Ever recommended for someone not to visit ER

rhan101277

rhan101277

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I just wanted to see if anyone has ever encountered a situation where the patient asks your opinion if you think they should go to the ER. Now of course you will recommend most to go. Have you ever told someone visit your general practitioner as soon as possible on minor calls? Like stubbed toes, small lacerations, skinned up knee etc.?

I would like to note, I have had the opportunity to ask this same question to a paramedic. I guess that is what he was, I didn't really care back then I knew I just needed help. I got shocked by a capacitor, he ran a 3 lead on me and looked at it. I told them I thought I was just shook up from the incident. I asked if he thought I should go to ER. He said he thought I would be ok if I calmed down but to call them if needed. Now I look back, I should have just went. If I was in his shoes, I dunno, I was very tachycardic 160bpm. Yes I was shook up, but what if something else was going wrong.
 
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My uncle who's a medic and my EMT instructor who is also a street medic both have told me that they have encouraged hypoglycemic diabetics to refuse transport after they've raised their blood sugar via oral or IM glucose and then had solid food to eat.
 
zappa26 said:
My uncle who's a medic and my EMT instructor who is also a street medic both have told me that they have encouraged hypoglycemic diabetics to refuse transport after they've raised their blood sugar via oral or IM glucose and then had solid food to eat.
Click to expand...

also on that note....hypothetically speaking of course... if one day when you and your partner are getting breakfast(dunkin donuts), and encounter a hypoglycemic patient having an acute "emergency", if you explain the emergency to the cashier, he may(probably will) give you a free box of donuts to raise that person(not patient yet)'s blood glucose level. you can then give that person a donut or two and advise them to have their accomplice drive them to seek a physicians care, and you can follow them in the ambulance, to make sure nothing bad happens.
This way there is no report, no patient, no drugs used, and 10 freee donuts.
hypothetically speaking of course:ph34r:
 
Yes, we recommend non transport in around 35% of our cases (~124,000 patients).

Difference here is it's not a refusal by the patient it a recommendation from the Ambulance Officers that the patient does not require transport.

This includes recovered hypoglycemic's and uncomplicated seizures for known epileptic pt's that are recovering.
 
We can't tell a patient "you don't need to go to the ED", but we can discuss different options with them. For example, on a general illness who isn't sure if they want to go to the ED I may tell them that if they don't want to go, they always have the option of seeing their regular doctor, or going to an urgent care clinic.

The closest I've ever come to telling someone "you don't need an ED" is explaining what the ED would do to treat their problem, and explaining that there wasn't much the ED could do that they couldn't do at home (The case I'm thinking of specifically was a pt with a small cut on their hand, it was not even close to needing stitches).
 
We transport all Pt's that want to go to the ER. But we do readily discuss options with our Pt's and do advise then if it is something that their Private doctor can handle, or even an urgent care... Also it has been known to accidently slip out that the Veterans’ hospital even while on diversion from ambulances will still take walk-ins
 
I agree with Aidey. I present the patient with all the options, but do cya by explaining that I am just an EMT and I do not have x-ray vision, electrodes under my fingers, or the ability to say that they absolutely do not need to seek further care... however, the way in which they seek further care is up to them as is when they seek it...

HOWEVER, I have recommended that people not seek care at the local ER (in some cases involving friends and family) due to the number of people I have known to be misdiagnosed there, develop serious complications, and in some cases die for things that they shouldn't have.
 
Rhan,

I do many of the same things as other posters - such as informing as fully as possible, making them aware of potential consequences, etc.

I typically stop short of giving them my opinion when the call is 'on the bubble' or anywhere near it. If I believe a person is sick and in danger if they don't go, then I give them my opinion that they should go.

But if they could seek other methods of transport to an ER or if their complaint is so minor that they could perhaps defer the tx by ambulance I let them know the consequences includings risks/billing/etc. If they ask I advise them as adults that they are responsible for making the end determination.

The closest that I typically go is telling them what I might do if I personally were in their situations.

Hope that helps.
 
Unfortunately, in the protocols I operate under most often (my college EMS system), I cannot make direct statements to this effect. I advise all my patients of their treatment and transport options, and the patient makes their own decision.

What I will do, is discuss with the patient what they may gain (or loose) from transportation, assessment and treatment at an ER, as well as other options (visiting PCP/University Health Center at soon as possible, for assessment in an non-emergency situation).

This comes to the effect of telling someone who has been feeling ill (independent from cliche flu-like symptoms) being told that they will likely wait at the ER for some time, be assessed, maybe have blood taken, and leave with a referral to PCP/UHC. What are they gaining compared to sleeping through the night, and going to UHC in the AM, and avoiding the cost of an ALS ride and ER visit?

Partially because of students not knowing when it is appropriate to call, we accept refusals in approximately 50% of our calls.
 
