Using the emergency room as a GP?

As someone with poor health who's prone to unexpected trips to the ER quite often, I've always noticed that there are way too many people who are not in an emergency. Most are there because their baby won't stop drooling or sneezed a couple of times prompting a panic attack. Others are just there doing general GP stuff - getting prescription, checking test results, etc.

This has always been a big problem and now even more so due the pandemic. Why do it?

EDIT so it seems most people condone going to the ER anytime you are worried because that's what triage is for. Please note that filling the waiting room with non emergencies increases the time it takes for a nurse to triage a real emergency, or could even contribute to the ongoing stress of these people. To each their own but I dont condone this.

Comments

  • Don't judge parents with babies. Babies can go downhill very suddenly, and something that just looks like a fever can be life threatening (eg meningicoccal). The parents may have rung a 24 hour advice line and been told to go into emergency - you don't know.

    Also just because you can't see blood spurting out of someone doesn't mean they may not be experiencing a life threatening condition or illness.

    Everyone else must be allowed to be there or else they wouldn't be. Eg getting test results - obviously they've been told to go there to get them.

    Emergency patients are triaged so you don't have to worry about waiting in a queue if you're having a heart attack.

    I think you need to take off your judgey pants and put them away.

    • I think you need to take off your judgey pants and put them away.

      OP, the trigger troll, strikes again!

    • +12 votes

      There was one point south Australia was running compaigns about non emergencies coming to emergency rooms. Believe it or not but some are completely unaware of a GP service and think the emergency is the only way to see a doctor.

    • Perfect. My wife had ectopic pregnancy 4 years back and we had to rush to emergency as she had excruciating pain. We feared it might be ruptured fallopian tube, but when we reached there, the nurse there took her BP which was normal and gave her couple of panadol and triaged her. after waiting for 4 hours, she started feeling normal and we came back. Others who looked far worse were triaged higher.

      • Any female of childbearing age with abdominal pain, needs a pregnancy test stat to rule out ectopic pregnancy.

    • -14 votes

      Don't judge parents with babies

      Yeah, don't judge people who are wasting time at the emergency room!

    • Exactly, if I had a non life threatening issue, I'd rather a small child go ahead of me and increase my wait time, even if in 99/100 cases they turn out fine, than risk that 1/100 or 1/1000 or more chance of something potentially life threatening occurring to that child. Not only are they fragile and have their life ahead of them, they can't explain what they are feeling.

      OP I feel for you with chronic issues causing you to visit emergency, and from an armchair position you can look at dozens of patients waiting and think what are they doing here. But without actually assessing, diagnosing, and knowing their medical history how can you judge that they wasted time. Maybe after they have received attention you can diagnose it.

      What do you suggest happen, an extra doctor or nurse come around and say what's your issue, and if they think its a non-issue without proper diagnostic send them to a GP? What if in the haste of it, they send the wrong person home.

      What this will lead to is a mistake, a death, a casualty, for every x amount of cases, if your okay with extra deaths over this I hope your not connected with health policies.

    • Went to (government) health clinic with child.

      Clinic called ambulance to take to Children's hospital

      Children's hospital staff treat us like "wtf you doing here?"

      ¯\_(ツ)_/¯

      • I hate that sort of misinformation then you are blamed for it. Complete segway, but this reminds me of, I rang Crimestoppers for a complaint about youths throwing rocks or bricks (something quite large and very loud on impact) at cars on a main road below from the top of an approx 4 storey high carpark building (whilst it was in progress)… the pre-recording said "if you are calling about a crime in progress, hang up now and call 000" - so I did. The 000 call operator gave me a stern dressing down because she thought it was just vandalism and told me it was not a 000 emergency, I was quite confused and annoyed frankly as I thought I was doing the right thing as instructed.

        ….so I tried to explain it was still going on, and the crimestoppers recording said to call 000, and I thought it was a risk because someone could get hit in the head by a rock from 5 storeys up or crash - but no… she corrected me further and apparently it's for life threatening emergencies like reporting of the injury / incident after it happens to get help, rather than to try get Police help to prevent it (by arresting the offenders)… She told me just to ring the police and gave me a number to call them on…. The discussion took her far longer than just taking the complaint and it being dispatched to police. I was very annoyed and didn't call them (as it would have been my third call to attempt to report), so several more cars windows and panels got smashed and they would have got away. I hope no one got hurt (but if they did I hope someone in the call centre realised the mistake of ignoring it and regretted it).

        ¯\_(ツ)_/¯ indeed

    • This.

