ways to keep people alive

It's not a good idea to shock a patient who's wide-awake
-Dr Kerry Weaver, ER

Emergency departments are interesting places to work. They really receive the whole gamut of medical issues. Hyperacute to super-chronic. Clear cut diagnoses to medical mystery. Life threatening to totally benign.

In most major emergency departments I've worked in, there are two different sections. One section is for sick people who are likely to need investigations and potentially admission to hospital. The other side is for people with minor or chronic complaints who can be seen quickly and likely discharged in a few hours. Working on the "Acute" side of the department can be scary but is interesting. This is where you see heart attacks, strokes, major trauma, appendicitis, etc. Working on the "Treatment" or "Fast Track" side is also fast-paced and challenging, but is often more difficult, as the amount of investigation need to be done is often unclear to me. People have vague complaints like a "head delay" associated with hearing their pulse in the right ear, back pain described as sharp, achey, and pressure-like all at the same time, or sudden onset of vomitting with no associated symptoms that has been happening for the past 7 years.

The ER doctors that work at VGH are specialists that only do emergency medicine. Everyone I've worked with has been very accomplished, but when I'm on the Treatment side of the ER, I sometimes find it difficult. There is an underlying premise in the ER that because someone came to the emergency department, they are probably very sick, or else they would have just waited to see their family doctor in the office. Unfortunately, many people don't have their own family doctor or perhaps don't have a good perspective on the the role of the ER in our healthcare system. Hence, we see many people who are quite well and have minor complaints. If they were being seen in an office, they would likely be reassured, and perhaps prescribed some medication. When they present to a major emergency department with many lab tests and sophisticated imaging available, they often get quite a smorgasbord of investigations to rule out various things that are unlikely. These tests can be useful, but are also often expensive, painful for patients and involve large doses of radiation. It's tricky, as the ER docs are trained to rule out life-threatening issues but it's hard not to feel like we are sometimes doing too much, especially when you see what is routinely done in smaller hospitals or in the office.

People should not be scared away from coming to the ER if they are sick or injured, but maybe a good rule is to ask yourself if what is going on is an "Emergency". If the answer is no, go to your family doctor or walk-in clinic. You will likely be seen in a more timely fashion and receive more appropriate care and follow-up.