Cape Breton doctor says some patients risking health by avoiding ER

A Cape Breton doctor says some patients are putting their health at risk by avoiding the emergency department in Sydney, N.S., because they are worried about long wait times and exposure to people with contagious illnesses.

Dr. Joan Salah, who works at the urgent treatment centre in North Sydney, said she told one patient who recently visited the centre because of chest pains to go to the hospital. He was placed on a stretcher and paramedics were ready to make the 20-minute drive to the Cape Breton Regional Hospital. But Salah said he refused to go.

The patient was told that he might die if he returned home "and he made that choice rather than go to the emergency department, which, when you're the paramedics and the physician standing there trying to convince him that his symptoms are worth being assessed in the emergency department, that can feel scary," Salah told Information Morning Cape Breton.

The patient did not go to the hospital by ambulance and Salah said she doesn't know what happened to him.

Vast majority seek appropriate care

In another case, a man with chest pains went to the ER but left because the wait was too long. He then waited a few days to visit the urgent treatment centre, where they were unable to diagnose the problem due to the delay, she said.

The vast majority of patients at the urgent treatment centre are seeking appropriate health care for their symptoms, Salah said, but others are increasingly showing up when they should be going elsewhere.

"What I'm seeing now is that people are staying at home, sort of waiting until it's bad enough to be worth that long wait. And for some people, maybe this is reasonable to wait a bit longer and see if they're going to get better on their own," she said. "But for some people, that's not a really helpful way of deciding whether or not to go to the emergency department."

The Nova Scotia government has said it is taking steps to improve the flow of patients in beleaguered emergency departments across the province.

But people need to realize that urgent treatment centres are not set up to diagnose or treat serious health issues and that despite the long wait, emergency departments have the staff and equipment to do that, said Salah.

The centres are intended to relieve some of the pressure on ERs by providing non-life-threatening care for things like mild pains, minor infections, simple fractures and aches and cuts, but the doctor said some people are now trying to game the system. 

"Patients will misrepresent what they have so that they can get in, and then when they come in say, 'Oh, and by the way, I'm having chest pain,' and that's so they can get their foot in that door without being told to go to the emergency department," Salah said. "I've had that happen two or three times."

But the doctor doesn't blame patients.

"This is not a criticism of that behaviour," she said. "The problem is the long waits and overcrowding that's in the emergency department. But then when people are making these difficult choices in those circumstances, sometimes those difficult choices can have really dangerous outcomes."

Even though emergency departments are overcrowded and understaffed, people still need to go there for serious health issues, Salah said.

"I absolutely do think they will get the care that they need.

"I do think that unfortunately people need to be their own advocate. So if you're in a crowded emergency department and you are feeling like things have changed or that you have fallen through the cracks, or that your symptoms are progressing, I would encourage people to tell somebody about that."

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