Whether the issue is a spiking fever, a fractured elbow or something far more traumatic, a trip to the emergency room can be a stressful experience for any patient. While you can’t control when or where you’ll need emergency care, you can prepare yourself for the possibility by recording or committing to memory certain pieces of personal health information. But which health stats will help the hospital staff provide you with more efficient, informed care, and what sort of information is unnecessary to provide? Five emergency medicine doctors sound off.
Dr. Torree McGowan, MD, FACEP
ER physician and professor, St. Charles Health System
Bend, Oregon
Knowing your medical history is essential for emergency physicians. There are many ways to store personal health information. A written list is great, but technology now has made it possible to have your medical history loaded on a thumb drive that looks just like a MedicAlert bracelet. Telling us that the information is “in the computer” isn’t enough. Information regularly shows up in our computer system that isn’t correct, so relying on our system can be dangerous without double-checking that info with you.
Here are the most important pieces of information to include on that list or drive:
Major medical problems, including any history of heart disease, lung problems, problems with your kidneys or liver, diabetes, any type of cancer, any reason your immune system doesn’t work normally and major surgeries (including any surgery on your chest, abdomen or brain). It’s nice to know about bone and joint surgeries, but those are less important.
Allergies. This may be the most important piece of information, especially if you have a severe allergy called anaphylaxis. If you are allergic to something, knowing your reaction is helpful as well. There is a difference to us, medically, if amoxicillin gave you a rash as a child or it made your throat close up and nearly killed you.
Know your medications. Have a complete list of your all of the medications and dosages that you regularly take, including prescription, over-the-counter and herbal medications. This allows us to make sure that your medications aren’t causing your symptoms, and that any medications we give you won’t interact dangerously with something you already take. If you are admitted to the hospital, knowing your dosages will also help us continue your normal care while in the hospital. If all else fails, throw all of your pill bottles in a grocery bag and bring them in.
Also, here’s a pro tip: Post a copy of your medical history and advanced directives on your refrigerator. EMS crews will check there if they are ever called to your house and you can’t answer for yourself. Furthermore, if you don’t have an advanced directive, please fill one out, even if you think you’re in good health and don’t need it. This document helps us make important decisions about your healthcare in the event you can’t answer for yourself.
In terms of what information is unnecessary, I actually don’t encourage people to memorize their blood type. If you are in a situation where you have to receive a blood transfusion very quickly, there are well-established ways to give blood safely. This blood comes from our O-negative type blood donors, and is safe for anyone to get in a transfusion. (By the way, if you are type O, please donate!) If I have to give you a blood transfusion in the emergency department, I will need to take a sample of your blood to send to the blood bank for them to screen very carefully and match with the donor blood to ensure no reactions occur. I also don’t advocate for memorizing a huge number of data points. Knowing general trends (e.g., my heart rate tends to run low or my blood pressure is usually around this number) can be helpful but not necessary.
Dr. Marco Coppola, MD, FACEP
ER physician, Colony ER Hospital
The Colony, Texas
It’s common for patients to come into the ER with a list of their medications and conditions, but I wish it was more common, especially because if a patient is unconscious, they obviously can’t tell us all that. (And I wouldn’t recommend getting all your health information tattooed on your chest. It doesn’t look good, especially on the beach.) I love it when patients come and can say, “Here are the medications I’m on, these are the surgeries I’ve had in the past and here are the allergies I have.” A lot of work can be saved especially by patients knowing their medications and dosages. It just wastes so much valuable time in the emergency room to try and figure it out.
In regards to blood type, I’m in the military, so on my dog tags, I’ve got my blood type engraved. There’s a reason for that: You’re in combat, you get hurt, you’re bleeding, you need blood, it’s a quick way to find out what type of blood the patient needs. It’s just something to think about on a personal level — I think it’s good to know your blood type in general.
Overall, it’s important for patients to take their healthcare into their own hands. It’s important for them to know if they have high blood pressure, high cholesterol, if they’re pre-diabetic, what their sugars have been like during the past week if they are diabetic. In regards to blood pressure, sometimes when patients see a doctor, they get what’s called “white coat syndrome.” They’re nervous or afraid to see a doctor, perhaps due to bad experiences in the past, so their blood pressure goes up automatically. I want to know what patients’ normal blood pressure is. The more I know, the faster I can help you.
Dr. Makini Chisolm-Straker, MD
Assistant professor of emergency medicine, Mount Sinai Hospital
New York City
It’s useful to know what your medical problems are, what your medications are and ideally the doses of those medications. It’s not as important for you to know what that medication is in regards to your diagnosis. I just need to know what the medicine is and how much you take.
