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Posted: 12/5/2007 6:36:30 AM EDT
[Last Edit: 12/5/2007 6:39:27 AM EDT by DavidC]
I'm not a big fan of using the ER as your primary care. I've spent too much time in ERs, both as patient and hospital administrator, to want people who don't need emergency care to be there.

That being said, my fiance and I are having a minor argument over this. The day before thanksgiving she fell on a flight of stairs. Banged up her knee and ankle. At the time she said she wasn't hurt enough to see a doctor.

Fast forward to today. She has been in pain since the fall, she has to be careful how she moves, and if she turns in her sleep the pain from the knee wakes her up. 800 mg of ibuprofen will let her sleep for about 4 hours. She refuses to go to the ER. She tells me that an ER isn't for treating insured people who have doctors. Only problem is, the soonest she can get an orthopod to see her is the 2nd week in January.

I keep telling her that joint injuries aren't anything to take risks on (I've had 6 knee surguries); she insists that the joint isn't damaged

ETA; Most recent email from her at work says she now has an appointment to see an orthopod a week from Friday. I still think she should go to the ER.
Link Posted: 12/5/2007 6:39:21 AM EDT
She should see her Primary care Doc or go to Urgent Care.

ER's are for emergencies.

If you have no UC in your area, then your ER becomes your UC.
Link Posted: 12/5/2007 6:40:22 AM EDT
[Last Edit: 12/5/2007 6:40:41 AM EDT by DavidC]

Originally Posted By thedave1164:
She should see her Primary care Doc or go to Urgent Care.

ER's are for emergencies.

If you have no UC in your area, then your ER becomes your UC.


No UC in the area I'm aware of. her primary got her the appointment for the 14th
Link Posted: 12/5/2007 6:41:02 AM EDT
Whether it's called the "ED" or the "ER", the "E" always stands for EMERGENCY.
Link Posted: 12/5/2007 6:42:03 AM EDT
[Last Edit: 12/5/2007 6:42:25 AM EDT by doggscube]
I cut my hand 10 days ago, three stitches, I didn't even think of UC, felt kind of stupid later as the closest UC is 2 miles away from home.
Link Posted: 12/5/2007 6:44:07 AM EDT
I always worked on the theory that anything less than arterial bleeding, impaled knives, gunshots or open fractures could usually wait until the next appointment.
Link Posted: 12/5/2007 6:44:21 AM EDT

Whether it's called the "ED" or the "ER", the "E" always stands for EMERGENCY.


+1000


I have used the ER once in 30 years. Wife's appendectomy. Last year.
Link Posted: 12/5/2007 6:44:42 AM EDT
Ha...that's sort of funny as wife and I had an argument about the same question on Thanksgiving. There are pretty clear guidelines about when to call 911...you know, chest pain, not breathing, profuse bleeding, unconciousness, etc. Doesn't your fiance have a primary care doc.? I'd try to go there first instead of the ER given the description of her injuries. Walking into an ER on your own is asking for a long wait unless you are lucky. ER's are useful for life and death circumstances and not so much for anything else.

dvo
Link Posted: 12/5/2007 6:45:49 AM EDT
[Last Edit: 12/5/2007 6:47:56 AM EDT by Alien]
I've never needed to goto the emergency room in my entire life. I almost had to go because the wound in my throat from my tonsillectomy opened up and blood was gushing out but it stopped bleeding luckily. Besides it costs like $50 copay for me to go. I'd probably have a shorter wait time and have a smaller copay at my regular physician. ER to me is for if you're in a "holy shit I need medical attention right now!"

Specialists suck for wait times. She doesn't have a regular "family practice" type doctor that she can see?
Link Posted: 12/5/2007 6:46:11 AM EDT
Don't think I'd got to the ER. Is there a walk-in (or limp-in ) clinic you can go to?
Link Posted: 12/5/2007 6:47:48 AM EDT
She tells me that her primary care told her that if she felt she needed to be seen immediately, to use the ER.

She just isn't taking the injury seriously, unfortunately. Joint damage doesn't get miraculously better; continued use without treatment can mean more damage.
Link Posted: 12/5/2007 6:48:03 AM EDT
There is no doubt in my mind that she has some serious damage to her knee. She can insist her joint isn't damaged all she wants, but I'm sure an X-ray will say differently. Get her to an ER. This is coming from a future radiologist.
Link Posted: 12/5/2007 6:49:42 AM EDT
[Last Edit: 12/5/2007 6:52:39 AM EDT by MightySwede]
Did she tell the orthopedics receptionist it was either an appointment soon or she was going
to the ER?

