Your choice of words in the emergency room (ER) could affect the quality of your care—or even your odds of survival. And I don’t mean being polite and saying please and thank you to everyone.
Busy ER doctors and nurses make rapid decisions about which patients are top priorities…and what tests and treatments patients require. How patients describe their conditions and concerns is crucial. A few well-chosen words could get one patient the prompt treatment he/she needs, while poorly chosen ones leave another suffering for hours—or facing a dangerous misdiagnosis. Frighteningly, the right or wrong language has been found to be a big factor particularly in women’s survival after a heart attack. Women more often report breathing difficulty, fatigue or dizziness, rather than the classic chest pain, leading health-care providers off track. Of course, what you say and how you say it affects both sexes.
Here’s the right language to use…
Speaking with the Triage Nurse
The single most important communication in the ER occurs almost as soon as you arrive, when a triage nurse (or other hospital employee) makes an initial evaluation of the severity of your condition, likely with the assistance of patient-evaluation software. This evaluation often takes just a minute or two, but if there are misunderstandings, it could lead to hours of delay if the nurse and the automated software decide that you’re not in immediate danger.
Older patients are especially vulnerable during triage because they don’t always experience the dramatic symptoms a younger person would in certain life-threatening situations. Example: A young adult is likely to be in obvious agony when his appendix is about to burst, leading to quick attention in the ER…but older people often experience only discomfort and loss of appetite.
When the nurse asks what’s wrong…
Briefly describe your one or two most concerning symptoms. Put these into context using phrases such as “the worst I’ve ever felt” or “I’ve never felt anything like this before,” if appropriate. Example: “I’m having upper-abdominal discomfort that’s not like anything I’ve ever felt before.” If it’s bad, say it’s bad.
If you’re concerned that your symptoms could be related to a serious health condition that you have (or you had in the past…or your doctor has warned you that you are at risk of developing), mention this as well. Examples: “I’m worried because the only time I felt something similar is right before my last heart attack” or “I’m worried because my doctor recently warned me that if I felt something like this, it could be a sign that I’m having a heart attack.”
What not to say: Unimportant details about your health saga. A busy triage nurse might cut you off before you get to your most concerning symptoms…or get so buried in your details that he/she overlooks your key complaints. Example: Some patients try to tell the story of how symptoms started small but grew over time—only to get cut off before they get to the part where the symptoms escalate. Get the important facts out fast.
When the triage nurse asks your pain level, likely on a one-to-10 scale…
Provide the honest number, then add a phrase that explains why this number should be taken especially seriously in your case, if appropriate. Pain tolerances vary—one patient’s seven might be worse than another’s 10. If you have a high pain tolerance, that’s something the triage nurse should know. Examples: “My pain level is seven…but this is the worst pain I’ve ever experienced.” Or, “I’ll say seven, but I said three when I had a broken collarbone—this is bad.”
What not to say: “10”—unless you truly are enduring what you believe to be the worst pain possible. When people say 10, triage nurses often are suspicious that they’re exaggerators, complainers or pain-medication addicts in search of a fix. Note: If you are instructed to use a one-to-10 scale, do not provide a number higher than 10 in an effort to express that you’re in extreme pain. That just makes you seem like someone who can’t answer questions accurately.
When the triage nurse tells you to take a seat and wait (or you’re told to follow someone to a treatment room)…
Ask, “What’s my triage level?” ERs are not first-come, first-served. Most ERs assign each patient a number from one to five that represents the level of urgency. The higher your number, the longer you’re likely to wait. One means that you require immediate care…two means you require care within the next 14 minutes…three means you need care within one hour…four means within two hours…and five means your case is considered “nonurgent” and you can safely be left waiting as long as 24 hours. (These time frames are guidelines, not guarantees—how long you actually wait depends on how busy the ER is.) If the ER waiting room is crowded and your number is five, it’s probably smarter to head to a nearby urgent-care facility, where the wait might be shorter.
Warning: Do not leave the ER if there is any reason to suspect that your condition might be life-threatening despite the high triage level assigned to you. If the situation did become a life-threatening emergency, your odds of survival would be much greater in an ER waiting room than in your car on the way to urgent care. If you don’t agree with your triage number, politely ask for the physician in charge to do a quick evaluation. You have the right to ask for reevaluation if you feel worse while in the waiting area.
What not to say: “How long will I have to wait?” ER staff have no way to answer this—a dozen urgent cases may be about to come through the door. Asking could get you labeled a pest.
Speaking with ER Doctors and Nurses
ERs can be hectic, and doctors and nurses rarely know their patients—a recipe for miscommunications, misdiagnoses and other mistakes. Four things to ask or tell ER medical personnel…
“Who are you, exactly?” Each time someone new examines you and/or offers a medical opinion, ask who that person is and what his title is. If it turns out it’s a student or resident—a doctor-in-training—ask, “Can I speak with the physician in charge after you are done with your evaluation?” You also have the right to ask for a consultation by a specialist such as a cardiologist for chest pain if your problem is possibly serious or you are not improving.
“What is this for? Who ordered it?” Get these details whenever a hospital employee hands you a pill, starts to stick an IV into your arm or says he’s going to take you for a test. ER staff sometimes get patients mixed up. If you’re told it was ordered by a doctor whose name you don’t know and/or it doesn’t sound relevant for your health problem, ask, “Can you double-check that this is for me?” For medications, be sure you have alerted everyone to your medications. Confirm that there are no interactions.
“It’s the worst I’ve ever felt.” Don’t just say this (and/or “I’ve never felt anything like this”) to the triage nurse, say it to doctors, too, assuming it’s accurate. It sends the message that you’re not a chronic complainer with an everyday issue—this is an extreme situation to be taken seriously.
“Could you run this by my primary care physician?” If you’re in the ER during your doctor’s office hours, ask the ER staff to call your doctor to discuss their conclusions before sending you home. Most doctors’ offices also can be reached after hours. Even an on-call provider should have access to your medical records and be able to offer the ER useful medical history. This is especially important if they’re sending you home with prescription medications.
Three things you should not say…
Do notsay: “I know which painkillers work best for me.” When patients request specific painkillers—especially opioids—it sends up red flags that these patients might be addicts fabricating medical problems to obtain drugs. (If you’re allergic to specific painkillers, definitely do say that, even if the allergy is noted in your records.)
Do notsay: “I need to see the doctor right now!” or “I’m going to sue!” Being demanding or making threats in an ER will not get you what you want, but it might get you labeled a nutcase or a problem patient—which would make the ER staff even less eager to deal with you. If you must ask for rapid attention—maybe you’ve been waiting for a half-hour for a bedpan—a polite-but-urgent request to a nurse at the nurses’ station is most likely to produce a rapid response. Example: “I know you’re busy, but I just can’t bear it any longer, could you possibly…”
Do not say: “Aghhhh.” Don’t scream or moan audibly if you can help it. ER staff sometimes take such vocalizations as signs that a patient is exaggerating or faking pain, perhaps to get quicker attention or because of a painkiller addiction. A silent-but-pained facial expression is a more effective way. It is best to seek ER care with a friend or relative to serve as your advocate.