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Do you really need to go to the emergency room?: Doctors’ Notes

It’s 8 o’clock on a Wednesday night. You’re feverish, exhausted and your joints are aching. You know you should see a doctor, but you’re not sure you should wait to get an appointment with your family doctor.

But do you need to go to the emergency department?

Sometimes it’s hard to know if you’re in the midst of a true emergency or not. The ER is always open, and the people who work there are happy to assess your health and provide you with care. 

If you or your loved one experience a sudden or severe onset of chest pain, difficulty breathing, headache, fainting, confusion, abdominal pain, weakness or uncontrolled bleeding, it’s best to call 911 and be taken to the emergency department.

But, if the symptoms are less sudden or less severe, there may be better places for you to get treatment. 

Ask your family doctor what their process is for seeing patients with an acute medical problem. Many family doctors’ offices hold after-hours clinics on evenings and weekends at their office or an affiliated office. Fevers, coughs, a new rash or illness, to name a few, can often be ideally seen in this kind of setting. 

If your problem isn’t an emergency, seeing your own family doctor can ensure continuity of care — they know you and your medical history well and will better understand how your symptoms might fit into a larger health context. 

Many doctors also have office staff who can listen to your description of the problem, and based on that information, urgently fit you in to their clinic schedule or direct you to the emergency department. 

If you don’t have a family doctor, Telehealth Ontario (1-866-797-0000) offers fast, free, confidential advice from registered nurses. They’ll ask you a series of questions to determine if you can manage the problem at home, if you should visit your family doctor, visit a clinic or go to a hospital emergency room. 

Nobody expects to experience an emergency, but there are things you can do now to make sure you’re prepared in the event of one. 

Know your medical history, what medications— and doses — you’re on and your tetanus status. Keep a printed copy of this information in your wallet. If you become unconscious or unable to communicate in an emergency, these details can be useful to paramedics, triage nurses and doctors who might need it to make quick decisions about how best to care for you. 

If you take care of an elderly relative, it’s a good idea to do this for them, too — especially if they have memory issues. 

If you’re experiencing new or severe symptoms and must call 911, paramedics will know where best to take you. If you’ve already been treated at a particular hospital— and can get there safely — it’s a good idea to return there for further care. That hospital will have your records and test results on file, which could be relevant to your care now. 

Here at the University of Toronto’s Faculty of Medicine, we’re also helping people stay out of the emergency department through a made-in-Toronto program called SCOPE (Seamless Care Optimizing the Patient Experience). 

SCOPE allows participating family doctors and specialists to communicate better so people can get the care they need faster. Sometimes, a quick consult with a specialist is all that’s required — which means you can get help without waiting months to get it. 

Through SCOPE, your family doctor simply calls a phone number to reach a variety of specialists like radiologists or internists. The team also includes key players like care coordinators who can help identify which community resources a person might need, or nurse navigators and health coaches who can work on your behalf to find out what happened to missing records or help manage a chronic condition.

SCOPE also gives doctors access to ConnectingOntario, a portal that allows them to get hospital or other community records for their patients. The idea is to allow secure communication so doctors can consult each other more readily and can get all the necessary information to make decisions. 

Since SCOPE began as a pilot project nearly five years ago, there have been more than 12,000 unique requests for SCOPE service, including 9,000 calls to the physicians hotline. About 40 per cent of these calls may have helped prevent a patient’s visit to the emergency room. 

If you do have to visit the emergency department, remember to ask for your discharge papers and copies of whatever test results are available before you leave. You can share them with your family doctor or keep copies yourself in case you need to return to the emergency department.   

Pauline Pariser is an associate professor in the Department of Family and Community Medicine at U of T’s Faculty of Medicine, associate medical director and primary care lead for SCOPE at University Hospital Network. Cheryl Hunchak is an assistant professor in the Department of Family and Community Medicine and an emergency physician at Mount Sinai Hospital. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email doctorsnotes@thestar.ca .