4 ms·

That's completely ridiculous. The bar is pretty high for me to go to an ER, I'm pretty sure anything on that list would need treatment faster than 6-10 hours.

That's completely ridiculous. The bar is pretty high for me to go to an ER, I'm pretty sure anything on that list would need treatment faster than 6-10 hours. Hell, its not recommended to keep a tourniquet applied for more than two hours and even then there's a specific protocol to follow as there's risk of what will be released back into your system. What are people even going to the ER for when they can wait for 10 hours?

tibbydudeza 3y ago
No medical insurance ???.
- _heimdall 3y ago
  That's a very different discussion. Personally, I think its bullshit if ERs are stuck with 6+ hours wait primarily with non-emergencies only there because they don't have insurance and want free care. Don't get me wrong, its bullshit both because they're clogging up the ER resources and because they're in a position where they may be unable to get or afford insurance. Its also bullshit that insurance is effectively a must-have today. The whole system is very, very broken.
hundreddaysoff 3y ago
I'm an ER doc. I work 3 nights a week and see probably 5--10 patients a week who have waited over 3 hours. The basic answer: most people don't go to the ER for emergencies. That is, they go for something like a rash, cough, or fatigue that they know is not an emergency. Many of them just want work notes, although some are convinced they have a legit emergency. We scoop up the real emergencies from the waiting room ASAP. Eg, no one in the waiting room is wearing a tourniquet; if they are, it's my job to either fix the bleed or get them to a vascular surgeon ASAP if I can't. The majority of people who spend hours in the ER waiting room have vastly higher time preference than your or I, and often lower socioeconomic status and higher anxiety as well. Often they can't afford phone service or even a car, so it's hard for them to get places quickly. Others are homeless and want a place to sleep or very anxious and just want to be somewhere with other people in the middle of the night.
- CoastalCoder 3y ago
  > I'm an ER doc. I don't know how you manage to do that job, but thank you.
  - hundreddaysoff 3y ago
    You're welcome! Basic answer: $250/h + benefits and 4 days/week "off". Plus, working in the ER at night is the most fun job I've ever had or probably ever will have. (Programming is second.) Despite this, I plan to pivot to my telemedicine business full-time within the next year. I know I am not invincible and the older I get, the more mistakes I am likely to make and the more working nights will become a risk factor for heart disease, diabetes, and the like. Plus, working nights wreaks havoc on the family, but it's the only option to work stable days each week in the ER. (Ie, most ER docs either work all nights or work a random rotating schedule of first, second, and third shifts.)
    - leaferino 3y ago
      What's your telemedicine business?
      - hundreddaysoff 3y ago
        Main telemedicine gig right now is diagnosing and managing HIV and other STDs. Patients love it as it's super private, and even testing can be done discreetly at home with a mailed kit. Currently completing an online fellowship in obesity medicine and plan to start my own online practice or collaborate with midlevels who do so. Will probably get into tele-urgent care as well. I've learned a little about all aspects of medicine as an ER doc, and it's exciting to apply that knowledge to telemedicine. Telemedicine is the Wild West right now. COVID-19 just opened it up a couple years back. We don't really know how to maximally benefit patients with it, but there are all kinds of new models being tried. When it works, it really works, without all the bloat and entrenched rentiers that can make brick & mortar medicine awful for both doctors and patients. Reminds me of the state of the Internet around 2000. Wide open.
    - 3y ago
sarchertech 3y ago
My wife is a pediatric ER doctor. The majority of the patients she sees shouldn’t be there from a strictly medical perspective. But parents can’t get off of work while anything else is open, first time mom doesn’t realize that a slight temperature and a cough isn’t an emergency, dad is finally fed up that his teenage daughter has been complaining of a tummy ache off and on for 6 months and Sunday at 2am is when he finally decided he had to have answers.
- _heimdall 3y ago
  While I personally am okay with giving a pass for new parents that are scared for their child, I don't get burdening our emergency system just because. I'd chalk new parents up to a learning experience in a new and uncertain time. For anyone going to the ER because it fits better with your work schedule, don't clog up the system for anyone that's truly in need and increase prices for everyone else.
  - wolverine876 3y ago
    > our emergency system It's not 'our' emergency system, it's the healthcare provider who now is often a for-profit. If they have a mismatch between supply and demand, the fix is obvious. It's not your problem, it's theirs.
  - watwut 3y ago
    Fairly often, a doctor told you itnis fine and then things escalated quickly. Or, you have appointment but it is weeks away. nope, people do not prefer to wait 8 hours in ER if there is an actual choice. Problems is, actual choice is often unreachable and just used to blame patients for bad system. Like with OP, 2am tummy ache means the pain massively escalated from something undistinguishable for run of the mill cramps doctors normally don't do nothing about. (As in, cramps you walk in with, they charge money and they won't do anything at all with and fonsider minor)
    - mschuster91 3y ago
