Navigating the World of Healthcare (pt 3): The Key Players

If you haven’t already, please read the previous installment – Navigating the World of Health Care (pt 2): The first Steps to Getting Help .

1. Emergency and Urgent Care Clinics

Doctors, Nurses and other Care Givers in the Emergency Room or Urgent Care Center have seen it all.

They are like Ringmasters, wearing many hats in the circus of the medical world. Twenty-four hours a day, these multi-taskers must assess a myriad of illnesses, injuries and conditions as they come through Emergency Room doors on legs, a wheelchair or gurney, while at the same time, constantly reordering the priorities of patients, and often making quick and seemingly inhumane decisions based on gut, experience and practicality.

Make no mistake – the ER is often the front line for many patients, emergent or not. I am an expert patient; Cystic Fibrosis affects most of my major organ systems, so I’ve seen a lot.

  • I have seen miracles performed.
  • I’ve witnessed people’s’ last breaths.
  • I’ve watched medical students make exciting discoveries.
  • I’ve held my breath as weathered, experienced experts cry.

The care providers in the ER must be militant in their daily operations. Assess, manage, negotiate, fight, surrender. The process starts the moment you walk or roll into the building, moving along to the gatekeepers at the registration desk, to the person who takes you “to the back”, to the nurse reviewing your symptoms, and finally to the doctor you will ultimately see and have to repeat your information. (This is when that list comes in handy!)

The television show, "ER, got a lot right .

The television show, “ER, got a lot right, but not everything.

Despite a network of on-staff or on-call specialists, the ER doctor may have to play any of the above roles, among many others.  If you’ve watched “ER”, the popular television series, you might think that every hospital is fully staffed with specialists, day and night. It’s not. Often, you’ll see one doctor, especially if it’s late in the day, at night or on the weekend. It’s a busy place with too many patients and too few practitioners.

What the show did get right is that there are all kinds of medical situations at the ER – burns, injuries, colds, heart attacks, gunshot victims, automobile accident victims. People sometimes use the ER for everyday problems, often because they lack health insurance. This mis-use not only clogs up Emergency Rooms, but costs taxpayers billions of dollars. I don’t say this from any political standpoint, but our government and the private medical sector must work together to  reform the healthcare system, so that people enter into the healthcare system at the right place.

So what actually is an emergency?

According to Elda Ramirez, PhD, RN as interviewed for the University of Texas Health Science Center at Houston’s online wellness magazine one should go to the ER for “anything over which the patient or caretaker believes they do not have control.” Examples in the article include:

  • Head, neck, bone and spine injuries
  • Cardiovascular systems
  • Digestive/gut systems
  • Super bugs
  • Any time your doctor feels he/she cannot treat you in a reasonable time frame, and refers you to the ER or Urgent care clinic

What not to expect at the ER

Many people go to the ER to get answers. Unfortunately, you rarely get them there. Given that only twelve percent of all ER visits end up with admission to the hospital, there’s a good chance that you will be going straight home after your visit. Referrals to other doctors or health care providers usually won’t come from the ER.

The ER staff’s job is to make you stable – bandage you up, stop the bleeding, control the pain, diagnose a life-threatening condition (heart attack, blood clot, kidney blockage, etc.) and send you on your way. In many cases, you will need to meet with a/your doctor to get proper follow-up care such as diagnostic assessments, medications, treatments and care plans.

Be a patient patient!

Be a patient patient!

Don’t expect a quick turn-around. Every patient is triaged by the level of severity of their condition, and constantly triaged every so often. So if you’re there with a broken arm and a gunshot victim comes in after you, you’re going to be waiting.

So you’ve decided you need care, and either have been to the ER and still need answers, or you haven’t made a move yet.

What happens if you don't need the ER, or after you've left there?

What happens if you don’t need the ER, or after you’ve left there?

We’re going to discuss the different types of doctors you may meet, usually in the order that one might see them. Please note that this list is not absolute nor a road map. I have listed different types of practitioners you may see on your road to wellness.

