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Don’t wait for emergency care, OHSU physicians urge

Forgoing a trip to the emergency room can be dangerous
OHSU Emergency Department
The OHSU Emergency Department, May 18. Visits to OHSU’s adult and pediatric emergency department are down about 30% from levels that would be typical for this time of year. (OHSU/Kristyna Wentz-Graff)

Many people are sensibly avoiding public places during the COVID-19 pandemic. However, emergency medicine physicians at Oregon Health & Science University are raising another even more pressing concern: Waiting too long to see a doctor can be dangerous.

Nationwide, hospital visits for strokes and heart attacks have decreased significantly, according to the American College of Emergency Physicians. OHSU treated 27 inpatients for stroke in the month of March – down from 53 during the same month a year ago.

It is unlikely these medical emergencies are happening less frequently, and more likely that people are just staying home.

Visits to OHSU’s adult and pediatric emergency department are down about 30% from levels that would be typical for this time of year – similar to reductions reported by other first responders and health systems elsewhere in Oregon and across the country.

“We really want people to come in when they need care,” said Mary Tanski, M.D., M.B.A., interim chair of emergency medicine in the OHSU School of Medicine. “There is a risk of waiting. If they’re having an emergency, things can get much worse before they see a physician.”

Tanski said OHSU emergency physicians are seeing fewer patients, but the cases tend to be more advanced and much more severe than normal.

For example, someone suffering from lower abdominal pain may have appendicitis. Waiting could lead to a rupture, and much more severe and potentially deadly repercussions than having it diagnosed and treated early with an appendectomy.

OHSU Emergency Department
Jordan Young, M.D., left, and Ran Ran, M.D., don protective gear before entering a patient room during a shift at the OHSU Emergency Department, May 18, 2020. (OHSU/Kristyna Wentz-Graff)

In a joint statement issued on April 22, leaders of several American medical organizations emphasized the importance of people calling 911 and seeking medical care for urgent health needs. The risk of forgoing medical care far outweighs the risk of contracting the virus, especially in hospitals that have taken extraordinary measures to ensure patient safety.

At OHSU, some of those measures include the following:

  • Masking all patients as soon as they arrive and restricting the number of visitors in the hospital.
  • Immediately separating those with respiratory symptoms into rooms to prevent the spread of respiratory illness.
  • Physical distancing and regularly sanitizing patient care areas.
  • Precautions among clinicians and staff, including all staff wearing masks, consistent hand washing and use of other personal protective equipment including gloves.

“Unless people have gotten really healthy all of a sudden, we suspect that people are having heart attacks at home and just not coming in,” said Matt Hansen, M.D., M.C.R., an associate professor of emergency medicine physician in the OHSU School of Medicine.

Heart attacks, festering infections and lack of medication to treat chronic disease can all lead to lasting complications or even death without timely treatment.

Stroke is a prime example.

“It’s critical that people seek care immediately when they or their family members see signs of stroke,” said Helmi Lutsep, M.D., a stroke specialist who is also interim chair of neurology in the OHSU School of Medicine. “In stroke care, time is brain. Timely treatment can lead to recovery, whereas waiting can lead to lifelong disability or death.”

Healthy people staying home has demonstrably saved lives by flattening the rate of infection in Oregon, and ensuring hospitals and health systems aren’t overwhelmed by cases of COVID-19. However, sick patients should not wait to seek medical care.

Hansen said he worries that some people who are elderly or live alone may be struggling with serious health issues and no one is checking on them due to physical distancing.

“People should check on their elderly neighbors if they haven’t seen them in a while,” he said. “Give them a call or ring the bell and step back to maintain physical distance. We have to still be a community and look out for vulnerable people.”

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