Why the ER is a mixed blessing for society

We live in an incredible age. Life expectancies continue to rise. The environment in the U.S. is cleaner than it has ever been. The sum of the world’s knowledge is at the fingertips of any and every smartphone user, waiting to be accessed when they finish playing Candy Crush. The face of poverty in America is still terrible to behold; but it bears little resemblance to poverty down the long march of human history. We fight wars, but they are (so far) distant from our endlessly entertained shores. All in all, it’s a pretty good time to be alive in America.

But what I continue to see in my work is a world of people separate from fundamental realities of existence. For instance, I don’t know how many times I have seen patients who fell and injured an extremity, who had normal x-rays, who then said angrily, ‘Well if it isn’t broken, tell me why it hurts!’ Because it’s bruised? Because pain exists without fractures?

Others, with even the slightest red bump from an insect bite, all but fly to the ER for evaluation. “When I saw that bump, I figured better safe than sorry!” And God bless the spiders. They catch the blame for everything.

“I’m pretty sure I have a spider bite.”

“Did you see a spider?”

“Nope, but that’s what it is!”

Understandably, it’s worse with parents of small children. Fever, in 2014, remains a thing of ancient mystery and terror despite untold numbers of commercials extolling the virtues of ibuprofen and acetaminophen. And even the youngest child or adolescent with a pulled chest muscle is dragged to the hospital because, “His grandpa had a heart attack, you know.” Smokers are surprised that they cough and the drunk amazed that they fell.

I’m not trying to ridicule anyone. In fact, I frequently say that one of the most important things I do is reassure people than nothing is seriously wrong. I love that part of my job. It’s easier 21 years into my career. (Reading glasses and some gray in my beard are excellent aids to reassurance.)

What I am saying is that it’s ironic that in an age of such knowledge, such access, such health care advances and so much money spent on education, we have citizens completely disconnected from the realities of their physical existence.

But I think it gets worse. All too many Americans are completely disconnected from their hearts and minds as well. It makes me so sad to see them confused about their emotions following the death of a loved one. It’s not mental illness. It’s called grief. Crying is normal; so is screaming, sometimes.

Young and old engage in sexual liaisons with many partners and then seem surprised that they are sad, or lonely; or that they feel unloved, rejected or angry. Children are neglected or abused by boyfriends or girlfriends of their parents who have no interest in those children. And the parents are surprised that their edgy partner, fresh from prison for drug trafficking, might be untrustworthy.

Families of divorce can’t understand the sorrow of their children; or of their own hearts. Furthermore, many are told that the guilt they feel over life choices is old-fashioned. Rather than dealing with the past, by facing it or making amends (or repenting, heaven forbid), our culture medicates and justifies every negative act and it’s associated toxic emotion. So much so that I see young and old alike medicated into near comatose states, still describing every pain as a 10/10 and still asking for ever greater doses of various medications to anesthetize their inner sorrow.

I think the physical disconnect has many causes. Ironically, the ER may be a cause. There’s no need to think or learn when every illness or injury can be seen by a doctor immediately. A mixed blessing for society, I admit. Part may also be the lack of the extended family, in which many families lose touch with the collected wisdom and knowledge of grandmothers and other loved ones. And part may be the lack of good, general health education in school.

As for the non-physical? Social sciences continue to confirm what priests and preachers and rabbis said for ages. Families matter. Our thoughts, beliefs and actions (surprisingly) have far-reaching consequences. Neglect of body, mind or soul harms all the rest.

But in an age quite literally hell-bent on expunging faith, morality and tradition and common knowledge, I fear we’ll be needing a lot more pills, and ERs, for quite a while.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test. This article originally appeared in the Greenville News.

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  • JR DNR

    I know now that the ER has one purpose: To stabilize critical conditions and refer patients back to their providers for follow up.

    I used to think the ER was like it was portrayed on tv: patient with mystery illness presents, teams of doctors put their brains together, zebra diagnosis is made, patient’s issue is resolved, no passing of the buck back to other providers. This is what most people I know think the ER is like.

