1. Patience will get you nowhere.
Emergency rooms are no fun. Babies are crying. Children are coughing and wheezing. People are uncomfortable. And that doesn't even include the people facing life or death situations who are rushed straight to a doctor. As nurses and doctors struggle to look after everyone, sometimes "somebody who doesn't know they're having a heart attack, who thinks they're just having shoulder pain, might not get noticed," says Dr. William Mileski, director of the emergency department at the University of Texas Medical Branch in Galveston. The moral: Speak up if you think the nurse or doctor has misunderstood your symptoms and don't be afraid to ask them to repeat what you said back to you to make sure your message is clear, says Dr. Mileski.
2. There's a cheaper option down the street.
After Michelle Morton's 10-year-old son hit his face with a ceiling fan last year, she skipped the ER in favor of an urgent care center associated with her doctor's office. They were in and out within an hour -- her son had a concussion -- and her copayment was $125 less than she would have paid for a visit to the emergency room.
An emergency department will never turn you away, but the hospital staff also won't necessarily fill you in on your cheaper options. There could be a clinic or urgent care center down the street that is better equipped to treat your condition, meaning shorter wait times and a smaller bill.
Of course, if the situation is critical, call an ambulance or head straight for the ER. But if you have the time and you're able, find out if there is an urgent care center associated with your hospital or doctor's office. You might avoid a trip altogether by calling a 24-hour medical help line for advice on ways to alleviate certain symptoms until you can see your doctor.
3. Bring a book.
Most patients don't realize that getting admitted to a hospital does not guarantee they will actually get a hospital bed. With some cash-strapped hospitals shutting down, there are fewer beds available for emergency room patients, who are sometimes required to wait for hours or even days on gurneys, in hallways, until a hospital bed opens up, according to a survey of physicians by the American College of Emergency Physicians.
Even if you get a bed, don't expect treatment to be swift. The average amount of time spent in the ER has edged up slightly over the past few years to four hours and seven minutes in 2009, up four minutes from 2008, according to the most recent research from Press Ganey Associates, a health-care consulting firm. Nearly 400,000 people waited at least 24 hours. And it's only getting worse, experts say, as the number of ER visits keeps rising. Annually, ER visits jumped 36% from 1990 to 2008, to 123 million, according to Press Ganey. And all that waiting doesn't end in the waiting room.
4. Come back in the morning.
Emergency room doctors work around the clock, but the quality of your visit won't be the same at all hours. Emergency rooms are typically busiest when we're busiest: during non-business hours. About 65% of hospital visits start on the weekends or before 8 a.m. and after 5 p.m. during the week, according to a 2010 report from the Center for Disease Control and Prevention. That means you should wait till the morning if you can. "You can show up at seven in the morning and be seen in 10 minutes but if you show up at seven at night it may take you 10 hours," says Dr. Rick May, a vice president with Health Grades, a health care ratings organization.
You're more likely to leave satisfied if you go between 7 a.m. and 3 p.m. than if you go at night, according to Press Ganey Associates. Satisfaction starts going downhill after 11 a.m., as appointments build up and wait times start getting longer. The day patients are least satisfied? Mondays.
5. We might make you sicker.
Maureen Daly, executive director of the Committee to Reduce Infection Deaths, drove her mother to the emergency room with a broken shoulder, where she was operated on and released. But days later, she was back in the hospital with an infection one Daly thinks might have been caused by a doctor who cleaned her mother's wound without washing his hands. (She saw it happen.) Over the next few months, her mother lost her ability to walk and that May, she passed away from the infection.
If you're worried about catching something from the person sneezing and wheezing next to you in the waiting room, you should be more concerned about the germs surrounding the doctor or nurse who sees you, say health experts. Doctors and nurses who fail to wash their hands before treating patients can put those visitors at risk for urinary tract infections, pneumonia, and blood infections, among other serious complications, says Betsy McCaughey, chair of RID.
