How to determine good ER/bad ER????

[catwoman]

Had to go to an ER Sunday night and was very dissatisfied. Now I'm wondering about how to select a hospital ER for my next emergency.
I had flown to New Orleans on Friday night for a cat show. During the night, I woke up with my left eye watering and in pain. I got by the weekend thanks to various eyedrops (antibiotics, lubricants) that friends loaned me.
When my flight landed Sunday night, I had my husband take me to a fairly good-sized hospital.
I was seen very quickly, but...
The doctor did not even touch me -- did not lift the eyelid, stain my eye to check for abrasions, scratches, etc. Just said, "Oh, you have conjunctivitis," said he would Rx erythromycin ointment & Vicodin (sp) for the pain.
Was home by 11:45 p.m. Stayed home Monday, in worse pain. John came home & called my ophthalmologist to get me worked in.
Diagnosis: corneal erosion, not conjunctivitis. My Dr. was able to spot the problem even before he stained my eye.
I will have minor surgery 7/26 to correct the problem. Turns out this was the reason I've suffered from an "allergy" manifesting itself in my left eye as far back as 1971-72.
Turns out the hospital farms out its ER services to a group of Drs. I doubt the doctor who saw me was an ophthalmologist.
I'm concerned about what to do should I ever need to go to a hospital ER for cardiac reasons. That's a possibility, what with a mechanical valve and being on Coumadin.
How can I determine NOW if a hospital ER is a good one?
Any ideas?
Since I work for a newspaper, I am going to pick our medical writer's brains, too.
I'm contacting the group of Drs. that staff this hospital's ER, my insurance company and my credit card company. Don't feel I should pay $100 when my eye wasn't examined!
Grrrrrrrrrrrrrrrrrrrrrrrrrrrrrr!

 

[McCln]

I hate to tell you this, the ER is not a good place to find a specialist. I have always had good experiences so far in only two er's, one as a child at Children's Mercy Hospital with allergies on skin of my foot as a preteen. Later, when I had a flare up in one leg and another time when I hurt head in a fall.
Most ER's are not bad, just doctors in training in them. Just try to be careful and remember, specialists are not in ER's. Take care and good luck on the surgery.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve

 

[Gemma]

Hi Marsha,
I have no idea how you pick a good ER - sorry!
Here in the UK, even a GP will have a good look at/in your eye before deciding what's up - if there's a problem or he can't see the back of your eye properly, he'll refer you to an opthalmologist for an eye test (I work at an opthalmologist's practice, and we have a few referrals a month where a GP wants a second opinion on possible injuries to/debris in the eye). It strikes me as very remiss of the ER doctor you saw not to even touch your eye before making a diagnosis of conjunctivitis. Maybe he's been taking his advice from Dr Kovac on "ER" (after he came back from Africa) to do the absolute minimum testing possible .
Good luck with the surgery - hopefully you'll be able to finally get some relief after 30+ years.
Gemma.

 

[tobagotwo]

Of the ERs I have been in, none compare to the TV series. I am going to Hollywood, if I ever need ER attention. Or perhaps to Chicago Hope, which is closer.

Frankly, most ERs seem to be set up for physical trauma cases, more than anything else. Ours has a 30-minute system, to ensure you're looked at promptly. They actually set a timer, and you get a visit for each step in your treatment at exactly 29 and 1/2 minutes. If the doctor says the NP will give you stitches, she will show up in 29-1/2 minutes to look at you. Then the nurse goes away to get the needle for - you guessed it - 29-1/2 minutes, etc. Childish, and horrible for the patients. Imagine going there with a stroke or heart attack. (This was not where I had my valve done.)

My two cents regarding visits to the Emergency Room:

- Be sure you know what any special needs are for your condition, particularly if you are on anticoagulation therapy or prescriptions that tend to be reactive with other drugs. Bring a prescription list with you, if you can.

- If you are on anticoagulation or have ongoing heart issues, strongly consider wearing a medical alert bracelet or at least carrying an alert card, which should include your current meds.

- If the doctor doesn't seem to be paying attention to what you're telling him, he probably isn't. Insist that he give you his attention for information you feel he needs to have.

- If he appears to be doing something in a way that does not seem appropriate to your condition or medication (including warfarin), question it immediately and firmly.

- Make sure he tells you the treatment plan before they execute it. If you disagree with the treatment plan (as may happen with Coumadin use), refuse the treatment, or force a consultation (if at all possible in your condition).

There is little sadder than hearing someone say later, "That didn't seem right to me at the time, but he was the doctor."


Best wishes,

 

[Mary]

Marsha,
Both emergency rooms in my town have two levels of care. Patients are triaged at arrival to determine if they are candidates for what is called
"convenient care." This designation means you have a medical problem that could be taken care of with a scheduled doctor's appointment, but due to time factors you've had to go to the ER. (And it sounds like that's what happened in your case) You are offered the option of going with convenient care if you qualify (it's not available if you need blood drawn, x-rays, etc.)
With convenient care, you would probably get a more thorough exam with the staffing done largely by nurse practioneers. Working parents with a sick child often pick convenient care because they can get treatment started that night and don't have to take time off from work for a doctor's appointment. The visit isn't normally covered by insurance. As a result, they expect payment before you leave.