I've even offered to sit all day and wait for a doc in the office to get a second...they
somehow seem to find a time for me to come in right away.

ETA: I guess I assumed she already had an ortho. If not, the ER's here have arraignments
with a practice, and if you are seen in the ER they can call and get you a quicker
appointment.
Link Posted: 12/5/2007 6:51:30 AM EDT
She is gonna be blaming you later for this. I can tell already!


"How come YOU didnt make me go to the E.R.?!?!??!?!"
Link Posted: 12/5/2007 6:54:03 AM EDT
Her primary care should've seen her on a priority basis, maybe not the same day she called (assuming he was totally 100% booked) but the next day for sure. If she was gonna go to the ER it should've been the day the injury happened. IMHO
Link Posted: 12/5/2007 7:00:30 AM EDT
If there is a good chance it could:

kill me
disable me
disfigure me

if I let it go overnight then I'm going to the ER. Everything else waits for my PCP.
Link Posted: 12/5/2007 7:15:15 AM EDT
She doesn't need the ED, but she does need to be seen prior to the 2nd week of January. She needs an x-ray at the very least and possibly MRI. If her pcp can't get this done, then the ED may be your only choice.

And if you do decide to wait (for whatever reason) - watch for swelling around the knee, an effusion can get infected and cause an abscess or worse. Fever and swelling- force her to go in right away.
Link Posted: 12/5/2007 7:25:37 AM EDT

Originally Posted By theBUBBAMANcan:
Whether it's called the "ED" or the "ER", the "E" always stands for EMERGENCY.


Well, if your doctor can't see you for a month then it is an emergency of sorts. So you wait 3 hours in the ER until they have time for you.
Link Posted: 12/5/2007 7:29:19 AM EDT
If there's a risk of bleeding out...
Plus the insurance sucks for ER. 20% deductible for ER or $15 co-pay for Urgent Care. I drove all the way to Minneapolis from Chicago after jacking up my ankle playing rugby to make sure I was going to be in-network and save a few bucks. The Urgent Care was down the hall from the ER, and they tried to steer me in the ER right away, but I refused on account of hopping another 100 feet to probably save me hundreds.

Is the emergency room going to be able to magically make an ortho appear? It's been my experience that unless you're damaged badly enough to be admitted to the hospital, they just give you some painkillers and tell you to consult with your primary and schedule a specialist anyways. She's just cutting out the middleman.
Link Posted: 12/5/2007 7:30:45 AM EDT
Any time I knew I wasnt going to die, I went to a minor medical center and got much better care than the ER provides. Doctors who listen and have the time to actually care.

Pain doesn't necessarily mean it is damaged severely, just that something happened and her body is letting her know. Beyond icing it down there's not much an ER can do except give her pain meds and tell her to make an appointment with an orthopedist or x-ray.
Link Posted: 12/5/2007 7:31:11 AM EDT
Not worth the time or effort.

They shoot horses, don't they?
Link Posted: 12/5/2007 7:38:35 AM EDT
[Last Edit: 12/5/2007 7:39:37 AM EDT by Dragracer_Art]
Before my knee surgery, I called an orthopedic specialist.
They couldn't schedule me for surgery for several weeks... They suggested I visit the ER at the local hospital to put the surgery on the fast track.

Everything from that point on was lightning fast.
I went to the ER and got an MRI done the same day... and within a day or two of that, had a visit/consultation at the orthopedic surgeon's office... and surgery a few days later.
Link Posted: 12/5/2007 7:42:35 AM EDT
An urgent care facility with X-ray capabilities might be best. If that's not available, ED is fine.

My prediction? She gets X-rayed, and it's negative. She follows up with the orthopod in Jan anyway, and if it's still not better, she gets her MRI.
Link Posted: 12/5/2007 7:43:43 AM EDT
The way it is now I suspect: Go to the ER when it can't wait till the morning, and, you can afford the ambulence ride or the copay for it.

Around here, it seems that people who can walk into the ER are treated just like the rest of the Mexicans--insured or not; dying or not. I also suspect that they roll out the red carpet for the non-ambulatory because the money's in the bank, or because of liability issues, or both.

How should it be? I don't know.

Link Posted: 12/5/2007 7:43:59 AM EDT

Originally Posted By thedave1164:
She should see her Primary care Doc or go to Urgent Care.

ER's are for emergencies.

If you have no UC in your area, then your ER becomes your UC.


+1

tell her to go to her GP first.
Link Posted: 12/5/2007 7:44:36 AM EDT

Originally Posted By skygod:

Originally Posted By thedave1164:
She should see her Primary care Doc or go to Urgent Care.