At one place, my crew can collectively recommend whether they try to see a GP next morning, accept transport, or whether nothing further should be required.

At another, I can't make direct statements. But I certainly can tell them what the ER will be like, and what they'll do.

Everywhere, I tell them I'm just an EMT and so on.
 
If they need to go, take them. If not, recommend they see their Dr.

Cut to the chase.
 
Yes. It's not that uncommon. Does it leave me open to more liability? Sure, but when it's done at appropriate times and in an appropriate way it's perfectly acceptable.
 
All the time. Dito for Mr Browns post + some psych pts + pts with coughs/colds/infections etc, minor paed stuff where the parents panic.

The legal element aside, because we don't have that so much, I suppose it comes down to how much confidence you have in your education. But even more important than having confidence in your assessment, is knowing your limits. Its an old one, and probably not the best rational decision making tool, but I generally think of my grandmother and what I would tell her to do, and go with that. If I couldn't confidently refuse transport to my grandmother, I wouldn't to anybody else's.
 
Up until the other day, I could honestly say I have never told a patient they don't need to go the the ER. Then we had a frequent flier call. The complaint was very mild foot pain that had been going on for the last three weeks and they were just tired of dealing with it (the patient's words, not mine). When asked if they had been seen by their family doctor for it they said no, not at all. We had already run our butts off, it was somewhere between midnight and two and I was done. I told them that it was something that should be addressed by their family doctor and not by calling 911 and going to the ER. Especially since they hadn't tried any OTC pain relievers, ice, staying off the foot, etc since the pain began. And did I mention, that was three weeks ago?
Needless to say, we still ended up transporting to the ER, and naturally it was the on 25 minutes away instead of the one 10 minutes away. They promptly put the patient out in the waiting room. I couldn't help but do a little happy dance inside, not that it will stop the calls from this particular person.

Typically, I use the same approach as everyone else. Explain the risks, benefits, and options available and let the patient make the decision. Of course, we all know that the patient's decision can be affected by how that information is presented. And then other times it can't. I spent close to a half hour one day trying to convince a lady to go to the ER and she never agreed to do.
 
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For me I don't recall discouraging ANYONE from going to the ER, but there were tons of patients I discouraged from going to the ER in my ambulance.

At the very least, "If you have any doubt whatsoever, go to the ER" would be my last words to them, and that would include if I said something like "You might just want to check in with your Primary Care Physician tomorrow.". Important thing to mention to non-emergent cases is they won't be seen any quicker if they come in by ambulance.

...and I think the medic screwed up, he should have at the very least instructed you to get to the ER for immediate exam. It was WAY beyond his experience to make a call on the electical stability of your heart after such trauma and ESPECIALLY with a rate of 160.
 
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firetender said:
...and I think the medic screwed up, he should have at the very least instructed you to get to the ER for immediate exam. It was WAY beyond his experience to make a call on the electical stability of your heart after such trauma and ESPECIALLY with a rate of 160.
Click to expand...

...and without a diagnostic 12-lead.
 
I have on many occasions talked over the various options with my patient. If they are unsure if they need to go, I will go over my interpretation of what's going on, their current vital signs and results of our exam and tests, and what the possible risks are for not going with us. I will explain what we will do for them, if anything; as well as what will likely happen at the hospital whether they go with us or via private vehicle.

I have been told that it is unethical to bring up costs as a consideration, and I tend to agree. If someone asks me the cost, I am honest and tell them what I know. I don't think it'd be right to bring up cost to deter transport, even if the transport is unnecessary in your eyes. (This applies only to 911. SCT/CCT, and IFT in general, are a whole different story.) How do others feel about this?
 
I honestly have no idea what the cost is for an ambulance ride. I know BLS and ALS rates are different, but beyond that I have no idea. I couldn't even ball park a guess. That is exactly what I tell pts too.

If the pt is concerned about cost I explain that my company and the hospitals in my area all have "charity care" which is where they may possibly forgive some of the bill to people who qualify because of low income or whatever, but I have no way of telling who will qualify ahead of time. There are also several charities in my city that you can apply to for help. For crime victims there is a crime victims fund to help pay their costs if they don't have insurance. I know at least 3 of our hospitals have a social worker/billing person who consults with pts who need help with their bills.
 
We don’t to tell a PT that we don’t think they should go to the ER if they ask. But we handle it one of 2 ways. Call county shift manager (RN) and give PT report and then hand phone to PT to ask them. Explain to them everything about what could be wrong with them and make sure they are well informed.

Our SOP is to fill out a PT report for all calls. If we do not transport they have to sign the PT refusal form stating they do not want to be treated and we have explained everything to them.

I transport 75% of my PT’s, 10% are no transport, and 15% we hand down to a BLS crew.
 
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