      > Like with OP, 2am tummy ache means the pain massively escalated from something undistinguishable for run of the mill cramps doctors normally don't do nothing about. ... and then, on average 7 years [1], later, the desperate daughter finally learns she had endometriosis all the time, and she could have been spared of years of suffering had one of the completely overworked doctors she had seen before actually had the time to delve deep into the issue rather than just hand out painkillers. [1] https://www.york.ac.uk/news-and-events/news/2024/research/diagnosis-endometriosis-delay/ https://www.york.ac.uk/news-and-events/news/2024/research/di...
dmoy 3y ago
> Hell, its not recommended to keep a tourniquet applied for more than two hours Minor note: this is somewhat outdated. They've determined now it's more like 4-6 hours before it causes any damage at all. Per Stop the bleed, Mayo Clinic, etc. But yea faster than 6-10 hours that's for sure. I bet if you went into that ER with an average time of 9 hrs and a tq stamped hour ago on your arm, they'd get you in pretty fast though. Triage is still a thing
- _heimdall 3y ago
  I actually had 6 hours for the tourniquet limit at first and did a quick sanity check online to find the 2 hour stat. Thanks for the clarification here, I could have sworn I had seen slightly longer times more recently but haven't gone through training in a while now.
  - FireBeyond 3y ago
    Yup, paramedic here. Several hours is entirely fine. We'll document the time of application. But (and admittedly different circumstances) ortho surgeons will regularly tourniquet limbs for several hours while doing their work.
    - osmano807 3y ago
      There's some practical limits as neurons start to have irreversible injury after 6 hours of ischemia and 8 hours on muscles. Usually we don't put tourniquets for more than 2h30min in lower limbs because after circa 2h we start to have some reperfusion injuries, lesser time on other segments. The usual protocol is to not use tourniquets unless necessary, for ER care have the tourniquets removed each 30min for a few minutes to reduce reperfusion injuries. For surgery we generally follow this with the intervals no bigger than 2h. (source: Ortho and Trauma surgeon)
choilive 3y ago
Most people go to the ER for non-emergencies. The good news: if they have you sitting around for hours then it means it was not an emergency and you (probably) won't die. Be worried if you check in and they hurriedly shuttle you into an exam room. That means they think you have an actual immediate life threatening emergency.
- _heimdall 3y ago
  Alternative translation, if they don't hurry shuttle you in you probably don't need to be in the ER.
  - RoyalHenOil 3y ago
    Unfortunately, at least in some regions, there is no other place to receive urgent (but non-emergency) care. Waiting a week or more for a doctor's appointment isn't going to cut it if you've broken your arm or if you've been bitten by a possibly rabid animal, and so you're stuck waiting all day or all night in the ER. It was a revelation to me when I moved from the US to Australia. Not only do I not have to pay for insurance, but it's so much easier to receive non-emergency urgent care as well. I can typically book a doctor's appointment for the next day (there are no insurance networks to worry about, so I have my pick of doctors), or if I need care sooner than that, my local ER usually has a wait time of under 30 minutes even for super minor treatment, like removing a sliver of glass from my foot (the high availability of doctors means the local is pretty quiet).
    - jonhpipoca 3y ago
      You're seeing public GPs or what kind of doctor? In Melbourne, public bulk billed GPs are hard to book for the same day, the best ones are regularly 1 week away. Private specialties (Endocrinologist, Psychiatrist) are months away. What you're doing that I'm doing wrong?
- bradley13 3y ago
  There are also the intermediate cases. I had a blood clot in the leg. Not immediately life threatening, but certainly so over a couple of days. I waited something around 1-2 hours, which was not fun, but completely understandable.
deleted 3y ago
[deleted]
Merad 3y ago
In the past year I've gone to the ER with my late 70s dad almost once a month including multiple waits in the 6-12 hour range. * Any time a senior (I guess anyone, really) falls and hits their head doctors want a head CT. Only place to do that is the ER, but if you aren't showing any symptoms of a brain bleed or similar problems, you're low on the priority list. * Dad had IBS and problems with severe constipation. Twice he was having significant abdominal pain and we were told by his GI doc to go to the ER for a CT to make sure there wasn't a serious problem going on. But again, pain with a history of constipation and no other immediate symptoms lands you low on the triage list. And indeed both times he was just constipated. * The worst time - the 12 hour wait - he was experiencing severe altered mental state. His neurologist, who normally has a 2-3 month wait for an appointment, thought it was serious enough to see him the next day. After examining asked if we could go down to the ER (their office is attached to a hospital) for a lumbar puncture and other tests to rule out a brain infection. Again, apparently the ER docs disagreed, so in the waiting room we sat. In general though my observation from all of those hours sitting in ER waiting rooms was that a significant portion of the people there were really just sick and probably should've been at urgent care or their PCP.
tibbydudeza 3y ago
We have private healthcare so you need medical insurance for treatment - if you don't then they stabilize you and send you to the nearest state hospital if it is warranted. State hospital - lots of folks who got stabbed or shot due to alcohol or crime related violence - apparently overseas medical students love to come here to learn all about trauma surgery and getting to stitching people up. Private hospital - people with babies who have fever or crying and folks with chest pains and in my case a kid who just had seizure - she got first dibs to ER because they triage cases.

