By Dr.Katie E. Golden
When you consider the average timeline of a patient’s emergency department (ED) visit, a relatively small amount of that experience is spent with a doctor at the bedside. This can naturally leave a patient wondering if they got anything out of their visit beyond some crackers and ginger ale, and a new appreciation for their warm bed at home. We thus want to take the time to provide a behind-the-scenes look into how doctors work in the ED. While we all wish our efforts would be more self-evident from the patient’s perspective, the patient deserves to understand the time we put into their evaluation, treatment, and care.
A doctor’s attention to an ED patient’s medical care starts from the time they walk in the door. Skilled triage nurses, who evaluate the patient when they check-in, are in constant communication with the doctors on staff about a patient’s presenting symptoms and their condition. This is so we can ensure the sickest patients get rooms as soon as possible, and also so the appropriate diagnostic orders are placed and started. We know the patient’s time is important, whether it’s because their illness may be progressing, or because she is a single mom and this is her only chance to see a doctor before she has to pick up her kids from school. Or the patient is just really hungry and Chick-Fil-A is about to close (no sarcasm from this hangry gal – this is totally valid). Whatever the reason, the doctors are constantly paying attention to the waiting room, facilitating triage, and orchestrating orders.
Once the patient is placed into an ED bed, the real work for the clinician begins. When a patient is brought back from the waiting room, a doctor or physician assistant assigns themselves to their care. Even before they see the patient, they often review the patient’s medical chart so they are up to date on their medical history, current conditions, medications, recent healthcare visits, and diagnostic tests. That’s right, we get to know the patient like a facebook stalker before a blind date.
After we meet and evaluate the patient, we place the appropriate orders for diagnostic testing, treatment, and symptom management. Throughout this process, the patient’s nurse is in constant communication with the doctor about the patient’s condition, vital signs, response to treatment and clinical course. While a patient may not see us again for some time, we are continually updated on their status and guiding their treatment as necessary.
Once we have all the necessary test results, the next step is to determine the patient’s disposition. This often means consulting with the patient’s outpatient doctors as well as in-hospital specialists. This can surprisingly be the most labor-intensive step for the ED doctor. In our increasingly complex medical system, coordinating a patient’s care can be complicated: it often requires multiple phone calls to several specialists, who are understandably busy doctors and not easily available. We are, however, tireless advocates for our patients. We will call as many times as necessary to make sure our patients get the right care, both in the ED and after their visit. If a patient is ultimately hospitalized, we also coordinate directly with the admitting doctors to ensure the smoothest and safest transition of care.
Finally, well after the patient leaves the ED and our shift is over . . . we document. And we don’t just do this because we are avoiding the return home to our screaming kids and annoyed spouses. Documenting a patient’s visit with us in the ED is an important part of their treatment moving forward, so all future providers can also be kept up to date and continue to provide the best care for the patient.
We know our encounters with patients can feel brief, especially compared to a routine outpatient visit in a calmer setting, but we hope our patients understand the care that goes into their ED treatment that doesn’t meet the eye. Like well-trained helicopter parents, we are always watching out for our patients and just want what’s best for them.