Since the start of the pandemic in mid-March, patient visits to emergency departments have halved.
In British Columbia, for example, Minister of Health Adrian Dix said there were 6,559 emergency department visits in the province on March 9, but only 2,995 four weeks later on April 6. .
Emergency physicians say they are concerned that people are too afraid to see a doctor and that this could have serious repercussions on their health.
Dr. Ken Milne, chief of staff at South Huron Hospital in Exeter, Ontario, discussed the problem with Brian Goldman, host of the CBC podcast The Dose.
Here is part of their conversation.
You are the chief of staff at South Huron Hospital in Exeter. I work in an emergency department. Let’s compare the notes. What do you see?
Patient volumes are declining in our little hospital … It’s a rural hospital. And we’ve also seen a decrease of about 50% in our [emergency department] volume.
Normally, I would see … a lot of patients with broken bones and cuts and bruises and sprains and I don’t see many of them. And you?
Yes, I would say that the volume of cuts, sprains and fractures is decreasing. And that’s probably because the Canadians are doing a fantastic job of smoothing the curve. And they isolate themselves physically. They try to stay inside. And so they don’t engage in as much risky activity as they normally would in the spring.
Besides the symptoms of COVID-19, why are patients entering?
We don’t see a lot of COVIDs. We see a lot of people worried that they have COVID. But the actual number of patients who test positive for COVID is very, very small.
Are there other types of medical problems you don’t see in the ER either?
I think this is where a lot of us are really worried. We don’t see the same number of heart attacks and strokes and other serious time-related emergencies. Just because we have COVID-19 doesn’t mean that all of these risk factors for heart attacks and stroke are gone. It is always the same number of hypertensive people, the same number of diabetics, the same number of people who smoke. So where are these people?
Why do you think they are not coming?
Well, I think they are afraid. We did an incredible job of spreading this message to smooth the curve, stay at home, isolate yourself. But what we should have added, “but if you’re worried, or if you think you have an emergency, don’t stay away. “
So let’s start to talk about some of the many reasons why patients should go to the emergency room where time is of the essence. A pregnant woman with ruptured tubal or ectopic pregnancy who hemorrhages in her abdomen; it’s the first that comes to my mind. What is the first that comes to your mind?
Well, being a middle-aged man, I’m thinking of a heart attack. So you know, if you have that, “Hmm, I wonder if this is indigestion or a heart attack”, please come in. We have special tests to be able to determine if this is a heart attack or heartburn? So if you experience chest pain, heaviness in the chest … we have effective treatments for these things, but they are time dependent.
The worst headache you’ve ever had. It’s also another. It could be a subarachnoid hemorrhage or brain bleeding.
Absolutely. If you don’t see patients with headaches, how can you determine who really has this life-threatening brain bleed?
The volume of these people who think – “hmm, could it be a stroke, or could it be a heart attack?” – it has gone down. But I still see people who have a heart attack or a stroke. But these people seem to show up later in the disease process.
With the example of a heart attack, we have what is called a completed heart attack. The heart muscle was damaged from the outside inwards…. Once this has happened, there is not much left to do. I see people who show up too late afterwards because they were afraid. Several people said to me, “I didn’t want to enter. I was worried about COVID. “
And they actually call it COVID phobia on social media.
Yeah. And my answer to them is always, I prefer you come, and let me tell you it was heartburn and send you home, then you stay home and die from a heart attack.
My standard line, even without COVID: If you are worried, we are worried. They know their bodies; they know each other. They know how they normally feel. … If you are worried enough to ask the question – “Could this be an emergency? – then please come in.
What is your message to patients who asked you if it was safe or who told you they were afraid to come because they did not think it was safe?
I have not seen any published reports of a patient obtaining COVID from a health care worker transmission while accessing the emergency department. That doesn’t mean it’s not necessarily there, because I couldn’t read everything…. And what does our department look like? We are hypervigilant. We have our masks. We put on our gloves. We wash our hands. We isolate people…. So it could be one of the safest places.
What would you say to moms and dads who are wondering when they should take their child to the emergency room during COVID?
I rely on parents to be experts [in] their children. So if they think something is wrong with their child, they should come in. Adults like you and me, we tend to have heart attacks and strokes. This is how we leave this earth. But with children, it’s usually breathing. They have healthy young hearts that keep going and going on. But if they have breathing problems, it still stings my radar.
Right now, wait times are going down because volumes are going down in the emergency department where you work.
Yes, if people are afraid that coming to the ER puts them at higher risk because they are used to having long wait times, wait times are dramatically reduced. If you have half the volume, our efficiency is much faster. So your time in the department will be much faster.
Patients may be anxious about going to the emergency room and using hospital resources which they fear will be better used by other patients. What do patients have to weigh to make a decision?
I think you can put it at both ends of the spectrum and have this dichotomy. There are obvious things that don’t necessarily have to be in the ER – like they need a refill. But at the other end of the spectrum, it’s clear, you know, that someone came out with a chainsaw and took off his arm. It really needs an emergency 911 call. And then there are the things in between. And that’s where we really have to focus and say, “Look, if you’re worried, you’re the arbiter. “
Because the emergency room is known as the light in the house of medicine which is always on and which is on for anyone, anytime, for anything. So don’t be afraid to come to the emergency room if you think you have an emergency.
Written by Brandie Weikle. Produced by Arianne Robinson and Dawna Dingwall. The interview has been edited for clarity and length.