tibbydudeza 3y ago

No medical insurance ???.

_heimdall 3y ago
That's a very different discussion. Personally, I think its bullshit if ERs are stuck with 6+ hours wait primarily with non-emergencies only there because they don't have insurance and want free care. Don't get me wrong, its bullshit both because they're clogging up the ER resources and because they're in a position where they may be unable to get or afford insurance. Its also bullshit that insurance is effectively a must-have today. The whole system is very, very broken.

hundreddaysoff 3y ago

I'm an ER doc. I work 3 nights a week and see probably 5--10 patients a week who have waited over 3 hours. The basic answer: most people don't go to the ER for emergencies. That is, they go for something like a rash, cough, or fatigue that they know is not an emergency. Many of them just want work notes, although some are convinced they have a legit emergency. We scoop up the real emergencies from the waiting room ASAP. Eg, no one in the waiting room is wearing a tourniquet; if they are, it's my job to either fix the bleed or get them to a vascular surgeon ASAP if I can't. The majority of people who spend hours in the ER waiting room have vastly higher time preference than your or I, and often lower socioeconomic status and higher anxiety as well. Often they can't afford phone service or even a car, so it's hard for them to get places quickly. Others are homeless and want a place to sleep or very anxious and just want to be somewhere with other people in the middle of the night.