ER's are for emergencies.

If you have no UC in your area, then your ER becomes your UC.


+1

tell her to go to her GP first.


Yup.
Link Posted: 12/5/2007 7:46:20 AM EDT
[Last Edit: 12/5/2007 7:47:57 AM EDT by INI]
When I dislocated/broke my shoulder on Oct 13, I didn't bother to go to the ER, it was at Oktoberfest, and I hung around the rest of the day and drank beer. I waited 2 days to see a doctor(ortho recommended by a client of mine who is a cardiologist)

I knew the ER wouldn't do anything for me except take my money, It was not a life threatening emergency, uncomfortable, yes it was.

She does need to get to a primary care and have it looked at before Jan.
Link Posted: 12/5/2007 7:47:38 AM EDT
The ER is for things that can't wait until your doctor's office opens.

Well, that's the way it's supposed to be. Now it's for people that don't have doctors and want free healthcare.
Link Posted: 12/5/2007 7:48:49 AM EDT
If it hurts enough...awwwww, fuck it, haul her stubborn rear end to the hospital or whatever ya' got and get it checked out. She can keep the ortho appt on the 14th but it sounds like it should be seen sooner as a precaution. Sometimes with certain injuries, there is a window for treatment. Joint injuries are kinda' important.
Link Posted: 12/5/2007 7:53:11 AM EDT
[Last Edit: 12/5/2007 7:53:47 AM EDT by aaron_fsp]
They are told its not an emergency as the "I dont give a F* I'm going to sit in the waiting room" types,
who after being triaged as non urgent Medicaid patients sit bitching
while a couple who hopes their child doesnt die try to keep it together is one of the few times I've ever wanted to slap a fully grown man.
Link Posted: 12/5/2007 7:53:24 AM EDT
The ER is for "immigrants" who don't have insurance, legal status, or anything a debt collector can go after; because they can't be turned away. The ER does however, still welcome people who have insurance and are willing to pay up front, that way they can collect the debt owed from others whom are not willing to assimilate.
Link Posted: 12/5/2007 8:30:34 AM EDT
FWIW, like a lot of women, her primary care is her OB/Gyn, and has already set up an appointment with an orthopod.
Link Posted: 12/5/2007 8:32:55 AM EDT
In an emergency ??

5sub



Know I'm going out on a limb here.
Link Posted: 12/5/2007 8:38:51 AM EDT
[Last Edit: 12/5/2007 8:39:34 AM EDT by Bubbles]
True story. In 1992 my horse spooked at a dog and threw me into a jump (low vertical); my right hip hit the jump and hurt like hell. I got up, had issues walking (major limp), and figured I'd "tough it out" for the weekend. After all, I wasn't bleeding and I hadn't fallen on my head so I figured the bruises would heal up and I'd be fine in a few days.

I was still limping Monday morning at the office... and a week later... and three weeks later. Finally my boss gives me the number of his orthopod and tells me to make an appointment or not come back to work.

So I see the orthopod... who took x-rays, then returned later with a wheelchair and told me to sit the hell down, and boy did I get a lecture!

My right hip was broken, and I'd walked on it for three weeks. I was admitted to the hospital the next day for surgery to pin it.

Go to the ER. Now.
Link Posted: 12/5/2007 8:39:26 AM EDT
Meh. Some of you are overly restrictive on the ER. Last time I got really sick I called my father, a doctor, and he said I could have strep and to go to the ER and get it looked at. So I did. Its not just for sucking chest wounds.
Link Posted: 12/5/2007 8:42:14 AM EDT
[Last Edit: 12/5/2007 8:44:08 AM EDT by wildearp]

Originally Posted By doggscube:
I cut my hand 10 days ago, three stitches, I didn't even think of UC, felt kind of stupid later as the closest UC is 2 miles away from home.


I've done the same. Don't feel bad.

OP: Be sure to tell the ortho doc your wife is in pain. Also ask if you can walk-in and stand by for a cancellation/opening. Sometimes you can squeeze in.
Link Posted: 12/5/2007 8:49:45 AM EDT
She needs to go to the ER.

A former co-worker of mine died from a bloodclot after a very minor fall in the locker room which injured his knee.