Bacteria can live on surfaces for weeks and care providers can pass those germs on to you when they treat a wound, insert a urinary tract catheter or give you a ventilator to help you breathe, says McCaughey: Don't be afraid to remind your doctor or nurse to wash their hands before they treat you.
6. To us, you're like a lab rat
Middle-aged visitors complaining of chest pains, heads up: Unless there's an arrow sticking out of your chest, expect a full, expensive medical workup, says Dr. Angela Gardner, past president of the American College of Emergency Physicians. Of course, they're trying to save your life, but if it turns out you weren't having a heart attack, your insurer may decide not to pay the bill. You'll be stuck for the costs of lab tests, a chest X-ray, and an electrocardiogram, she says.
Another reason emergency physicians order so many tests: They're especially vulnerable to lawsuits, which may lead them to ramp up testing when treating the conditions that are most likely to land them in court, such as heart attacks and appendicitis, says Gardner. Roughly 1,500 medical liability claims were filed against emergency room doctors between 2005 and 2009, up from the about 900 claims filed between 2000 and 2004, according to the Physician Insurers Association of America, an insurer trade association.
Of course, doctors say these tests are needed to rule out the most serious conditions. And most patients, they add, are fine with that until they get the bill.
7. ...but don't expect us to figure out what's wrong.
There's a good chance you'll leave the emergency room just as confused about your condition as you were when you got there. Emergency room doctors want to confirm you're not dying and you're not likely to get any worse; they don't normally have time to get to the root of your symptoms, says Mileski. That could mean getting some aspirin to treat the pain, but not learning much about what caused it in the first place. As a result, expect another trip to another doctor in your near future. More than 60% of ER patients are referred to an outside physician or clinic for further treatment, according to a 2010 report by the CDC
8. Good luck seeing a specialist.
Say you crushed your hand with a hammer, or tore your ACL in a backyard game of touch football. You can go to the emergency room (and probably should), but you might not get the care you need: There's a shortage of medical specialists who are willing to work in emergency rooms, orthopedic surgeons, hand surgeons, and urologists in particular. Nearly three-fourths of emergency departments reported shortages of specialists in 2005, up from two-thirds in 2004, according to the latest research from the American College of Emergency Physicians. For patients, that means a longer wait, or getting transferred to the closest hospital with the needed specialist.
Many medical specialists refuse to work in emergency rooms because of the high costs of malpractice insurance and low reimbursement rates for their services, says Dr. Melissa Barton, residency director for emergency medicine at Sinai-Grace Hospital in Detroit. If you have time, ask your primary doctor for a recommendation. Or call the hospital to ask about nearby clinics that may specialize in treating your condition.
9. Your doctor can get you priority access.
Giving your doctor a heads up before you get to the ER, especially if he or she has privileges at the hospital, might get you through the door quicker. Eileen Wolter, a mother of two in Summit, N.J., says her husband called their son's pediatrician after the toddler bumped his head during a shopping trip. The doctor was able to alert the physicians on call at the hospital that the child was coming, allowing the boy to be sent in to get an MRI as soon as he arrived.
Your doctor might also suggest another hospital that is better equipped to treat you, says May. Or he may make an exception to see you after hours, as Wolter's pediatrician did one Saturday morning after her son suffered a deep gash on his finger.
10. You can choose your doctor.
Most people don't know they can choose their own doctors in the emergency room, says May. Exercising the option could be useful if you regularly see a doctor associated with the hospital or have been treated in the hospital before. You might also want to request a specialist that your primary doctor has recommended.
It can be comforting to go with a doctor you know and trust, says Dr. May, especially since some specialists are sparse in the ER. Nearly 40% of emergency room doctors are not board certified or residency trained in emergency medicine, according to the Institute of Medicine, a federal advisory body. And the majority of emergency room doctors in suburban or rural areas are trained in family practice or internal medicine, not emergency care, according to the Institute.
Corrections & Amplifications
An earlier version of this story cited a study in which 200 emergency room physicians said they knew of patients who died while waiting in the ER for hospital beds; these patients had already been admitted to the ER and seen by a physician.