Doctors Confess: 10 Ways Patients Screw Up in the ER

Here’s how these common patient behaviors can derail your getting the right diagnosis and treatment as quickly as possible.

By Lauren Gelman
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    You’re not clear why it's an emergency.

    Doctors want you to be able to clearly articulate why you need urgent care. “If somebody hasn’t called their primary care doctor or regular specialist, I wonder why are they here to see me?” says Leana Wen, MD, an emergency physician at George Washington University and coauthor of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests. “Maybe they called their doctor, but can’t get in for a week. Maybe they’re concerned they have a heart problem. Either way, tell me what you’re really worried about.”

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    You don’t disclose all of your medical problems.

    Here’s a common scenario. “I ask a patient if they have any medical problems; they say no,” says Dr. Wen. “Then they tell me they’re on insulin and I look on their chest and they have a big scar indicative of cardiac bypass surgery. So clearly they have some medical conditions.” You might not make the connections, “but we need to know everything about your medical history otherwise we are spending all our time playing detective work when we could be helping you,” Dr. Wen explains. “When you’re stressed out, confused, weak, sick, or injured, it’s impossible to accurately represent your medical history to a physician,” says Myles Riner, MD, a retired emergency physician who blogs at The Fickle Finger. “I even have trouble doing that.” Solution: Bring a card that lists medical conditions, past surgeries, allergies, and a list of all the medications you’re on (including dosages).

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    You don’t know what medication you take.

    Patients commonly tell Dr. Wen this totally unhelpful description: “I take this blue pill and I take this white pill.” She says, “Well, I have no idea what those pills are!” Write down the names and dosages, or bring them in with you.

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    You’re looking for a third or fourth opinion.

    Some people come to the ER because they’re convinced other doctors they’ve seen have misdiagnosed their problem, Dr. Riner says. “It’s not the role of the emergency department to take someone with a chronic medical problem and try to second-guess all the other providers who have treated this patient,” he says. With these patients, “their expectation is that this new doctor is going to do all these tests, make a diagnosis, and get them instant relief.” That’s not to say that patients with chronic conditions should never go to the ER. “But it takes a certain amount of self awareness to be able to say, ‘you know this is just my same old back pain and it doesn’t make sense to go the emergency department expecting a magical cure’ versus ‘this headache is so much worse than all the other headaches I’ve had before, so it’s time to go to the ER,’” explains Dr. Riner.

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    You treat it like a primary care visit.

    Don’t expect emergency physicians to resolve a host of different, unrelated problems, says Dr. Riner. It’s unrealistic to think this doctor you’ve never met before who doesn’t know your patient history will address all your medical concerns in an urgent care visit. Focus. Know the main reason you’re there, and let your doctor help connect the dots. “Some symptoms can be tied together, and we’re trained to review them and see if we can find a common cause,” Dr. Riner says.

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    You lie or hide the truth.

    It’s natural to want to conceal less-than-ideal habits to a doctor, but doing so could change your diagnosis. Be honest about smoking, drinking, drug use, and alternative remedies, says Dr. Wen. “If you come in with a cough, I’d be more likely to order a chest X-ray if I knew that you smoke,” she says. “If somebody comes in with chest pain, it matters a lot if they’ve used cocaine.”

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    You beat around the bush.

    “Don’t ever be embarrassed about a symptom, no matter what it is,” says Alfred Sacchetti, MD, chief of emergency services at Our Lady of Lourdes Medical Center in Camden, New Jersey and a spokesperson for the American College of Emergency Physicians. “When people have a sensitive issue, they tend to dance around it, which could lead the doctor in a different direction.” Remember, the doctor’s seen and heard pretty much everything. Dr. Sacchetti recalls a doctor who once told some extreme (and gross) stories to a patient worried about her GI issues, adding, “There’s nothing you can tell me about your diarrhea that would surprise me, so tell me honestly what’s going on.”

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    You don’t mention when cost is a concern.

    “We’re not providing you with good care if we prescribe a drug you can’t afford to fill, but usually there’s a way around it,” say Dr. Wen. “Maybe we can give a generic, a different medication, or maybe you don’t need it at all. But if you don’t bring it up, I won’t know it’s an issue for you.”

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    You text, or are constantly on the phone.

    “It’s very annoying, as a busy emergency care provider, to walk into a room when a patient’s on their cell phone,” says Dr. Wen, who says this happens a lot, especially with younger patients. “It’s not respectful not only for the provider’s time but for the doctor’s other patients. I might have 40 other patients [and your behavior is] not polite to them.” Texting while you wait? Fine. But when a care provider comes to talk to you, put down the phone.

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    You don’t share when you're frustrated.

    “If you have an issue with the physician, nurse, or anyone else in the emergency department, don’t be obnoxious about it, but don’t hold it in,” says Dr. Riner, who insists that doctors appreciate knowing this information. “When you’re in the emergency department, there’s a really good chance that there’s somebody a heck of a lot sicker than you and that person has to be foremost on your physician’s mind,” says Dr. Riner. “If your doctor seem rushed or distracted, understand it’s because they’re trying to juggle all these balls at once.” A polite way to say this could be as simple as, “I have to tell you, you seem so rushed. Could you sit down and just spend a few minutes to go over this?” or “Doctor, would you rather come back? I’ll be willing to wait if you need to do something else and return when you have more time.”

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