She probably won't die, but she needs to get checked out. With all tha pain, there is something bad going on in there.
Link Posted: 12/5/2007 8:51:51 AM EDT
I went in with a dislocated Elbow swelled up like a Melon(small) Sign here Hiwa,,uuh Miss I cannot lift my arm it's a piece of dissconected whatever,,,an X will do than

I save my Emergencys for real,,,have ya' ever used Super Glue to close a wound? it works wonders
Link Posted: 12/5/2007 9:08:22 AM EDT
height=8
Originally Posted By DavidC:
She tells me that her primary care told her that if she felt she needed to be seen immediately, to use the ER. he


Heh good luck getting seen "immediately" at an ER. I damn near cut my finger off trimming some hedges (didnt quite make it through the bone) and sat in an ER waiting room for 2 hours before i even got to see the triage nurse. Even then the half severed finger isn't what got me in, i had high blood pressure. Which is funny because im standing there bleeding on the floor right in front of her and she's confused as to why my bp so high and had to call another nurse out. The second nurse looks at the first nurse, looks at my finger, then gives the first nurse a hat. She didn't even have the insurance forms handy at her desk, she had to go to the back and dig around for them.
Link Posted: 12/5/2007 9:20:32 AM EDT

Originally Posted By SNorman:

Originally Posted By theBUBBAMANcan:
Whether it's called the "ED" or the "ER", the "E" always stands for EMERGENCY.


Well, if your doctor can't see you for a month then it is an emergency of sorts. So you wait 3 hours in the ER until they have time for you.

If your primary care doctor can't see you for a month then he's obviously taking on too many patients and you need to find a new one.

I was always taught that if you couldn't bend it in an odd place, it wasn't leaking profusely from an odd place and you could remember to worry about those two then you probably don't need an ER visit.
Link Posted: 12/5/2007 9:21:47 AM EDT
Sincerely, and again...at least around my neck of the woods: The ER staff roll out the red carpet for those arriving in an ambulance. Whether the ambulance-riding patient arrives unconscious or if they walk off the ambulance, seems to be irrelevant.
Link Posted: 12/5/2007 9:22:51 AM EDT
Make a fucking apointment! She obviously can handle it until you can see your local GP in a day or two
Link Posted: 12/5/2007 9:39:29 AM EDT

Originally Posted By Paveway_:
Make a fucking apointment! She obviously can handle it until you can see your local GP in a day or two



How about you actually read the thread before you open your mouth?
Link Posted: 12/5/2007 9:44:47 AM EDT

Originally Posted By DavidC:

Originally Posted By Paveway_:
Make a fucking apointment! She obviously can handle it until you can see your local GP in a day or two



How about you actually read the thread before you open your mouth?


How about not.

One is not required to read an entire thread before posting, reading the first post is sufficient.

So MYOFB.
Link Posted: 12/5/2007 9:45:26 AM EDT

Originally Posted By injun-ear:
Sincerely, and again...at least around my neck of the woods: The ER staff roll out the red carpet for those arriving in an ambulance. Whether the ambulance-riding patient arrives unconscious or if they walk off the ambulance, seems to be irrelevant.


Yes, if you are transported by the squad, you will probably get priority treatment. If you walk into the ER on your own, be prepared to wait (non-busy ER times excepted).

dvo
Link Posted: 12/5/2007 9:50:05 AM EDT

Originally Posted By Paveway_:

Originally Posted By DavidC:

Originally Posted By Paveway_:
Make a fucking apointment! She obviously can handle it until you can see your local GP in a day or two



How about you actually read the thread before you open your mouth?


How about not.

One is not required to read an entire thread before posting, reading the first post is sufficient.

So MYOFB.



I think we have a winner for the most moronic post of the year. The moron is too busy to read the thread where it is already made clear that the point he failed to make using foul language has already been addressed, then tells the OP to mind his own business in his own thread.

Yep. A solid "If breathing wasn't autonomic I'd be too stupid to live" post.
Link Posted: 12/5/2007 10:44:50 AM EDT

Originally Posted By DavidC:
She tells me that her primary care told her that if she felt she needed to be seen immediately, to use the ER.


A new primary might be in order.
Link Posted: 12/5/2007 10:51:43 AM EDT
The way my Blue Cross is set up, it is sometimes cheaper for ME to go to the ER rather than the clinic. I know it sounds stupid, but it's true.

I stabbed my thigh with a utility knife one time. When I pulled the blade out, a little yellow glob of fat came with it and fell on my pant leg. The cut was about an inch and a half long, and the depth of the blade. not life threatening, but it needed stitched up.

I drove out to the clinic, which is attached to the hospital, and explained to the receptionist why I wanted to see a doctor. She knew me, knew my insurance. She told me I could see a doctor at the clinic, but it would be cheaper for me if I walked down to the ER and had them stitch me up. I told her the copay didn't worry me, the blood running down my leg did. She said I could wait if I wanted, but why should I sit and wait and pay more as well?

