Using the emergency room for routine physicals

One of my patients thanked me for saving his life.  Apparently, many years ago I had told him that most men’s first complete physical is in the emergency room in the midst of their heart attack or stroke.  I have been in practice long enough to have forgotten many of the things I have told patients.  I try to capture the pearls I have learned over the last 30 years and share them with my readers.

Before I was a family physician, I was an emergency room physician.  The ER was an excellent training ground for a family physician.  Many patients use the ER as their primary source of medical care.  In a society built on instant gratification, the ER is the pinnacle of accessibility, open 24 hours a day.  The ER is the perfect “one stop shop,” making radiology and laboratory services instantly available.  The ER is falsely economical as most insurance companies cover ER visits.  What the ER is not and can never be is a family doc’s shop or a reasonable place to seek routine medical care.

One of the cornerstones of family medicine is continuity of care.  A long- term relationship between the patient and doc is essential to proper diagnosis and treatment.  Knowing patient “Q” for 25 years allows me to read between the lines.  Patient “Q” assures me that she is “fine”; she just has a little cough and has been tired.  Patient “Q” has lost substantial weight.  I noticed it as soon as I walked into the room.  Patient “Q” is pale; I noticed that fact immediately, as well.  Patient “Q” insists she is just stressed.  She minimizes everything.  Patient “Q” knows and trusts me.  At first, she balks at my suggestion that she needs blood work and an x-ray; then she gives in.

Patient “Q” has lung cancer and is anemic.  Had patient “Q” gone to the ER for care, the doc may have believed her story, not recognizing her weight loss or pallor.  Patient “Q” is alive and well.  Her cancer was diagnosed early enough to be treated successfully.

As for my patient who responded to my admonition that most men have their first physical at the time they are being seen for their first heart attack, he is doing well, being seen for yearly physicals and dealing with medical problems uncovered during those physicals.

There is almost always a time, prior to your getting sick, when the disease process is subclinical (below the radar).  Diabetes starts 10 years before it is diagnosed; doing damage at a microvascular level that is not readily visible.  Finding it in the “pre-diabetes” stage gives you a chance to stop it!

Blood pressure starts to rise over a period of time.  Identify it early; and you have an opportunity to improve and change your lifestyle and, perhaps, stop it in its tract.  If you can’t stop it, you can treat it.  Waiting for the heart attack is just foolish.

A PSA (test for prostate cancer) is relatively worthless.  A series of PSA tests taken over the years, in conjunction with a digital rectal exam (DRE), may well save your life.

While no one has a crystal ball with which to predict the future, a long-term relationship with your doc can lead to early diagnosis and improved outcomes.  The ER is the place to go in an emergency.  Ninety percent of the patients I saw as an ER doc were not emergencies.  Those patients belonged in their doc’s offices.

If you don’t have a doc, find one.  If you do have a doc, see him/her at least once a year.  The life you save may be your own.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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