In regards to medical problems, if you have diabetes, for example, knowing how your sugars have been in the past week or so will help us treat your illness. If you know how your blood pressure has been recently, that’s useful for us to think about as well.
What people are allergic to and what happens when they get that medication and/or food is also vital to know. Food isn’t as important because it’s generally not a first priority to feed you in the emergency department. But it’s useful, for instance, if someone comes in with a hypoglycemic episode. We’re going to give them sugar intravenously, but we also want to feed them because that’s what’s going to stay longer in the body. So if I don’t know that you’re allergic to, say, tuna fish, and that’s what our hospital has in the sandwiches, that would obviously be very bad! Yet for some people, their allergic reaction to a medication or food may be “Oh, I get nauseous.” That’s not nearly as concerning to us as “Oh, I have anaphylaxis.”
For people who are bringing in children, we have a weight scale, but if they already know the child’s weight, that can move things a little bit faster if they need, for example, pain medication. Honestly, we’re eventually going to weigh the kid again just to make sure, since they grow so fast, but it can help us be more efficient.
Something that’s not useful for patients to tell us is their blood type, because frankly, we’re never going to take your word for it before we give you blood. Why? Because if you’re wrong, you’re really, really wrong. If it’s an emergency and you’re unconscious, you’re getting type O-negative blood. We give patients O-negative because it’s the universal donor of sorts. Then, once the lab has processed their blood sample, we give them blood specific to them. I also don’t necessarily need their primary care doctor’s name, because depending on the hospital, I usually don’t need an accepting physician in order to admit the patient. It can be useful for trying to understand about medication changes, yes. It’s also useful in the case that someone is going to follow up with their doctor in a week, but it’s not essential to the critical management of an acutely ill person.
Dr. Katie Byrd, MD
ER physician, Washington Adventist Hospital
Washington, D.C.
The most important thing that patients can do is to have a list of their medical problems, what they’ve been diagnosed with in the past and medications that they’re taking. One of the most common things that we come across in the ER is that patients have no idea why they take certain medications or what the medications are. Even if they don’t know their medical problems, just having a list of medications in their wallet is extremely helpful, because usually we can just look at the list and figure out it out. Other information that would be helpful for us is the name of their primary care doctor, if they have one. If they have a problem that they’re seeing a specialist for, the name of that person is helpful because in order to coordinate care, we’ll want to contact their doctor. Also, knowing what surgeries you’ve had and why is helpful. You’d be surprised by the number of patient who don’t know why they had a particular operation or where that scar on their abdomen came from.
Most patients don’t know their blood type unless they’ve donated blood. If we need to know a patient’s blood type, we send off a type screen, which is a test that looks for what the blood type is. Certainly if someone is in a really dire situation where they’re bleeding out and unstable, then we do a transfusion with what’s called a cross-match blood, which is type O-negative blood that you can give to patients of all blood types.
Lastly, we’re going to check your vital signs when you check in, so that’s not super important to note. The one caveat to this is, if you arrive complaining that you have a fever and you’ve taken Tylenol or ibuprofen before coming in, that’s important to tell us. We’re going to check your temperature, and it’s going to be normal. Thus we’ll think you don’t have a fever.
Dr. Henry Zeng, MD
Department of emergency services, Jackson Memorial Hospital
Miami
Tell us if you have diabetes, high blood pressure, HIV, heart failure or any other issue. If you’ve had surgeries in the past, share that information too. In regards to medical history, another issue is this: Even if some people do know their medical problems, they may neglect to mention a condition like HIV because they live with it every day, take medications for it and don’t experience any side effects from it. Thus they forget about it, but that could be relevant to why they’re in the emergency department.
Unfortunately, as people get older, they tend to accrue more and more medical problems. As a result, they have a long medication list. You don’t need to know every medication by heart — that’s very unreasonable. But carrying a list of medications in your purse or wallet is one option. In this day and age, a lot of patients can look up their health account on their pharmacy’s website using their phone too.
Beyond medical problems, surgeries and medications, there are a few things that parents should know when they bring their children in. First off, be really specific about how your children react to things. A lot of pediatric patients are very young, so they can’t clearly express or verbalize what’s going on with them. Parents, or whoever accompanies the child to the ER, should be really be well-versed in how they’re acting, like how the child is eating, how the child looks, the child’s energy level, their skin, their bowel movements, their urination — things that some pediatric patients might not really comprehend.
For younger children and infants, it’s also important to know their vaccine status. If a child is unvaccinated or is behind the schedule for vaccinations, that opens them up to other diseases that the physician will have to consider. It’s also important to go over how they were born. If they were born premature and/or they had a prolonged stay in the neonatal intensive care unit, these things can factor into why a child is feeling a certain way in an emergency department.
Responses have been condensed and lightly edited.