Most people dread going to the ER at their local hospital. For many, the source of that frustration has been the incredibly long wait times before seeing a doctor when at the ER. In a recent article, more and more Candians are leaving the ER after excessively long wait times.
I do not agree with one physician’s comment in the article with regards to the influx of patients going to the ER with small concerns as being a misconception. That disagreement is based on the fact that a high percentage of people do not have a family doctor.
For many people even trying to go to a Walkin Clinic for care can be a challenge. I know the office that our Nurse Practitioner works out of has Walkin Clinics available and they fill up very quickly.
Therefore, these people with small concerns who would otherwise be seen by their family doctor, or seen at a Walkin Clinic, are going to their local ER for those concerns. In fact, a recent Auditor General’s report in Ontario indicated that “one in five patients who visited the province’s emergency departments were only there because they did not have a family doctor.” Not urgent care.
The Consequences
One of the consequences of an influx of patients with small concerns going to the ER is a growing frustration of the ER Doctors and Nurses. When I was in my final semester of Nursing, I got really sick and ended up in the ER. I saw one of the ER doctor’s (who was with his intern) explaining to a patient that if they end up coughing anything up, to spit it into a specimen bottle and bring it back. The patient was given the specimen bottle and left. The Doctor was given the next chart which was mine. He came over, looked at me, turned to his intern and said, “Now here’s someone who’s sick!” I got the sense that he was getting frustrated with the number of people coming to the ER with small concerns. After being examined and x-rays done, I was admitted with really bad pneumonia in both lungs. That was nearly 30 years ago and the frustration regarding those small concerns still happens.
The overcrowding in the ER is putting incredible pressure on the Doctors and Nurses to essentially process as many cases as possible in order to reduce the long wait times of people in the waiting area. In doing so, many assessments are rushed and needed diagnostics are potentially not being done. In some hospitals, the ER has become the proverbial assembly line.
In mid 2023 we had our 13 year old daughter in the ER with an unusually strong headache and ear pain. She was prescribed ear drops and we were sent home. In the month that followed additional visits were made to the ER with our daughter having unusually strong headaches. Some of those headaches were so strong that she was actually screaming in pain and punching pillows. She was given Toradol administered intravenously for the pain and we were sent home. On the 7th ER visit my wife was asked to leave the room and our daughter was questioned privately. She was asked questions about alcohol and drug use as well as any other stressors. All of which was negative.
On the 8th visit to the ER we insisted on a Computerized Tomography (CT) scan to be done. The doctor tried talking us out of it because of our daughter’s age and the radiation exposure. The doctor spoke with radiology and they reluctantly did the CT scan. The CT scan showed an irregularity near the Pituitary gland. A follow up Magnetic Resonance Imaging (MRI) was ordered, which was done 6 days later.
The day after the MRI, we had our daughter in the ER again with severe head pain. The doctor indicated that the MRI showed that our daughter had a small brain tumor, roughly the size of a nickel on the Pituitary gland!
What made the situation worse was that with the overcrowding of the ER that day, staff were only allowing one visitor at the bedside. While sitting in the waiting area, I received a text from my wife telling me our daughter’s diagnosis. I was quite shocked and went over to one of the Nurses. I indicated that I just received a text from my wife stating that my daughter has just been diagnosed with a brain tumor and if I could go back and see them. I was told that there were no exceptions due to the “volume of patients” in the ER. My wife was communicating with the staff on her end as well with regards to me being allowed to go back where they were so that I could see them and she was told the same thing.
So I had to wait in that crowded ER waiting area for quite awhile, before my wife and I were able to switch spots so that I could see my daughter. This was because my wife was communicating with the various Doctors, Nurses and other medical staff . Yet, I could not be part of those conversations!!!
It took 8 ER visits before a CT scan was finally done, of which we had to really fight for. The majority of those visits resulted in the same medication administered intravenously. Different medications were prescribed ranging from oral Toradol to nasal sprays. One would think that after the second or third visit to the ER, a CT scan, or some other diagnostic imaging would have been done. Yet, with so many people going through the ER with small concerns, many of the urgent cases get brushed off.
I must say that when the CT scan showed the irregularity, followed by the results of the MRI, the attitude of those tending to my daughter in the ER dramatically changed. We were no longer viewed as the hypochondriac parents, which many parents bringing their child to the ER are often viewed as.
Many of the overcrowded ERs need to have a section set up similar to a Walkin Clinic in order to manage the patients with small concerns. Afterall, it’s an ER. This would free up the ER Doctors and Nurses to see the more urgent cases in a timely manner. If that small concern turns out to be something more serious, the patient’s care can be quickly adjusted without having to be discharged and then readmitted to the ER. Furthermore, the ER Doctors wouldn’t feel the time pressures of a large waiting crowd to do the more thorough assessments and order the appropriate testing/imaging if needed.
One step in the right direction to alleviate some of the pressure in Ontario’s ER’s, is the expanded role of Pharmacists to prescribe medications for Minor Ailments. In addition there are proposed changes for Midwives in Ontario to prescribe different medications and tests.
Hospitals need to get a handle on their ERs as the situation is only going to get worse with our aging population. As the baby boomers get older, increases the potential of more people going to the ER. It’s also important to recognize that as the baby boomers retire, that also means many doctors retiring.
Good News?
As for our daughter, she and my wife went to SickKids hospital in Toronto for a couple of days in early November 2023, for more tests and imaging to determine the next steps. The tests done at SickKids showed that our daughter does not have a tumor. Her pituitary gland is large for her age. However, the scans showed that there is some bulging which will be regularly monitored every six months.
We are currently trying to manage her frequent head pains the best that we can and seeing the various doctors locally until her next appointment at Toronto SickKids in May 2024. Various treatments are being tried to safely manage her pain, while at the same time helping her so that she does not miss out on so much school and other activities.
I want to be clear that not every child with a headache is going to have a potential tumor, cyst, or other abnormality in the brain. Having said that, parents in similar situations as ours need to be persistent after so many trips to the ER and/or seeing their primary care provider for the same symptoms over and over, for additional assessments. When we were insisting on the CT scan we said, at the very least let’s rule out something potentially being wrong in her brain. In fact, just before my daughter was discharged from the ER (after learning the results of the MRI), the pediatrician praised our persistence.
Until next time, stay safe, healthy and strong.
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