Understanding the ER
ERs are romantic. They even had a show called ER on TV. Doctors would meet and fall in love. Sometimes they would skip the falling in love and just meet. All of this in the midst of severed limbs, GSWs (gun shot wounds), heart attacks and a variety of ingested objects. There have been dozens of shows like this teaching us that behind all of the blood and vomit an ER is really a magical place where only two outcomes exist: fix it or die.
It’s no wonder that when people are really feeling bad they think it may be time to head for the ER. On their minds is that the doctor has to do something powerful; fix it or let me die! This is certainly true when people have severe acute back pain. Maybe it hurts so bad that they can barely walk. Or maybe the pain is constant and intense. They are desperate for help and they think the only person who can help them are the heroes of the ER.
This is not an ER bashing article. I would never bash the ER because it serves a vital function in our society and these doctors and nurses are great at what they do. However, it’s important to understand exactly what it is that ER docs do.
The “E” in ER stands for Emergency. These doctors are the best in the business when you are dying RIGHT NOW. They have the training, skill and talents to snatch you back from the jaws of death. They are also there when other doctors (me included) are cozy in bed. Health crises don’t just happen during business hours. They handle the messes. If a bone is sticking out of you arm they will patch you up and send you on your way.
So when you go to the ER with severe back pain or headache, etc., your ER doctor is trying to assess whether this is a problem that is posing a clear and present danger to your health, NOW. If you go in with severe back pain they will ask you about muscle control, bowel/bladder control, sensation, and test your reflexes. Assessing these signs will tell them whether or not you are having an Emergency. Yes, it is clear that you are having severe pain but if you’re not also in imminent danger forgive them if they seem dismissive. Prescription and next patient please.
This can be a real source of frustration for patients because they were expecting the romantic ER where some handsome young resident on his 3rd straight 12 hour shift, fresh from a passionate conversation with the trauma nurse he is dating from the day shift, comes to the rescue with a procedure which will solve all of their problems in under an hour (with commercials of course). Instead they are told that they won’t die and here is a pain-killer/muscle relaxant cocktail in the mean time.
The truth is that in the absence of signs that your headache or back pain has some sort of neurovascular component such as numbness, tingling, muscle weakness, changes in vision or bowel/bladder function your problem is probably not an emergency. That is not to say it is not serious. I think that severe pain is serious. It just isn’t going to kill you. Believe it or not you would probably be better served in a situation like this by a chiropractor and/or massage therapist than an ER doc. Manual therapy is very effective for acute problems such as these. In fact research has shown that it is more effective than muscle relaxers and pain killers.
I don’t tell people to go to the ER unless I think their life is in danger. If that is the case then it’s the best place for them to be. Otherwise the best place for a person with severe musculoskeletal pain of any kind is with a chiropractor. It’s what we do. They just don’t make romantic TV shows about it…. yet.