The second level of care is true Emergency Room. Any and all life threatening conditions are treated by these doctors. The hospital where my husband works is designated a Level 4 trauma center with the same designation given to it's Emergency Room. It is staffed twenty four hours a day by physicians and surgeons whose specialty is emergency medicine.
If you presented with a heart emergency, you would receive much different care than what you experienced with a nonemergency.

Perhaps you should contact the hospitals and ask what is available in their emergency rooms. Do they offer a tier level of treatment options? Hospitals want your business, so they should be happy to send you information on their services.
Good Luck!
Mary

 

[catwoman]

Mary:

I tend to think pain in the eye **is** an emergency, since it can be a symptom of a very serious, potentially life-threatening problem. And after all, you only have 2 eyes. No chance for an eye transplant.

About 10 years ago, one of our cats slashed my mouth and my husband rushed me to the same hospital's ER. No one would touch it, except to give me ice. They called in a plastic surgeon, a DDS/MD, who sewed me up. Dr. Schuster was out on the golf course when I arrived at the hospital. This was on a Saturday.

That's why I expected that anyone presenting a serious problem with their eye would be seen by an ophthalmologist. If not that, then at least the attending physician would examine the eyeball -- not just look at the patient and choose the easiest diagnosis to get the patient out of the way.

 

[Gail in Ca]

I agree that the eye should've been given more exam time, but it seems in some ER's they just make a quicky diagnosis and treat as if you shouldn't have come in for such a minor thing.
I took my daughter to an urgent care clinic when her eye was very painful and it had gotten worse at around 5pm on a Sunday. I heard the doc we were to see complain about people like us who come in at the last minute before they close. I almost left then and there and should have. He quickly looked at her eye and she almost screamed from the pain, he put opthalmic antibiotiic ointment in and patched it, said it was conjunctivitis. The only good advice he gave was to see her pediatrician in the am. She had bad pain all night and we took her to her regular doc, who just had to touch my daughter's eye to know it was worse than 'pink eye". She got us into a opthamologist right away and she was diagnosed with iritis, a very rare condition for a teenager. (The pediatrician suspected this and had only seen one other case in her long practice, she is a great lady).
If not treated right she could've lost sight in the eye.
Some doctors are idiots who shouldn't be in the profession.
Also, I think ER's have an unwritten 'at least 4 hour rule' where they keep you about 4 hours, and most of that time you just lay in the bed waiting for help.
Gail

 

[The Bionic Duo]

Marsha
Wow just hearing these things gives me the willy's. I'm very nervous about anything with the eyes, espically since they found a tumor in my right eye--getting a diagnosis on that took several days even though it was discovered by my opthamalgist. I can't even imagine anyone in the ER would know what to do with eyes.

Gail
This is the first time I've ever heard of anyone besides my mother having Iritis (it is a type of artritis). She had it on and off for many years, and because of the large dosages of drops they used to dilitate the eye it is now permanently dilitated and has very limited vision in that eye--she is now 81 years old so this happened over a very long period of time. It certainly is not something you want to ignore.

Joan

 

[catwoman]

Gail & Joan:

I've contacted my insurance company about the ER visit and dissatisfaction with the ER doc. Also talked with the "patient advocate rep" at the hospital and voiced my dissatisfaction. Will be writing a letter this evening to the group of docs who staff that hospital's ER.

 

[Gail in Ca]

Iriris, to Joan

Iriris, to Joan

Yes, my daughter's diagnosis was a rare one for her age.
Her pediatrician then sent us to a rheumatologist and endocrinologist.
The pediatric rheumatologist at Stanford determined she probably has
pausi-articular juvenile arthritis.
However, she has had no more iritis in 3 yrs and has no other arthritis symtoms, so far.
We hope for the best. I wonder if this is inherited from me, since my diagnosis was granulomatous aortitis. She might have gotten inflamatory problems from me, but it's hard to say.
Gail

 

[The Bionic Duo]

Gail

You know I have never thought about inflamatory diseases such as arthritis running in families. What I do know is that if you are prone to arthritis, it can invade any injuries or disturbances in the body. I have arthritis in my hands and from the many bangs and falls on my left knee have had to have it replaced due to arthritic damage. My eye doctor at UCSF has told me that she is watching the eye that had the tumor for any signs of arthritis because it has been "disturbed". (I only learned of this recently when I went for my annual checkup at UCSF--I had the radiation in 1998--its amazing what the Dr's forget to tell you.)

Glad to hear that you daughter has had no re-occurances of the Iritis, it can do some serious damage to the eye.

Joan