Guide: The Journey to the Emergency Room

Do you need to go to the ER? It’s not good news, but thanks to the following tips, this journey will be easier.   

1. Share your decision to go to the ER with others, and if possible, try to come with someone you trust.

2. Over the years, you have accumulated illnesses, diagnoses, and tests, which your memory cannot contain. It’s advisable to have a folder at home with copies of these documents to present to the ER doctors, in addition to the referral letter, which may also be written hastily and lack important details from the near and distant past. It’s preferable that this folder is organized by event dates.

3. Bring the medications you take, whether regularly or occasionally.

4. Prepare a list of medications to which you are allergic or have stopped taking for various reasons (those that didn’t help you).

5. Be patient and tolerant. Emergency rooms are the bottleneck of the medical system; doctors are very busy, and the priorities might not align with what the patient or their family thinks is appropriate. You might have to wait many hours between examinations and may leave feeling more tired and exhausted (and not always satisfied). Expectations may not be met even if eventually admitted to one of the departments.

6. It's advisable to bring drinks and a little food when embarking on this journey, but it's important to adhere to medical instructions, which sometimes prohibit eating and drinking before certain medical procedures.

7. The question of whether you'll return home or be admitted will remain open for a long time. Thus, it's advisable for someone to know where your apartment or car keys are, where the checkbook is, the bank account number, and more. It may be wise to authorize a close person to act on your behalf in case of need. There are additional steps that allow you to appoint someone to make medical decisions if you are unable to answer such questions yourself.  

Understanding the Doctor  

The ER doctor must address several tough questions and determine priorities. Sometimes, they must act with maximum speed, while other times they must remember the rule that haste makes waste, and it’s advisable to wait for observation and/or monitoring until deciding whether to stay in a department or return home.

The speed of treatment mainly depends on the nature of the medical issue, though much depends on the referral letter, its phrasing, and question presentation. When an elderly person arrives at the ER, these considerations expand:

1. The presentation of illnesses, signs, and symptoms may be atypical and misleading.

2. Additional chronic diseases and numerous medications might complicate or obscure the illness picture and thus the treatment.

3. Elderly patients are more prone to forget important details about their illness history, due either to the acute situation they find themselves in or their cognitive function.

4. Laboratory test norms don’t always match older patients with those of the younger population. Even the interpretation of these results might differ.

5. The reserves of various systems are less than in youth. This might not immediately manifest but should be considered.

6. Social support isn't always available or sufficient. Thus, it's recommended to call a social worker to help provide alternative services.

7. Basic daily function may change due to the event for which the elderly entered the ER. While in younger people, this might be visible, in the elderly, these changes are harder to assess but are necessary realities. Knowing the basic daily function before the acute illness is crucial.

8. The elderly have a lesser ability to adapt to the limitations of their new illness than the young. These changes are known to the ER doctor (or ought to be) and are considered. In general, prolonged complaints due to chronic diseases are unwelcome by ER doctors. The more dramatic and rapid the change, the more attention is received. Frequent ER visitors may be viewed condescendingly unless there's a significant change in their condition.

Subjective complaints like pain without objective signs are often referred to a specialized clinic for these complaints. When leaving the ER, you should keep the discharge letter and make copies before giving it to your family doctor.