect your problem is an emergency, you are wise to seek help.

Dr. Esther Choo, an emergency physician shares

6 Tips for Getting the Most Out of Your Emergency Room Visit

a speed limit sign with an H for hospital , 5 miles
A hospital will have a full service emergency room, although the level of services differs based on the size of the hospital.

Dr. Deborah Burton, pediatric ear, nose, and throat physician gives

5 Top Tips to Best Use Urgent Care Centers

a sign on a building -"express-urgent care"
Don’t expect an urgent care clinic to offer all the services of an emergency room.

Your definition of an emergency and your insurance company’s definition may differ-and that difference may cost you money. Read why here.

Is it an emergency? Insurer makes patients question ER visit

exploring the HEART of emergencies

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

Helicopter landing at a hospital to deliver a critically ill person.
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3 keys to effective communication with your doctor, part 1

“Patient engagement” is a buzzword in health care these days, but what does that look like?

Professionals in health care believe patient engagement means improving communication between doctors and patients. And for good reason- they also believe that doctors and patients need to communicate better.

Patients complain that doctors don’t listen to them or respond to their questions and concerns, don’t spend enough time with them, and don’t use language they can understand.

Physicians feel frustrated when patients ignore their advice, misinterpret instructions, and seem uninterested in their conditions and treatments.

 

 

The main problem with health care communication is that it involves people- and people frequently communicate poorly, and sometimes not at all. It never will be perfect. But we can do better.

So what is true patient engagement anyway?

 

Dr. Rob Lamberts writes

“Engagement is about interaction, listening, and learning in relationship to another person.”

 

 

Barbara Ficarra, R.N. , puts it this way:

“Patient engagement is a connection between patient, caregiver and health care provider.

An empathetic and trusted relationship forms and mutual respect is fostered.

Patients and their families are empowered and they are active in health care decisions.

Those patients and consumers who choose to be actively involved and in charge of their health work together with their health care providers to successfully reach their health goals and needs.”

Vietnam clinic setting

Communication is challenging when patient and doctor don’t share a language.

 

 

 

Many leaders in health care believe doctor-patient communication is less than satisfactory, so they are teaching physicians how to talk to patients more effectively. But  to be engaged and empowered, patients need to develop skills also, and learn to approach their physicians in a way that is perhaps different from what they have done in the past.

 

I  like to start with the basics. What do I mean by communicate?

The dictionary defines it as – to convey or exchange information, thoughts and feelings. Therefore, it’s not just about words.

It can also mean to join or connect.

The definition which I think most applies to this topic is

Communication is –a connection allowing access between persons

 

doctor holds patient's hand

on a mission trip to Mexico; photo by Brian Edgerton

 

I believe the first, and most important step in communication is establishing that connection, or relationship.

If we try to start exchanging information, or even thoughts and feelings before we have established a connection, it is like to be unsatisfactory.

 

For example- think about a recent retail service experience – one that worked and one that didn’t. Perhaps it was a call to customer service to get a phone service problem resolved. Or maybe you went to a car dealership and interacted with a sales person. Whatever the situation, and whatever the outcome, you probably rated it more favorably if you felt connected with the person helping you.

Recently I called my medical insurance carrier to resolve some unpaid claims- and my insurance is through a government agency. I dreaded the call, expecting a difficult unpleasant conversation. But the rep was professional, efficient and confident. She started immediately by telling me her name and position, then asked me my name. She then accessed and reviewed my account, giving me feedback about what she found. Then we started working on my problem, and continued until it was resolved. I was surprised to have the situation taken care of not only efficiently but pleasantly.

 

 

I propose there are three keys to effective communication; realizing there is no one right way, no one size fits all. Each person and situation is unique, with different personalities, and styles of relating.  Some or all of what I suggest may not be appropriate or work in some situations.

 

 

In dealing with others be willing to be frank , flexible and forgiving.

Approaching others with generosity, grace and gratitude makes  it easier to connect.

