Please help me feel better about what happened at the E.R.

October 26, 2008 11:57 PM

I am trying to resolve some angry and anxious feelings I’m having about emergency medical care my husband received this weekend. Very long story inside.

Over the past week, my husband had a few bouts of chest tightness and lightheadedness. He is an otherwise healthy and fit 30-something male who is under a lot of stress from work right now. Last Friday after lunch, he felt lightheaded and dizzy and almost passed out. After an hour or so of laying down, he felt better and continued working. His chest felt intermittently tight, but no sharp pains, so he did not go to the doctor.

After a full night’s sleep on Friday night he woke up Saturday morning still feeling chest tightness and some lightheadedness, so I took him to the local Urgent Care Center. He was given an exam and an EKG, which the doctor said was “abnormal” and “showed signs of a heart attack.”

Side note: I felt at the time that something was off about the diagnosis, but who am I to second guess a doctor when she says your husband’s life is as risk at that very moment? For example, every time he mentioned “tightness” they interpreted that as “pain” – which they ended up focusing wholly on – and they basically brushed off the lightheadedness.

Anyway, due to this “abnormal” EKG, husband was rushed in an ambulance to the Emergency Room at a nearby hospital. As you can imagine, considering we drove ourselves to the Urgent Care Center just fine, and he wasn’t feeling all that bad, this caused a bit of a freak out. Husband was shaking with nerves, and the whole situation was quite alarming. He was placed on oxygen, given some spray under his tongue, hooked up to an IV, the whole works.

Upon arriving at the ER to meet my husband who had arrived via ambulance, I learned that the EMTs in the ambulance did an EKG that showed zero abnormalities. Then the doctors at the ER did another EKG, which was also totally normal. All this time his blood pressure, pulse, and oxygen levels were just fine. The ER doctor consulted with a cardiologist and their suspicion was that the Urgent Care doctor had one of the EKG sensors on backwards, which essentially read the heart backwards, therefore showing “permanent damage” that, if true, would have shown up on future EKGs (which it did not). They also did further blood tests that showed everything was 100% normal.

After many hours of waiting, he was declared totally fine and discharged with instructions to rest and see his regular doctor. That’s it.

Now I am struggling with two main things:

1. I am feeling very angry that the error of the first doctor led to a whole circus of unnecessary events. Is this par for the course in health care and do I need to just get over it? Is it their job to overreact to everything because they are extraordinarily risk-averse to under-reacting? Do I need to file this under “better safe than sorry” and just move on? (As you can tell I am having a hard time with this…)

2. I am feeling very anxious about what kind of bill we are going to receive for all of this. My husband has good health insurance (PPO) but I have no idea what or how much will be covered, what the total cost may be, and if the insurance company will bill us for a lot of it because most of it ended up being totally unnecessary. I imagine the ambulance alone costs a small fortune. Am I just supposed to wait around in anticipation a five-figure bill to drop in my mail slot any day?

My husband and I have been lucky to be in good health and we have virtually zero experience with hospitals, health care, insurance billing, etc. I’m not sure if I should simply be grateful that we have health care at all and get over my negative feelings, or if I have a right to be angry. I am also worried sick about how much this whole circus is going to end up costing and I am trying to prepare for the worst. I would appreciate any advice, either concrete (perhaps I could call the insurance company?) or anecdotal (something that either validates my feelings or puts them in perspective).

To be clear, we are taking his health seriously, and he has an appointment with his primary care physician tomorrow. Hopefully we can get to the bottom of what is REALLY wrong with him and how to address it.

We have not talked to our families (or anyone) about this because we don’t want to alarm our parents and frankly, I’d really like to just forget about it. The whole thing was just frightening and rather embarrassing.

Thanks in advance for your advice and answers.

posted by jay dee bee to health & fitness (28 comments total)

People who work at hospitals and medical centers refer to "Urgent Care" and "Minor Emergency Clinics" as Doc-In-The-Box. No matter how large or small a community they serve they do not hire the cream of the crop as far as techs, nurses and med staff go. Not to say that there are not any good ones out there somewhere...I know of one when one certain doc is on duty...but by and large you get under or over diagnosis out of them.

Yes your costs for the trip and ER care will be large but most insurance companies will pay their share.
posted by bjgeiger at 12:30 AM on October 27, 2008

Think of it in a proceess-related manner. You had concerns. You went to the doctor. He had concerns. Those concerns were found to be unfounded.

Plus check to see if you have irrational anger at your husband because you were upset by his health crisis. Its totally normal and totally human and says nothing about you as a person. It may be easier for you to experience that anger by focusing it on the doctor and not your husband. If true, there's no need to express that anger, but you can acknowledge it exists.