My copay at the clinic would have run about thirty bucks and the insurance bill would have been maybe a hundred bucks, tops. But since I am self employed, and injured at work, my Blue Cross would cover 100% if I was treated at the ER. So Blue Cross shelled out about six hundred bucks for five stitches, and I paid nothing.

Sometimes the insurance companies do it to themselves.

I've also had several ER visits that involved gushing wounds or chest pains. I don't feel I've abused the ER services, but that one incident seemed over the top. Still, who am I to argue with the clinic personnel? The ER wasn't busy, I was getting stitches in less than fifteen minutes, and the hospital made good money.

My insurance, which I pay for, picked up the tab which was huge because of their own stupid policies.

DavidC's fiance should have a PCP, for one thing. She should have already have had x-rays taken. If her regular doc couldn't order them, than urgent care (which we do not have here) would be the next step. Going to the ER a week later for x-rays, well, not so sure about that one.

Here, I would have seen any doctor available (probably my PCP) and gotten some sort of initial treatment. But this is a relatively small town, and I don't grasp a lot of the mechanics of healthcare in a big city.

Link Posted: 12/5/2007 11:18:22 AM EDT
[Last Edit: 12/5/2007 11:19:31 AM EDT by DavidC]

Originally Posted By AR-10:

DavidC's fiance should have a PCP, for one thing. She should have already have had x-rays taken. If her regular doc couldn't order them, than urgent care (which we do not have here) would be the next step. Going to the ER a week later for x-rays, well, not so sure about that one.



She does; her ob/gyn. I've been trying to get her to see a doctor since she fell; I tried to get her to go to the ER that day. But part of the problem is that she grew up in a family where you simply didn't use the ER for any medical care that wasn't immediately life threatening. So now we are at a point where she finally told her PC how much pain she is in and the PC made her an appointment for 10 days from now with an orthopod and wrote a scrip for something other than the ibuprofen she has been taking to deal with the pain.

If we had UC centers around here I would drag her to one. Her main specific symptom, severe pain on lateral pressure, sure sounds like ligament damage to me. Ligaments can heal, but if she slips and falls in the ice and snow there's a good chance she''ll do even more damage and once you really rip up the ligaments the repairs are complicated and painful. We have a very good local hospital with a fast, high-tech ER that could have films and an MRI done in a couple of hours if they are busy, quickly if they aren't. Her ER copay is $20; not a big deal.

Link Posted: 12/5/2007 11:35:53 AM EDT
(Disclaimer: This should not be taken as medical advice, and no doctor-patient relationship is expressed, implied or created by the mere writing/reading of this post).

Sorry for the legal crap... blame the lawyers for that noise.

Here's how this is going to go down if she goes to the ER:

She's been walking around on this knee/ankle for a week or so now; the likelihood is high that it isn't broken. That's not to say it couldn't be broken (only an Xray can tell you for certain), just that VERY few people can tolerate walking around on a broken leg for very long before presenting to the ER, if only to get the pain treated. I don't know how tough your wife is, but I can count on two hands the number of people I've seen (over the last decade or so) suck up a broken leg for any appreciable time period.

She likely has a knee sprain. Unless it's a meniscal injury, cruciate ligament tear, or other surgically-repairable injury, there's no point in rushing to the ER (unless you just need more medicine for pain). They're probably going to take a basic Xray (which won't show you ligaments or cartilage... only bones), and once they determine it's not broken, give you an immobilizer/splint, a set of crutches, pain medication, and a referral for an outpatient MRI if they suspect ligamentous injury. That assumes, of course, that the knee isn't so swollen that they can get a thorough enough examination to detect ligament laxity.

They are extremely unlikely to do an emergent MRI in the ER, simply because those are a big deal to set up, take hours to accomplish/read (during which time you're taking up a bed that a sicker patient might need) and there's no emergent indication in this case.

Apart from open fractures, open joints, and certain types of dislocations, there are not that many knee sprains/injuries that require emergency management. Most are taken care of on an outpatient basis.
Link Posted: 12/5/2007 11:37:24 AM EDT
[Last Edit: 12/5/2007 11:44:10 AM EDT by AR-10]
I have been hanging around on some medical boards lately, and I have noticed that some (a lot?) women use an OB/GYN as a PCP.

Why is that?

And why the heck didn't her doctor order x-rays a long time ago?

Not busting on you, I am just trying to understand the whole doctor thing. I've had arthroscopic knee surgery, and I understand your concerns. I don't understand the doctor's actions.

Edit to add;

TheGrayMan answered the x-ray question, I guess. I don't remember how they imaged my knee to see the torn meniscus (sp?). Maybe they didn't.
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