2. General practitioners

These guys and gals are like the General Store of doctors. They have the necessities, but offer nothing but the basics. They are usually open only certain days of the week and certain hours of the day.

Unless your doctor has a practice of one, chances of seeing him/her or getting him/her during on-call hours are slim, but rest assured that GPs in general have the same training and information at their fingertips, and can help you survive the common cold, rashes, and the like.

A General Practitioner covers all the basics.

A General Practitioner covers all the basics.

These days, it’s tough to find a GP who is taking new clients. The best way to get around this is to try to get in with a practice that has several doctors on-site. They’ll share access to your records,  and you’re more likely to get an urgent appointment with someone.

The downside is if you happen to have complex medical problems and a close relationship with one doctor. Sometimes, you’ll have no choice but to see another doctor, if yours isn’t on site that day, or on vacation, or just can’t fit you in.

Rest assured, that the doctors will contact each other for recommendations and suggestions if one doctor happens to know your history very well.

3. Internal Medicine doctors

Internal medicine doctors often hold practice as General Practitioners, but they have great knowledge of our insides. They are particularly skilled in putting puzzles together. A patient walks in with a string of seemingly unrelated issues, and an Internal Medicine doctor’s job is to figure out what box, if anything, the symptoms fit into.

Got organs? An Internal Medicine doctor knows them.

Got organs? An Internal Medicine doctor knows them.

Many times, a diagnosis is quick and obvious. Other times, these doctors scratch their heads, consult specialists, and in some cases, have to raise the white flag. In my experience as a patient, these doctors probably experience the highest incidence of frustration.

GPs and Internal Medicine doctors don’t have all the answers, and sometimes have to make referrals. This is where Specialists come in.

4. Specialists

If you want a doctor with OCD, Specialists are your friends. At some point in their early young adulthood, these people loved something so much, that they spent years and hundreds of thousands of dollars just to learn everything they could about it.

Specialists love their area of expertise so much, that they often go on to research, teach, and write about it.

These doctors often work as part of a close team or practice, and share information with their colleagues. You have a good chance that when you need help, your doctor is the “on-call” doctor, and that if you are in an acute crisis, your doctor has conferred with his colleagues enough that they can help you in your particular doctor’s absence.

Whether it’s an organ or a system,  congenital or acquired condition, these are the guys with answers.

Specialists are the problem-solvers.

Specialists are the problem-solvers.

Many specialists are also surgeons in their field, some performing very specific procedures.

I’ve met specialists who have invented and patented diagnostic procedures and treatments to allay or fix maladies. One of my physicians created and patented a surgical procedure to diagnose and treat a very specific disorder, something so rare that the television show “Mystery Diagnosis” featured a young woman with the disorder on one of their episodes. I happened to need the same procedure and the production company asked me for permission to film the entire process from administration of anesthesia to the completion of the process. You wouldn’t know it was me unless you looked very closely at the beginning of the surgery. Hey, my insides are famous now!

5. Surgeons

Surgeons are quite literally, the mechanics and plumbers of the medical world.

They deal with pipes, tubes, taking things apart and putting them together. As children, surgeons might have taken apart telephones to see how they work, killed bugs just to see their guts, or peeled off band aids just to scratch off that scab to see what will happen.

Surgeons fix you up.

Surgeons fix you up.

Surgeons are the people who are often heralded as heroes – bringing a human from near or at-death back to live in a matter of hours, performing a life-saving transplant, setting bones, taking out diseased organs, and fixing problems of all kinds.

Though they spend the least amount of time interacting with conscious people, surgeons are probably the most likely to take the patient’s outcome to heart. They might be the loners of the medical world, who are happy working only in the sterile environment with piped in Mozart or Metallica competing with the beeps and alarms of the Surgery Suite (which usually isn’t a suite – some of those surgical rooms are the size of closets).

*All images and copyright belong to the respective photographers.

In Part 4, we’ll talk about the support and management system – Nurses and Allied Health professionals.

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