By now you have some idea of the best times to visit the ER and what to expect when you get there. Having demystified the notion of triage, the actual doctor visit, and, to some extent, the means by which it all gets paid for, it’s now time to address the topic of significant others. These are the friends and relatives who’ve accompanied you to the ER, usually for moral support. Read on to learn what we expect from them, and what they should expect from us.
Almost no one comes to the emergency room alone. I don’t blame you. Something unpleasant and possibly dangerous has just happened, you are not feeling well, and you have to go to a place that requires you to cede control of what’s about to happen to you to a bunch of people you’ve never before met in your life. Of course you want someone there for moral support, and, hopefully, a ride home when the nightmare is over.
It is also reasonable that you would want that person, or those persons, by your side during the entire ordeal. We understand. Unfortunately, that is not always possible. When you are first brought back to the department there are things that might need to be done during which the presence of one or more extra people would be a distraction or impediment. Drawing blood, for example, can provoke an untoward reaction from a ‘non-pro’. Having to pick your visitor up off the floor after a fainting episode and have him registered as a new patient is just adding more unnecessary work to an already busy day.
Also, there are privacy issues. If you are an adult, no one has the right to your medical information but you and the people treating you. There may be questions asked that you would prefer to answer without your friend being present. It is also possible that you might not be as forthcoming with certain bits of pertinent information if someone else is there to hear them. Whether or not you are sexually active and with whom come readily to mind.
So, don’t be surprised or indignant if the doctor wants a moment with you alone. As soon as the coast is clear, so to speak, your visitor or visitors will be allowed back. One at a time. Most ER’s have space limitations and having more than one visitor with each patient creates crowding problems, further loss of what little privacy you do have, and inefficiency. Work it out among yourselves. It’s like tag team wrestling. One visitor in, the previous visitor out. The more willing you are to comply with this system the more happy the staff will be to accommodate your requests, even to the point of letting more than one person at the bedside if the place isn’t too busy.
There are exceptions to this rule. If the patient speaks no English but the person with him does, that person will likely be allowed back immediately. The more exotic the language spoken, the more likely this will be. Many of us can speak enough Spanish to make ourselves understood, and given the large number of Philippino nurses, Tagalog is usually not a problem. If the patient speaks Hmong we will be looking for all the help we can get.
The Feds have recently issued a diktat banning the use of non-professional translators in the ER. I’m not sure why, since in practice this has held us in good stead for many, many years. In theory, which is the world in which the Feds live, it is possible that things could be misunderstood, errors could be made, patient safety jeopardized. OK. Fine. We will use the special phone line to speak to the professional Hmong translator. One receiver for us, one for the patient, and a crackly connection in between. But we will also avail ourselves of the family member at the bedside. No one is more concerned for the patient’s safety and well being than we are, regardless of what the Feds might think.
Young children are another exception to the rule. If the child is accompanied by both parents, both will be allowed to stay from the outset. If, though, there are multiple young children we would prefer one parent to stay with the patient and the other to ride herd on the siblings somewhere other than in the emergency room. It’s difficult enough for the staff to wrangle one child, let alone two or three.
A young child with a laceration requiring sutures is best left in the hands of the ER staff when the time comes for the suturing to be done. This is counterintuitive to most parents who understandably assume that the child needs them most when things are looking their worst. In fact, the opposite is usually the case.
In order to do the job properly the child will need to be restrained. This could involve being wrapped in a sheet, creating what is known as the ‘baby burrito’, or strapped to a papoose, a short board with velcro straps over the chest and legs, or, more likely, both. If the laceration is on the scalp or face, there will also be someone holding the child’s head still. The child will object. Loudly. The wound will be anesthetized and from that point on there will be little if any actual discomfort. But the child will continue to object to the indignity of being held down and physically assaulted by his caregivers.
If the parents are in the room, the child will expect them to intervene. When they do not, and start singing nursery rhymes in a well intentioned but futile effort to calm him, he will become more frustrated and angry. This anger and resentment could well carry over to the post-treatment period. There are enough good reasons for children and their parents to have issues with one another. Hanging around impotently while he gets his laceration fixed should not be one of them.
Let us be the bad guys. We’re used to it. (See the section on Insurance Cards above.) Once we’re done you can come rushing back into the room to ‘save’ your child from the evil ER personnel. It works. But we recognize that not all of you are going to believe it and will insist on being present. It’s your choice. We only ask that if you do decide to stay, you stay far enough away from the body part being worked on to allow us to get it over with as quickly as possible. If you feel you must sing, fine.
Adolescents. Enough said. They are not adults and therefore have no expectation of privacy but are old enough to have grown up problems. You as the parent have the right to be with them throughout their ER visit. They as the adolescent are almost certainly involved in behaviors they think you don’t know about and don’t want you to learn about. The best solution is for you ask the doctor if it would be OK if you stepped out of the room for a few minutes. The second best solution is for you to comply if the doctor asks you to leave.
If you do leave the room we should have a nurse present as a chaperone. If you see that we do not, request that a nurse be there. It is for our mutual protection. Once you are gone we will have the best chance of finding out what your child has been up to and whether or not it has any bearing on his or her current problem. Of course, some of you have remarkably open and honest relationships with your children and there are no secrets. Great. Now take a hike for a little while. We will let you know when it’s safe to come back into the room.
Next time, etiquette.
Dr. Jim Pagano, MD, FACEP, is the chief medical officer of Precision Scribes and has over thirty years of emergency medicine experience and cooks a mean Italian dinner.