      As someone who had been to emergency few times due to broken bones (not sticking out though), i probably looked like i had no issues as I was able to sit upright and maintain my calm.

      However, of course the hospital prioritised me over some other people waiting there that looked sicker etc whereas in my experience after the accidents I had, I looked more normal than other people because the adrenaline rush was still there.

      As soon as I lay on the bed thats when the reality (the pain, the trauma) kicked in haha

    • The night my first born had her MMR jab she had a seizure. We rushed to emergency, panicked, and by the time we arrived she had come round and looked pretty normal.

      Good to know there were people sat in the emergency waiting room judging the shite out of us and muttering we shouldn't be there.

      Reminds me of my mum who was terminally ill with pancreatic cancer. She was a proud lady so always made sure she looked nice when she went out even though she was gravelly ill. She used a disabled spot (as she was permitted due to the extent of her sickness) and was given a huge amount of abuse by a man for using the spot when she 'wasnt sick'.

      People need to realise not every sickness is visible.

  • I've always noticed that there are way too many people who are not in an emergency.

    Unless you are a GP how do you know the patient's condition?

    They might have symptoms that it takes an experienced/trained eye to decide the seriousness of.

  • Do you really think regular sick people want to wait in line at the Emergency Department?

    • Ditto.

    • +8 votes

      Or, anyone healthy (not sick) will go just because of boredom?

      For the OP, those you see in the Emergency Department are those not under an emergency. Those at real (urgent, life threatening) risk are already being treated.

      • No idea why you got negged

      • Those at real (urgent, life threatening) risk are already being treated.

        Either because they got triaged that way, or because they came in through the ambulance door, not the front door.

        • or because they came in through the ambulance door

          Not always.
          I was taken by ambulance and then wheeled to the waiting area as another assessment (before triage) realized I wasn't going to die after all as they initially thought.

          I'm fine now, thank you :-)

    • ^ This!
      Last time we brought our baby to Royal Melbourne Children, got there in the evening around 7 and we didnt leave until 2 in the morning!

      you'd think people go to hospital and sit in the waiting room because it's fun/free?

      • I always go hang out in the ER in the middle of the night with my kids when I'm bored too!

  • Some people dont have a bulk billing GP so its a way of accessing free health care.
    Some have a diagnosed mental illness that requires them to attend with minor physical complaints in order to be reassured everything is OK.
    Some have borderline personality disorders and although functioning members of society they catastrophise minor ailments.
    A lot are complete idiots that will go to ED with totally ridiculous complaints that need no medical attention whatsoever but they are so clueless and lacking in commonsense its beyond belief.

    • Do you work there?

    • Some people dont have a bulk billing GP

      Find one.

      Even in remote communities there will be a doctor that can bulk bill. They might not initially but if you continue to need their assistance regularly and tell them that the financial cost is a burden they'll figure something out for you

      If you live in a major city you are just being lazy.

      • Find one.

        They did. The ER.

        There's no need to mess around 'bargaining' with a health care provider when you can just go to the ER.If the various health departments saw it as an issue they could legislate further around bulk billing - that's not something the individual should have to deal with, especially when they're ill.

        • EDs aren't bulk billing. Their budget comes from the internal hospital which is part of the state budget. Bulk billing comes from Medicare which is federal money. When you present to ED with a non-urgent condition, the cost of that presentation is taken away from the rest of the hospital. It's a huge issue.

        • You're a bum. This is a massive issue. We see backpackers do it all the time. Pay up, don't abuse the system. Selfish.

    • Definitely a bit of this goes on there!

  • Unless you're a qualified physician then you have no idea what is an emergency for any particular patient. I had to go in with kidney stones once, I'd look perfectly fine to anyone other than the fact I am in excruciating pain. My 2 year old almost always gets referred to emergency with any cold or flu like symptoms due to underlying health conditions.

    At certain times of day patients can only be triaged via the emergency department due to the administrative facilities of a hospital being closed, they won't necessarily be treated by an emergency doctor.

    • -19 votes

      Kidney stones are absolutely an emergency, if only for the fact that it causes intensive pain which is frankly cruel not to treat as a priority.

      • My mum was in excruciating pain and needed something removed. Her BP was consistently 160 and she was admitted twice. They put her on the surgery waiting list, probably at least 3 months. This isn't the first time the public system has screwed her over either and the other time was much worse. Needless to say, she's deathly afraid of the public system. I myself had to wait 10 years for braces even though I was classified at the highest level (really crooked teeth and one growing on top of another). I probably would've gone private as well if it wasn't for the 'oh I'm sure you'll be there soon'.

        • I hope your mom is okay. Yes, it is inconvenient to wait that long for treatment but I hope she is okay in the end.