    • buzzkillerjsmith

      That’s what it should be for. But a lot of time there is no provider to follow up with. The gigantic urgent care around here kinda sorta manages chronic disease –with a new doctor each time.

    • medicontheedge

      Nope. The ED is a walk in clinic with the CAPABILITY to deal with life threatening emergencies. We MARKET to the non-emergent demographic. And the overflow waiting room for providers who overbook. and the “free” pregnancy tests and tylenol for the welfare patients.
      Don’t kid yourselves. The general patient population wants their medical care delivered like fast food: cheap, quick, and without any effort on their part.

  • Thomas D Guastavino

    FYI. Not a week goes by that I see patients in my office who fell, were seen in the ER, had “normal” X-Rays, were told nothing was broken, sent to their GP who treated them for several weeks for a “sprain”, eventually sent to me. First, I review the original X-Ray. 10% of the time a small fracture is seen. Under the dictum: :If it walks like a duck and quacks like a duck, it is probably a duck, I will order an MRI or Bone scan . Half the time an occult is seen. At times it gets exhausting trying to deal with an angry patient or , especially, parent. My advice ER physicians: NEVER say there is nothing broken. Say you dont see anything broken so if the pain persists we may have to run some tests to find it.

    • Lisa

      And “sprains’ can be serious. I sprained my thumb and it was a miserable injury. It took a full two months before I could turn the key in my car and another ten months to heal completely. I did go to the ER for this one because I my thumb was broken and it was late at night. The ER doc told me about the type of sprain I had (hunter’s thumb) and told me to see a hand specialist to follow up.

      • Thomas D Guastavino

        You are right that sprains can be serious. In this case I was pointing out that it is not a good idea to tell patient with a normal X-ray that nothing is broken when in fact there may be an occult fracture. Not only does it send the patient down the wrong treatment path it has led to some very angry encounters.

    • Patient Kit

      I was an orthopedic zebra. In July 1999, I went to my local ER for one of the very few times in my life because I had sudden pain in my right leg so severe that I couldn’t walk on it at all. ER doc told me it wasn’t broken, was probably sciatica and I should see an orthopedist. Which I did. Because I couldn’t walk and was in excruciating pain.

      Orthopedist also said nothing was broken, ordered an MRI of my back and diagnosed me with sciatica. NSAIDS, PT for pain management, a short round of (I think) prednisone? and a spinal injection later and I was marginally improved but still having trouble walking without pain.

      In November 1999, the pain was getting worse. I was just walking down the street one day (no trauma involved, no fall, no car accident, no getting whacked in the leg with a baseball bat) when the pain suddenly got really bad and I collapsed, hanging onto a fence. I didn’t go back to the ER. I waited until after the long Thanksgiving weekend and went to my orthopedist on Monday morning. At that point, he said my femur was fractured and I went into emergency surgery later that day — to fix the fracture and biopsy the bone. A lesion in my femur had caused part of my bone to die and weaken and break. Thankfully, the lesion was benign. But it took 2 years before the bone began to heal. And it took 5 second opinions with 5 different orthopedic surgeons to come up with a theory on why my pathologic nonunion femur fracture wasn’t healing. It suddenly started showing signs of beginning to heal 2 years after it fractured right before I was scheduled for a second surgery at the Hospital for Special Surgery in Manhattan. Thankfully, there was no cast involved, only plate, rod and pins and I could swim during those two years with a fractured femur.

      I remain very resistant to going to the ER for anything. Last year, I couldn’t swallow for 4 straight hours, not even a sip of water, but I resisted going to the ER. I don’t think I ever really had sciatica. Glad that particular orthopedic odyssey is over.

      • Thomas D Guastavino

        You have piqued my curiosity. Do you know the result of the biopsy? Did you ever take the drug Fosamax?

  • rbthe4th2

    Yes. I have argued before to not go to the ER. The other option was taking it like a man but the other half wasn’t around at the time. LOL … you forgot to add women being a major pusher to send men to the ER.

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