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Massachusetts Medical Society's Physician Focus

October 2013

Inside the ER


  • An estimated one of every five Americans visits a hospital emergency department each year, for a total of nearly 130 million visits annually.

  • Today’s emergency “room” has become a sophisticated department within the hospital, with resources to handle just about any condition.

  • Physicians urge patients to “prepare for emergencies,” by having certain information readily available, such as medications, medical conditions, and contact information for their doctor and relatives.

  • Patients who experience certain symptoms – chest pain, difficulty breathing, signs of a stroke, or severe bleeding – should waste no time in getting to an emergency department.

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The specialty of emergency medicine, celebrated by such popular television programs as NBC-TV’s “ER” and Discovery Health’s “Untold Stories of the ER,” has long captured the imagination of Americans. It has also become a critical component of American health care.

The ER is now regarded as the nation’s true medical safety net, where everyone, regardless of age, status, ability to pay, or any other criteria can be treated.

“Our mission,” says Jeffrey Hopkins, M.D., chief of emergency medicine at Milford Regional Medical Center in Milford, Massachusetts, “is to see whoever comes through the door. They can have conditions that are minor illnesses, major trauma, or serious life-threatening conditions. But part of our training is to provide care for whoever comes in that door.”

Emergency medicine has come a long way since it first was given separate status as a medical specialty in 1972. Emergency physicians are now trained in multiple areas, such as adult medicine, pediatrics, obstetrics, and surgery. And while the name has stuck over the years, “ER” is somewhat of a misnomer.

“Where it once was a single “emergency room” in hospitals,” says Nathan MacDonald, M.D., chief of emergency medicine at Lowell General Hospital in Lowell, Massachusetts, “it is now a sophisticated department, with multiple rooms with multiple functions.”

Dr. MacDonald and Dr. Hopkins, both board certified in emergency medicine and Fellows of the American College of Emergency Physicians, are the featured guests on the October edition of Physician Focus with the Massachusetts Medical Society. They joined host and primary care physician Bruce Karlin, M.D. to take an inside look at hospital emergency departments, how they operate in today’s health care environment, and what patients should know about them.

Today’s emergency department, says Dr. MacDonald, who is also president of the Massachusetts College of Emergency Physicians (MACEP, the state specialty society of emergency physicians with 950 members), is capable of not only identifying a patient’s illness, but also of triaging him or her through the emergency department and completing all the necessary complex workups that may be needed, such as blood analyses, x-rays, or other diagnostics. Emergency medical personnel can also call on other specialists, such as cardiologists or neurologists, should they be needed.

While one never knows when an emergency will happen, both physicians say it is prudent for patients to prepare for one. They urge patients to plan which emergency department to go to and strongly recommend keeping up-to-date lists containing medications, medical conditions (such as high blood pressure or diabetes), allergies, name of primary care physician, name and contact information for relatives, and advance directives (indicating preferences for care should a patient be unable to communicate). Having that information readily available is a great help to emergency medical personnel and can make the treatment move more quickly and smoothly.

So when should a patient go to the emergency department? While some health care experts suggest that the emergency department is overused by patients and such use contributes to higher costs, the physicians are focused on the patients.

Both agree that, if possible, patients should first check with their primary care physician. But both also agree that certain symptoms -- such as chest pain, difficulty breathing, heavy bleeding, or signs of a stroke -- should prompt patients to go directly and quickly to the emergency department. “If people feel they have a true emergency, they should go,” says Dr. Hopkins. “It is difficult for patients to triage themselves.”

The physicians are also quick to remind patients that the emergency department is open every day, around the clock.

“You should be prepared for any emergency,” Dr. MacDonald says, “but know that when you come to the emergency room, you’re in the hands of trained nurses and doctors who are going to do everything they need to do for you.”

Watch the above video for more conversation, including discussion about how patients are ‘triaged’ through the emergency department, the relationship between emergency physicians and primary care physicians, and the differences between emergency departments, urgent care centers, and retail health clinics.

MMS/Richard Gulla

American College of Emergency Medicine

Massachusetts College of Emergency Medicine

Medline Plus – First Aid

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"Emergency Medicine" PSA

From left, Bruce Karlin, M.D., Nathan MacDonald, M.D., Jeffrey Hopkins, M.D.
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