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Against the Grain with Dr. Chad Edwards | Tulsa Sports Injury| Podcast 7 – Part 2
Brian: Right.
Dr. Edwards: Those kinds of things. Really, the question is, can this wait or not? When it comes to things like chest pain, things that would be concerning for a potentially life threatening issue …
Brian: Better to be over cautious.
Dr. Edwards: Absolutely. Those things, if you think …
Brian: 45 year old, over weight male with chest pain, probably come on down.
Dr. Edwards: Yep. You need to go. That is going to take precident over knee pain. It might take precedence over a broken bone. We may do a couple of things and then you may sit and wait for a long time.
Brian: Give you a good pain killer and there you go.
Dr. Edwards: Exactly, because we’re screening these things. We might get some vital signs and we might get an EKG and then you may be sitting and waiting, or we might get blood work.
Brian: Right.
Dr. Edwards: All of this stuff is cooking and then if the labs come back and there’s no, EKG looks normal and a doctor may not have even seen the patient yet.
Brian: You’ve gotten past the most serious check marks.
Dr. Edwards: You’ve gotten information that helps you prioritize.
Brian:Right.
Dr. Edwards: If you get an EKG and there’s big, what we call, ST segment elevation, that guy immediately goes to the top of the line.
Brian: Right.
Dr. Edwards: Because that’s a potentially fatal condition.
Brian: Right there on the spot.
Dr. Edwards: Exactly. There’s a lot going on behind the scenes that patients don’t necessarily see.
Brian: Right.
Dr. Edwards: When you’ve got one ER … I remember when I was in a 16 bed ER and at 2 o’clock in the morning, I was the only doc.
Brian: Oh my gosh.
Dr. Edwards: I had 16 beds. Sixteen patients that I’m supposed to take care of, plus whatever is in the waiting room and I’ve got to prioritize those, plus you still have ambulances that could still come in.
Brian: Wow.
Dr. Edwards: What are you going to do? You do the best you can. You’ll start collecting data because you want as much of that data so that when you go see the patient, you can immediately determine, this patient needs to come in the hospital, they can go home, they’re going to die, they’re not going to die, and here’s our appropriate follow up. That’s what we’re trying to do. In the emergency room, you’re trying to answer a couple of very basic questions. Is the patient going to die or not? Do they have a life threatening condition that we can intervene on? Do they need to be admitted or can they go home?
Brian: Right.
Dr. Edwards: Those are really the questions that you want to ask. I’ve had patients that would come in through the ER and they’re coming in for a relatively chronic thing, it might be abdominal pain.
Brian: Right.
Dr. Edwards: Which, that can be problematic. You’ll do a work up, looking for certain things. Does this patient need to be admitted?
Brian: Right.
Dr. Edwards: Do they need surgery? Can they go home? Those basic questions, you’re going to ask every time. The ER has a process through which we work through those things. We’re not looking for the final answer. We’re not looking for, why do you have that abdominal pain? In the emergency room, you don’t care.
Brian: Yeah.
Dr. Edwards: The only thing you care about is, do they need to be admitted? Are they going to die? Do they need a surgeon? Can they go home? Those really basic questions. We do want to try and help that patient, but they have pain. They have the same pain a month later and it hasn’t gotten any better and they come back to the ER, you’re going to get the exact same work up.
Brian: Mm-hmm (affirmative).
Dr. Edwards: Essentially, for the most part because they’re trying to ask the same questions. Patients will be very frustrated that, I’ve done this 5 times and they keep doing the same thing and it’s frustrating to them. I understand that, but you’re asking the wrong question. You’re asking an emergency room question. You got to quite asking the emergency room question and go find a primary care doc, go find gastroenterology, go find somebody else that can actually work this up. In the ER you just can’t do that.
Brian: Yeah, I think a lot of people go to the ER because they feel like their primary care physician is not going to see them for a week. It’s just a pain, it’s too much or too irritating, whatever the problem is.
Dr. Edwards: Right, certainly, that’s one of the things that we do different at Revolution. If they’ve got an issue and they need to be seen, we’re going to get them in. Almost without exception. We’re going to get them in as quickly as we can. I don’t want them to spend their money in the urgent care or the ER.
Brian: You’re just going to get a whole other level of service with you.
Dr. Edwards: It’s the most cost effective way to deliver way is with a one on one relationship with a primary care provider. It’s one of the most cost effective ways to do it.
Brian: Right.
Dr. Edwards: That doctor knows the patient. They know what’s going on. They know their meds and supplements and those kinds of things. When you get any other provider, you have to start from scratch. The minute you cross the threshold in the ER, you’re automatically, you’re costs go up.
Brian: Yeah.
Dr. Edwards: It’s hundreds of dollars just to have the doctor come in and wave his hands over you.
Brian: Yeah.
Dr. Edwards: It’s just incredibly expensive.
Brian: Talk to me about when I go to the ER, is there any communication with my … Is a … I come in with a chronic problem that has worsened, how much, as a family care physician or primary care physician to that person, how much communication can and will happen in those hours in that ER clinic?
