Emergency Department Angst

Tonight, one of my close relatives sliced his index finger through to the bone with a hand saw, and ended up in the ER. After evaluation by the PA, his case was discussed with the hand surgeon, who requested his admission for a flap operation in the morning. With my knowledge of this patient’s insurance status (“managed” care), I had pretty low hopes that this preliminary plan would go through. It wasn’t fifteen minutes later that we received the call stating he would be discharged home. What transpired over the subsequent hour was nothing shy of a miracle. The admitting hospitalist was remarkably able to secure the patient an appointment with the specialist in the morning and also magically obtained authorization for surgical repair tomorrowafternoon in the same hospital that he will be leaving tonight.

Even with me present to translate all these updates into plain English for the patient and his family, this process was still a disaster. You see, when we are talking about someone’s health, the most important factor is HOPE. Does the patient have hope that he will get better? No matter how simple or complex the case, the real heart of the matter is HOPE. And this patient in the ER had his hope shattered like a crystal vase dropped from the second floor balcony onto an angry, mean concrete driveway below. The variety of dispositions he was given in an hour, the shear uncertainty of his future, the sad news that he was no longer going to be treated in the hospital… These take a HUGE toll on the patient’s health that no measurement tool can ever capture.

What remains to be determined is how we can take this same situation and make it smoother. I knew from the beginning that this patient was not going to be admitted, but I held out hope and bit my tongue when I wanted to say this to him. Perhaps, in retrospect, I could have laid out that option before he heard it from someone rushing behind the drapes of a sterile, bleak ER. Hindsight is 20/20.

This is a challenge that we hope to face head on at Harmony Health MD one day as we expand our scope and develop the engine to treat patients in multiple locations as we do right here at Harmony Home.

Dr. Emil Avanes Physician Director at Harmony Health MD

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