 

The People

“Hello, my name is Dr. Oglesby, and I’ll be examining you today.”

Customer service depends on connecting, and that usually starts with knowing who you are dealing with. The first item we exchange in any human interaction is usually our name.

Dr. Oglesby nametag

 

 

You should learn not only the name of your doctor (and other health professionals; I’m going to concentrate on physicians in this post) but also their specialty– internal medicine, cardiology, psychiatry, etc

What is their role in this patient’s care? Is this doctor primary or a consultant, and

what issues are each managing? (especially in a hospital situation)

 

And they should know the same about you and any family members who are actively involved in your care. Tell your doctor what name you prefer to be called if it’s different than the name on file. Your doctor should know who is your legal next of kin or who has POA (power of attorney if applicable)

Introduce other family and friends and identify the primary contact person; this  first level of receiving and giving information, is especially important in the hospital setting. This will create continuity as the doctor speaks to the same person every day.

 

If you take a friend or relative to your doctor’s office with you, make sure they understand what their role is. Your family’s insights and observations provide helpful information to supplement what your doctor learns from you. They can help you remember and understand answers and instructions. But this isn’t a time for them to discuss their own medical issues with the doctor.

 

 

 

The Setting- where you interact with your doctor, is important but often overlooked; as the patient you likely will have little control over this, but is a factor to consider when choosing a doctor or hospital in advance. If you are already in a medical setting, giving feedback if there are issues that make you uncomfortable.

A hospital setting is different from an office, but some general principles apply.

 

hospital

Patient engagement is vital during a hospital stay.

 

 

Ideally it should be as comfortable as possible, private, and quiet, so you can hear and see each other well. In the hospital, ask visitors to leave.

Friendly greetings are fine anytime you encounter your doctor, but discussions of personal medical information don’t belong in the hallway, elevator, or cafeteria. Likewise, if you run into your doctor at church or the grocery, just say hello.

Come to an office visit prepared. If you have test results, previous medical records, xrays, etc. bring them with you. Not all doctors will request it, but most will appreciate an up-to-date list of all medications you take, or even bringing the meds with you. Turn off your phone. Bring a friend for support but not a social visit.

Expectations about time can create conflict, whether the visit lasts longer or shorter than you expect. If you weren’t told, ask the office how long the appointment is for, realizing that it will only be an estimate; it will depend on what you and the doctor end up discussing and what you need done.

 

Showing up on time helps the office keep to their schedule and shows the doctor you are serious about your care and respectful of other patients’ time. If the office is consistently poor at time management, address it respectfully; sometimes it is best to move on if this continues to be an issue that bothers you.

Most hospitals and clinics have abandoned paper charts for computers, using electronic health or medical records- EHRs or EMRs. I’m not going to dwell on it now, but computer use in the exam room or bedside has changed the dynamic between doctors and patients in ways that often are not compatible with connecting and communicating. For now, I’ll just tell you this is a problem doctors recognize and are working to make computer use more patient and doctor friendly.

 

Connecting with your healthcare providers depends on acknowledging feelings- depending on the current status of the illness, progress to date, future prognosis, there may be a range of emotions – worry, fear, despair, hope, relief, anger, resentment, frustration. Give feedback respectfully; if anything about your care is not as expected, or doesn’t seem appropriate, or you just don’t understand something, speak up.

 

Expressing feelings honestly and respectfully, and listening with empathy and respect can build the trust that is vital to creating a connection for effective information exchange – conversation.

checkerboard

Any human interaction is better with effective communication

 

Here is a previous post where I discussed the importance of communication between doctors and patients.

And here is how one medical school is helping students learn The Art of Communication 

In the next post I’ll talk about how to talk to your doctor so you get the information you need and can understand.

 

E Rob Lamberts is an internal medicine-pediatrics physician who blogs at More Musings (of a Distractible Kind).

Barbara Ficarra, RN  is creator, executive producer and host of the Health in 30® radio show, and founder and editor-in-chief of Healthin30.com