CoastalCoder 3y ago
> I'm an ER doc. I don't know how you manage to do that job, but thank you.
- hundreddaysoff 3y ago
  You're welcome! Basic answer: $250/h + benefits and 4 days/week "off". Plus, working in the ER at night is the most fun job I've ever had or probably ever will have. (Programming is second.) Despite this, I plan to pivot to my telemedicine business full-time within the next year. I know I am not invincible and the older I get, the more mistakes I am likely to make and the more working nights will become a risk factor for heart disease, diabetes, and the like. Plus, working nights wreaks havoc on the family, but it's the only option to work stable days each week in the ER. (Ie, most ER docs either work all nights or work a random rotating schedule of first, second, and third shifts.)
  - leaferino 3y ago
    What's your telemedicine business?
    - hundreddaysoff 3y ago
      Main telemedicine gig right now is diagnosing and managing HIV and other STDs. Patients love it as it's super private, and even testing can be done discreetly at home with a mailed kit. Currently completing an online fellowship in obesity medicine and plan to start my own online practice or collaborate with midlevels who do so. Will probably get into tele-urgent care as well. I've learned a little about all aspects of medicine as an ER doc, and it's exciting to apply that knowledge to telemedicine. Telemedicine is the Wild West right now. COVID-19 just opened it up a couple years back. We don't really know how to maximally benefit patients with it, but there are all kinds of new models being tried. When it works, it really works, without all the bloat and entrenched rentiers that can make brick & mortar medicine awful for both doctors and patients. Reminds me of the state of the Internet around 2000. Wide open.
  - 3y ago

sarchertech 3y ago

My wife is a pediatric ER doctor. The majority of the patients she sees shouldn’t be there from a strictly medical perspective. But parents can’t get off of work while anything else is open, first time mom doesn’t realize that a slight temperature and a cough isn’t an emergency, dad is finally fed up that his teenage daughter has been complaining of a tummy ache off and on for 6 months and Sunday at 2am is when he finally decided he had to have answers.

_heimdall 3y ago
While I personally am okay with giving a pass for new parents that are scared for their child, I don't get burdening our emergency system just because. I'd chalk new parents up to a learning experience in a new and uncertain time. For anyone going to the ER because it fits better with your work schedule, don't clog up the system for anyone that's truly in need and increase prices for everyone else.
- wolverine876 3y ago
  > our emergency system It's not 'our' emergency system, it's the healthcare provider who now is often a for-profit. If they have a mismatch between supply and demand, the fix is obvious. It's not your problem, it's theirs.
- watwut 3y ago
  Fairly often, a doctor told you itnis fine and then things escalated quickly. Or, you have appointment but it is weeks away. nope, people do not prefer to wait 8 hours in ER if there is an actual choice. Problems is, actual choice is often unreachable and just used to blame patients for bad system. Like with OP, 2am tummy ache means the pain massively escalated from something undistinguishable for run of the mill cramps doctors normally don't do nothing about. (As in, cramps you walk in with, they charge money and they won't do anything at all with and fonsider minor)
  - mschuster91 3y ago
    > Like with OP, 2am tummy ache means the pain massively escalated from something undistinguishable for run of the mill cramps doctors normally don't do nothing about. ... and then, on average 7 years [1], later, the desperate daughter finally learns she had endometriosis all the time, and she could have been spared of years of suffering had one of the completely overworked doctors she had seen before actually had the time to delve deep into the issue rather than just hand out painkillers. [1] https://www.york.ac.uk/news-and-events/news/2024/research/diagnosis-endometriosis-delay/ https://www.york.ac.uk/news-and-events/news/2024/research/di...

dmoy 3y ago

> Hell, its not recommended to keep a tourniquet applied for more than two hours Minor note: this is somewhat outdated. They've determined now it's more like 4-6 hours before it causes any damage at all. Per Stop the bleed, Mayo Clinic, etc. But yea faster than 6-10 hours that's for sure. I bet if you went into that ER with an average time of 9 hrs and a tq stamped hour ago on your arm, they'd get you in pretty fast though. Triage is still a thing