          If they saw her any sooner, it could mean someone who may potentially need the facility more urgently goes without. That would be disastrous.

          (They didn't defer her surgery without good reason. I hope.)

          This is why we shouldn't encourage congestion of the ED but we play a fine line of also not discouraging potentially morbid cases.

          wait 10 years for braces

          That's purely elective. It has nothing to do with the issue of emergency.

          • @tshow:

            I hope your mom is okay. Yes, it is inconvenient to wait that long for treatment but I hope she is okay in the end.

            Thank you, yes shes better-ish now

            If they saw her any sooner, it could mean someone who may potentially need the facility more urgently goes without. That would be disastrous.

            Yeah, that's what I like to think !

    • "Unless you're a qualified physician then you have no idea what is an emergency for any particular patient".

      That must come as a very big surprise to the triage nurses who categorise the urgency of presentations at the ED.

  • It's absolutely not your place OP, to question why other people are in the ER.

    • well actually it kinda is if those other people are preventing or delaying treatment for his potential real emergency.

      • If it was a real emergency he would spend zero minutes in the waiting room.

        • real case of just a few months ago. My brother in emergency after a car accident (head on with a drunk driver, delivered to hospital in an ambulance). He was poorly triaged from a rushed nurse and then doctor and released from hospital the same evening he came in (overworked emergency department packed with people). He had broken bones in his foot and a fracture in his lower leg as well as compressed disc's in his neck (none of which checked). By morning he could barely move and was in agony with a leg that had ballooned to twice its size and needed another ambulance back to hospital. He got a formal apology from the hospital but that is the sort of crap that happens when emergency is being misused.

      • Gromit…. That's what the triage system is for. The OP needs to mind their own business.

  • Using the emergency room as a GP?

    Yep only GPs are entitled to go to the ED.

  • Where I live there's a 3 week minimum wait time to see a GP.

    • What if it's an emergency - not an ED type emergency but if you need to see someone that day?
      My GP is usually fully booked for a month but if you ring about 15 mins before they open they'll give you an appointment.

      • Then you're screwed.
        I broke my thumb 2 years ago, it took 4 months to get any sort of treatment due to delays (wait to see GP, wait for an x-ray appointment, wait to see GP again, wait for fracture clinic appointment, wait for MRI because incompetent doctor thought I had bone cancer, etc.) and by that time it didn't heal because it had been too long.
        If I'd gone to the ED straight away I might still be able to open jars and use a screwdriver, but I didn't realise it was broken at the time it happened.
        It's pretty frustrating to pay the same for Medicare as any other taxpayer while knowing there's no service to back it up.

        • A broken bone is a legitimate reason to go to the ED and for me it was the only way to get into the public system. To get a referral to the hand clinic (and eventual hand surgery) I had to go to the ED first. I even got a referrel and an x-ray privately, but was told I still had to go to the ED if I wanted to go public.

          I think funneling a lot of stuff through ED is a way to not miss things. A broken bone could be fine and you can live with it for a few weeks before treatment, or it could have caused internal bleeding and you could be hours from death. Having both patients in the ED only inconveniences the person with the minor break, but could save the life of the person with internal bleeding.

          • @samyall: After I had the first x-ray done (which was 5 weeks after the injury) I was explicitly told not to go to emergency because it was "too late" for them to do anything. But 3 months later the fracture clinic still decided to treat it with a cast…

            • @ssquid: The cast is only part of the treatment. They may have reduced the fracture and now need to fixate the bones in the correct place for fusion. The cast is valid.

      • You'll need to provide an example. We get a lot of "emergencies" where people have left something for way too long but suddenly they need it done that day due to personal circumstances.

        "I've had this hernia for the last six months. It's an emergency. I'm flying off tomorrow!".

        In the end, ED soaks up these sorts of cases but it's not meant to be that way. It may have or eventually will come at the expense of someone else's life.

    • If you're in a city then you can travel further afield to see a GP, no? When I was like 10 I was violently ill on a Sunday and my mum drove me like 30 mins to the closest open doctor's office. When I got there the doctor noted that one of my symptoms was motion sickness >.<

    • If you rang up and said "I think my thumb is broken" they would have seen you that day or referred you to hospital.

      • That's exactly what I said. "Oh no, you'd know for sure if it was broken" was the reply.
        This was the bulk billing GP clinic. Every other GP in town refuses to see any new patients.

        • "Oh no, you'd know for sure if it was broken" was the reply.

          That is when you go "I know my thumb is broken, the pain is horrible. Can I come see someone today to make sure?"

