A recent blog by Dr. Suneel Dhand, MD, about the confusion created by discharge paperwork  from the Emergency Department got me thinking about several of my medical malpractice cases where this was a recurrent problem.  Much of the confusion comes from some Emergency Doctor's misconnection with their patients about the purpose of an Emergency Department.

Many patients go to the emergency department when they are concerned they have a serious illness that may require urgent treatment.   They, quite understandably, view this as seeing a doctor.  They don't make the distinction between an emergency room, urgent care, and their primary care.  They just know that they are seeing a doctor, and their expectation is that this doctor will treat their condition. 

Emergency Medicine doctors, however, often view their job as quite different.  This is where there is a disconnect between the Emergency Medicine specialty and their patients. Often, Emergency Department doctors see themselves not as a doctor who will treat your condition, but someone who determines whether you need immediate treatment/surgery/hospitalization.  If not, then you are sent on your way to get further care to hopefully cure your problem.  Said another way, they see themselves as fireman who check to see if there is a fire, and if not, then leave you to call a contractor to figure out what caused the smoke in your house. 

In the end, the patient thinks they did what they should by seeing a doctor, and the doctor thinks they did what they should by making sure there was no immediate life threatening emergency.  But, the patient walks out of the ED not knowing that their care is not complete, and they critically need follow up care. 

A recent client of mine framed this quite well.  He told me he did not go back to see his doctor after discharge from the Emergency Department, as was stated on the discharge instructions, because, “I just saw a doctor who told me I was ok.  Why would I turn around and go see another doctor?”

This problem is only added to by the multiple caregivers that give instructions to the patient in the ED.  Sometimes the nurse, after quickly talking with the doctor, gives the discharge instructions about what steps the patient should next take.  Sometimes it's the doctor, who gives the discharge instructions.  Sometimes nobody does, but the system relies on the reams of confusing paper given as you are hustled out the door. 

Confusion about discharge instructions is common and causes real injury.  Hopefully this blog will help you understand that many Emergency Department doctors are not attempting to treat your current condition.  They are only a stop gap until you get more care.  To avoid confusion, try to wade through the multiple caregivers and paperwork to understand what care you need after you are discharged from the Emergency Department.