_heimdall 3y ago
I actually had 6 hours for the tourniquet limit at first and did a quick sanity check online to find the 2 hour stat. Thanks for the clarification here, I could have sworn I had seen slightly longer times more recently but haven't gone through training in a while now.
- FireBeyond 3y ago
  Yup, paramedic here. Several hours is entirely fine. We'll document the time of application. But (and admittedly different circumstances) ortho surgeons will regularly tourniquet limbs for several hours while doing their work.
  - osmano807 3y ago
    There's some practical limits as neurons start to have irreversible injury after 6 hours of ischemia and 8 hours on muscles. Usually we don't put tourniquets for more than 2h30min in lower limbs because after circa 2h we start to have some reperfusion injuries, lesser time on other segments. The usual protocol is to not use tourniquets unless necessary, for ER care have the tourniquets removed each 30min for a few minutes to reduce reperfusion injuries. For surgery we generally follow this with the intervals no bigger than 2h. (source: Ortho and Trauma surgeon)

choilive 3y ago

Most people go to the ER for non-emergencies. The good news: if they have you sitting around for hours then it means it was not an emergency and you (probably) won't die. Be worried if you check in and they hurriedly shuttle you into an exam room. That means they think you have an actual immediate life threatening emergency.

_heimdall 3y ago
Alternative translation, if they don't hurry shuttle you in you probably don't need to be in the ER.
- RoyalHenOil 3y ago
  Unfortunately, at least in some regions, there is no other place to receive urgent (but non-emergency) care. Waiting a week or more for a doctor's appointment isn't going to cut it if you've broken your arm or if you've been bitten by a possibly rabid animal, and so you're stuck waiting all day or all night in the ER. It was a revelation to me when I moved from the US to Australia. Not only do I not have to pay for insurance, but it's so much easier to receive non-emergency urgent care as well. I can typically book a doctor's appointment for the next day (there are no insurance networks to worry about, so I have my pick of doctors), or if I need care sooner than that, my local ER usually has a wait time of under 30 minutes even for super minor treatment, like removing a sliver of glass from my foot (the high availability of doctors means the local is pretty quiet).
  - jonhpipoca 3y ago
    You're seeing public GPs or what kind of doctor? In Melbourne, public bulk billed GPs are hard to book for the same day, the best ones are regularly 1 week away. Private specialties (Endocrinologist, Psychiatrist) are months away. What you're doing that I'm doing wrong?
bradley13 3y ago
There are also the intermediate cases. I had a blood clot in the leg. Not immediately life threatening, but certainly so over a couple of days. I waited something around 1-2 hours, which was not fun, but completely understandable.

deleted 3y ago

[deleted]

Merad 3y ago

In the past year I've gone to the ER with my late 70s dad almost once a month including multiple waits in the 6-12 hour range. * Any time a senior (I guess anyone, really) falls and hits their head doctors want a head CT. Only place to do that is the ER, but if you aren't showing any symptoms of a brain bleed or similar problems, you're low on the priority list. * Dad had IBS and problems with severe constipation. Twice he was having significant abdominal pain and we were told by his GI doc to go to the ER for a CT to make sure there wasn't a serious problem going on. But again, pain with a history of constipation and no other immediate symptoms lands you low on the triage list. And indeed both times he was just constipated. * The worst time - the 12 hour wait - he was experiencing severe altered mental state. His neurologist, who normally has a 2-3 month wait for an appointment, thought it was serious enough to see him the next day. After examining asked if we could go down to the ER (their office is attached to a hospital) for a lumbar puncture and other tests to rule out a brain infection. Again, apparently the ER docs disagreed, so in the waiting room we sat. In general though my observation from all of those hours sitting in ER waiting rooms was that a significant portion of the people there were really just sick and probably should've been at urgent care or their PCP.

tibbydudeza 3y ago

We have private healthcare so you need medical insurance for treatment - if you don't then they stabilize you and send you to the nearest state hospital if it is warranted. State hospital - lots of folks who got stabbed or shot due to alcohol or crime related violence - apparently overseas medical students love to come here to learn all about trauma surgery and getting to stitching people up. Private hospital - people with babies who have fever or crying and folks with chest pains and in my case a kid who just had seizure - she got first dibs to ER because they triage cases.