          If they gin you around then you go straight to ER.

          • @serpserpserp: The pain was not horrible. It swelled at first (not excessively) and when it went down it didn't go back to behaving normally.

            As a new patient, saying something like "the pain is horrible" and insisting you see someone straight away gets you put at the back of the queue because it's assumed you're only after meds (as told to me by one of the receptionists that I have come to know personally since then).

            • @ssquid:

              saying something like "the pain is horrible" and insisting you see someone straight away gets you put at the back of the queue because it's assumed you're only after meds

              I've worked as a medical receptionist before. If I told a GP that some thinks they have broken their thumb and they are saying the pain is horrible they'll tell me to direct you to ED if they can't be bothered or they'll take the call and do a quick assessment which can determine if they'll see you or not.

              They will absolutely not make you wait 3 weeks to see you if you genuinely believe you have a broken bone and a good receptionist will assist you to get seen somewhere else if there is truly some bottleneck with patient bookings. But where I worked they'd just tell you to come down and wait and they'd squeeze you in. Even if you sat their all day, they would see you after closing hours because you waited all that time.

              Yes, this was a country clinic, first location there was only two GPs in the area. The other area there was 4 full time ones in the town.

            • @ssquid: I'm gonna have to disagree with that one. From my own personal experiences with ED's , which has been quite a few occasions over the years unfortunately, every couple of years I inevitably do something! Haha!

              I have quite a high pain threshold or at least pretend I do! This can on occasions work against me as someone that presents to triage screaming and crying, we could possibly have identical symptoms but you can almost bet your last dollar that they will be prioritised ahead of me and possibly some others.

              The last couple of times I've left ED after 4-5 hours (last time was for slicing the end of my little finger off) I've stated I'm never telling them the pain is OK… It's severe!!
              However it appears I am too honest, as each time I am back there, I can never bring myself to do it! Haha.

  • so its okay for you to use the ER but not others?

    • You see, unlike those babies, the OP has actual poor health (yes, he's the judge). Now, if only the hoi polloi would stay at home, he wouldn't have to wait so long.

  • Something small and simple can be a symptom of a much larger issue.

    For example, I went to the ED due to a headache. A few hours later I was admitted into the ICU with multiple failing organs.

  • "data* from the Australian Institute of Health and Welfare (AIHW reveals that 2.9 million (35%) emergency department (ED) presentations were for lower urgency care in 2018–19."

    https://www1.racgp.org.au/newsgp/professional/eds-continue-t...

    • 35% seems low. Is that people who shouldn't have ever bothered to go or people who turned out to have nothing major?

    • Yeah, no. Maybe at a select rural hospital that would be a true statistic. I would hazard a guess 70-80% would be cat 3 or lower.

      • The definition of 'lower urgency' used by the AIHW which is much more specific than just category 4 and 5 triage (and it doesn't include category 3, as might be expected given it has the label of 'urgent'). It also excludes those who did not arrive by ambulance, police or correctional vehicle and were not subsequently admitted to hospital, amongst other criteria.

        So while about 48% of presentations in 2018-19 at EDs were category 4 or 5, that drops to 35% as 'lower urgency' when you add the extra criteria noted.

  • ER is an American term.

    We commonly use the term ED (Emergency Department) or just Emergency for short for our Aussie hospitals.

    • hospos. get it right

    • I worked in one and I still called it ER.

      It's a lot more exciting!

      Just like exclamation marks!

      • Tshow, I presented to Emergency with full thickness burns on 25% of my body. I wasn't in any pain, and you couldn't see them. I got the bus there, on my own.

        Was I ok to go there?

        They gave me skin graft surgery.

        I burnt myself because I was very upset.

        Was I allowed to go to Emergency even though I hurt myself?

        When oh god, oh man amongst men, oh law maker of ozbargain should I stay home and suck it up and when should I seek medical attention?

        • Irrelevant much?

          At no point did I say people with injuries should not use the ED, much less for burns.

          Thanks for stalking my comments and replying with antagonistic ignorance. Please don't burn yourself again.

  • Get yourself a horse and chase these people down.

  • +35 votes

    Can wait for OP's next thread…

    As someone with poor health a mustang who's prone to unexpected trips to the ER dealer quite often, I've always noticed that there are way too many people who are not in an emergency. Most are there because their baby Focus or Fiesta won't stop drooling or sneezed ratting or creaking a couple of times prompting a panic attack. Others are just there doing general GP servicing stuff - getting prescription oil topped up, checking test results wheel alignment, etc.

    This has always been a big problem and now even more so due the pandemic. Why do it?