Surviving the Emergency Room, Part 1: About Us and When to Come

honest emergency sign

Good advice

When I’m not helping to run Precision Scribes, I am an emergency physician. For those who don’t work there, “The Emergency Room” is one of those semi-mythic places that inspires a bit of fear and awe. Open 24 hours a day and staffed with heroic doctors and nurses who can cure every ill. (That’s the perception, anyway.) It’s a place you hope you never have to go, but are thankful is there even so.

I’ve practiced emergency medicine for years in a variety of emergency rooms, and while in some ways they’re all a little bit different, in more ways they are all alike. And unlike most people who hope they never have to go to the ER, it’s my job to go several times a week (at least).

So I thought it would be informative to create a “user’s guide” to the ER that tells you how to get the most out of your trip to the ER with the least amount of pain and suffering for all involved. A document written for a person like you, who hopes they never have to see an ER in person, from a person like me, the doctor who’ll be waiting there to take care of you in case you ever come.

In the first of what will be a several part series, we’ll talk about who emergency physicians are, and what time is best to come to the ER. I hope you enjoy it.


At one time or another just about everyone will have an “Emergency Room Experience”. Maybe you will be the patient, or, just as likely, you will be there with a friend or family member in need of emergency medical care. Either way it will not be a planned event and it will not be convenient. If you are the patient there will be pain and possibly some bleeding involved, you will most likely not know the doctor or nurses taking care of you, their qualifications to do so, or track record. At best it will be an unpleasant interruption of a normal day. At worst—well… But there are some things you should know and some things you can do to minimize the chances of that worst-case scenario.

This user’s guide is intended primarily for those patients who enter the Emergency Room through the front door, having arrived via some sort of private transportation. Those coming through the back door on a gurney being pushed by several firemen and EMTs are generally given a bit more leeway—though the situations in which they are not will be discussed a little later.

About Us: Emergency Physicians

Emergency Medicine is an actual medical specialty. To become an emergency medicine specialist there are certain things a doctor must do. First is the completion of a four-year residency program after graduation from medical school. Then there is the Board Exam. This consists of a written exam, which, if passed, is followed several months later by an oral exam. Only upon successful completion of these tasks can a doctor become a Board Certified Emergency Medicine Specialist. But is doesn’t end there. In order to maintain board certification a recertification exam has to be taken every ten years.

Not all hospitals require the doctors working in their ER’s to be board certified, though most do, and in large urban areas it is the rule. Why, you might ask, does this matter? Because when you have an emergency medical problem you have enough on your mind without having to wonder whether or not the doctor taking care of you knows what he’s doing. Chances are he does.

In an emergency you are going to go, or be taken, to the ER closest to where the problem occurred. Since your home is the likeliest spot it might be wise to do a little research before the need to visit the place arises. Find out which is the hospital nearest you, go to its web site, or call the hospital administrator, and get the information you need. Are the ER doctors board certified? Is the hospital a paramedic receiving facility? A trauma center? Is it a department with special expertise in pediatrics?

The workplace is another popular spot for accidents, injuries, and exacerbations of chronic problems to occur. So, you probably want to do the same bit of research into the hospital nearest your place of employment. Of course none of this does you any good if you are on vacation or out driving around somewhere far from your normal haunts and get into an accident. In those situations you will have to find whatever comfort there is in knowing it is difficult, at best, to prepare for the unpredictable.

That said, let’s discuss some things you are likely to encounter once you enter the system.

Pick Your Spots: What Time To Come to the ER

I think it’s fair to say we all know that not everyone who shows up in the ER has a true medical emergency. The cough you’ve had for two weeks, the ankle you sprained three days ago, the rash you’ve been scratching for a month, the ingrown toenail that just won’t get better. And we know you don’t have a regular doctor, or you have one but can’t get in to see him for another two weeks, or you have an appointment to see her in two days but it’s going to interfere with your tee time. Or maybe there’s an insurance issue. Your HMO wants you to go to their clinic but it’s too far away, or you don’t have insurance, or you think you have insurance but what you really have is Medicaid and only three doctors in your area code accept it. Whatever the case, it just seems the ER is the best place for you to be seen.

We know these things and we are fine with them. We also agree that your problem deserves expert medical attention. But does it need that attention at 6:15 PM on a Saturday? Probably not. This is important because Emergency Rooms have a rhythm, an ebb and flow. This is true of all ER’s. Let me explain.

The ER staff, the nurses, techs, clerks, and doctors, work shifts. Depending on how large the department is and how many patients are seen each day, there will be more or fewer shifts per day, of shorter or longer duration. What is almost universal, though, is that the day shift begins somewhere around 7 AM.

At 7 AM, thereabouts, the ER staff is fresh, fully caffeinated, and ready for a new day. Coincidentally, there are usually very few patients in the department at 7 AM. That’s just the way it is and it’s why you should show up with your not-really-an-emergency problem at that time. You can get in and out before the place becomes a zoo. Your window is narrow, a couple of hours, max. If you miss this window you might want to pack a lunch.

Again, this applies only to those patients with less than emergent problems. If you have run your thumb through the skill saw, fallen off your roof and now have a peculiar angulation of your forearm, or spilled a cup of hot tea in your lap, please come immediately.

Next Time

Next time, we’ll begin a walkthrough of a typical ER visit, beginning with what you should expect when you first arrive. See you then.