Together Patient Advocates Blog

I recently assisted a client at the ER and was thinking about how important it is to have everything you need when you arrive to ensure safe care. Today, I'd like to focus on how you can best advocate for yourself at the ER as well as how to be most comfortable while there.

First and foremost, it's most helpful to have someone with you to at the ER. This can be a friend or family member, or an independent patient advocate like myself. This person should ideally be someone who knows your basic medical history and who is willing to speak up, if needed, to help you advocate for yourself.

It's essential to bring an updated list of your medications or the medication bottles themselves, your medical problems, your ID card/insurance card and your living will or POLST (if you have one). Although we were visiting a hospital system in which my client had been recently admitted, they didn't have her current list of medications. This information is essential to the care providers who see you in the ER - they need to know your medications to know what is safe to prescribe so that they avoid interactions, and to know what to change when you're on your way home again. I have met a number of clients who carry outdated medication lists with them - please, make sure it's updated and accurate before you go to the ER. When I was working as a physician, I often had patients tell me they were taking "a little round white pill" - lack of specifics can lead to life-threatening complications!

Knowing what your medical problems are is also important. For example, if a physician knows you have a history of diabetes and high blood pressure, their risk assessment of your chest pain rises. It's not uncommon for patients to tell the ER that they have "no medical problems" yet they are taking 10 different medications for high blood pressure, diabetes, heart disease, etc. This information can be carried on a simple index card in your wallet, or logged in a cell phone application. Whatever is easiest for you.

Everyone needs a living will or POLST completed (we'll discuss that in a different post), and if you have one, bring it with you to the ER so that the ER physicians know what your desires are in case of a resuscitation.

So, now that you've done the above, how can you best advocate for yourself once you're at the ER?

1. Succinctly tell the staff why you're there. They don't need the 2 year story of your abdominal pain; they need to know what's different about your pain that made you choose to come to the ER tonight. For example, "I've had abdominal pain for 2 years but tonight it is cramping, more severe pain and I'm vomiting."
2. Don't exaggerate your symptoms. Lying so that you can be seen faster doesn't help anyone, and only serves to frustrate the team caring for you which leads to worse care for you. We've all heard the story of the boy who cried wolf...
3. Be prepared to answer the following questions: What makes your symptoms worse? What makes them better? What have you tried to improve your symptoms?
4. If you're concerned that your symptoms are caused by something specific, it's ok to tell the doctor that: "I'm worried I'm having a heart attack."
5. Be prepared to tell your story over and over and over. Be patient and keep telling it thoroughly. You'll first tell reception, then the triage nurse, then the actual nurse caring for you, and finally, the doctor treating you. If you're admitted, you'll have to tell the admitting physician as well. Each person needs to hear the whole story; don't assume information is being communicated from one to the other.
6. Be patient. If you're not getting care as quickly as you'd like, while frustrating, it means that someone else in the ER is more at risk of dying than you are. If you get angry, or yell at the staff, your care will suffer.
7. Take along anything you'll need for comfort: take along a charging cord for your cell phone, a good book, your headphones.
8. If you don't understand something, ASK. It doesn't help you at all to go home uncertain of your diagnosis or your plan of care.
9. Before you leave, ask the doctor what symptoms should cause you to return to the ER.

These simple steps can help ensure you receive the best care possible.

*POLST=Physicians Orders for Life Sustaining Treatment.