STATE OF EMERGENCY: Sending a patient home doesn’t mean nothing’s wrong: physician

If things get worse, patients urged to return to hospital. 'It's not rote advice. It's sincere," one doctor says.

The Abbotsford Regional Hospital emergency room has come under scrutiny after the recent deaths of two patients.

The Abbotsford Regional Hospital emergency room has come under scrutiny after the recent deaths of two patients.

This is part of a multi-story Special Report on Abbotsford Regional Hospital and its emergency department. For more stories, scroll to the bottom of the story or click here.

Emergency department medicine is full of challenges, with physicians only seeing symptoms presented by patients when attending the hospital, according to the three emergency room doctors interviewed by The News.

Patients are initially evaluated by a triage nurse, who ranks a system on a five-unit priority scale which determines how quickly he or she will be seen by a doctor.

When an emergency department physician encounters a patient, it’s usually for the first time. A doctor can evaluate physical symptoms and, if the patient is conscious and alert, find out about the recent past and other health issues.

A preliminary diagnosis often is a reflection of what is the most likely cause of the symptoms, rather than a 100 per cent certainty.

A physician will often want to know more, and can order further investigation. But those tests themselves often carry their risks that need to be factored into any decisions.

Other times, a physician will send a patient home. The physicians The News spoke to were adamant that sending a person home does not mean doctors think the person is healthy and doesn’t need further treatment.

Unfortunately, in at least two serious cases, it appears there was reluctance on the part of Abbotsford patients to return to the local emergency room.

But doctors said sending a person home can reflect just the need for a passage of time to clarify the cause of a problem.

“That doesn’t mean we don’t want you to come back,” said Dr. Alan Drummond, who added that it’s important that physicians communicate as much. “We definitely want you to come back … It’s not rote advice, it’s sincere.”

Doctors noted that a death after discharge doesn’t necessarily mean a physician did anything wrong. A health problem can look to the most experienced of doctors like one thing, and turn out to be something totally different.

“Medicine is not 100 per cent perfect,” said Dr. Eddy Lang, who works in Calgary’s emergency rooms. “We can’t detect everything.”

At the same time, Lang said that mistakes are “incredibly rare” in his jurisdiction. Of 300,000 emergency department visits in the Calgary area, Lang said “I don’t think we can count on more than one hand the number of serious misses that result in a very bad patient outcome.”