Finally, I'm certain you'd prefer that if your husband had a real problem, that the doctor at the Urgent Care sent him to the hospital. Whether or not he attached those sensors right, he made the right call. The data said problem and he reacted by sending you to specialists.
posted by Ironmouth at 1:14 AM on October 27, 2008

Emerceny medicine stinks. The staff is stressed, overworked, and definately human beings. You and your husband were also stressed out and are both human beings. In other words it's a room fool of fragile people with freaky shit going on. What a great environment to make mistakes! Everyone who's on the treatment end feels a bit traumatized.

I'd file it under "Still alive! Cool!" and move on with your life, being glad you can. The only other option is to get to work on a real heart attack, because no one is responsible, really. Mistakes happen. Write a letter to the urgent care center if you're concerned, but that's really all you can do. But really, as far as mistakes in health care go, this was about as minimal as you can get. (Think about it going the other way for a moment.)

Any decent insurance should cover the vast majority of emergency care. I'm sure looking through your PPO's web site would give you a better idea of exactly what they cover.
posted by Ookseer at 1:23 AM on October 27, 2008

I think you're underestimating your fear. And I think that anger is the natural presentation of fear, and the urgent care doc is the most obvious person to blame for how frightened you were.

These things take time - sometimes a long time - to process. You'll likely feel very differently in a month or a year. This is all very fresh. Try to get some perspective. Had the urgent care doc been right instead of wrong, your husband's life may well have been saved by this huge flurry of emergency activity.
posted by DarlingBri at 1:33 AM on October 27, 2008 [1 favorite]

#1. As a doctor, I often ask myself, how many scenarios like this am I willing to entertain in order to prevent one 30-year-old guy from dropping dead. The answer is quite a few.

#2. Call your insurance company. They pay people to sit by the phone and wait to be asked questions like this.
posted by ikkyu2 at 1:33 AM on October 27, 2008 [7 favorites]

and if the insurance company will bill us for a lot of it because most of it ended up being totally unnecessary.

I can help at least with this one...

Your husband went to the urgent care, was administered tests ordered by a doctor who then sent you to the ER, where more tests were ordered by a doctor. The medical necessity of your tests is not determined by the results, but by whether a doctor feels they are necessary. I work with diagnostic imaging and let me tell you... If insurance companies didn't have to pay for negative tests, we'd be out of business in a week.

Take this opportunity to learn about your insurance before the bills come in. I've had insurance that involves a copay for ER visits, $50 or so. My current insurance involves a deductible, so the first $1k of bills would come to me. Some involve a copay percentage. Depending on what kind of insurance your husband has, just looking at the card may clear a lot of this up.

(Note though that Urgent Care and ER aren't the same. It's possible you may end up with a bigger bill out of the Urgent Care visit than the ER visit if your plan involves an ER copay.)

Also some policies require that you call your insurance to let them know you guys went to the ER within a certain amount of time. If you're not sure about your policy, I'd go ahead and do this just to make sure your ducks are in a row.
posted by FortyT-wo at 1:42 AM on October 27, 2008

erm, I meant to say coinsurance percentage instead of copay percentage.
posted by FortyT-wo at 1:43 AM on October 27, 2008

1. I am feeling very angry that the error of the first doctor led to a whole circus of unnecessary events. Is this par for the course in health care and do I need to just get over it? Is it their job to overreact to everything because they are extraordinarily risk-averse to under-reacting?

Well, not over-react to *everything*, but when you're talking about chest pain... yes, that is their job. Especially if *their* test shows abnormalities accompanying said chest pain. *They* are unaware that they did the test incorrectly, so that's what they have to go on and if it's saying "permanent damage" - they need to get on that, STAT.

(Remember: Everyone's human. Even on House, Dr. Chase does the tests wrong. Or is accused of it daily.)

Worst case scenario: It's a heart attack.

If they react quickly, get him to the ER, they have a good shot of treating any problems that may occur, saving the heart muscle, etc. If he develops an unstable rhythm, they have the equiment to defibrilate him. If his oxygen levels are low, they can give him 02 via mask. Etc. Hopefully, he gets better. If not, they've done everything they can do.

If they choose a more laissez-faire approach... he *might* get better. He might not. And if he doesn't...

Their ass is legally on the line. Imagine if he'd really had permanent damage and they'd given you the option of more tests. And you chose not to do them. Worst case scenario in THAT situation is that he dies. And if he did... they could potentially be facing one hell of a lawsuit.

50% of what a doctor does is treat the patient. The other 50% is prevent a lawsuit. If you think your health insurance payments are high, their malpractice insurance is even higher.
posted by grapefruitmoon at 3:29 AM on October 27, 2008

You can be both grateful and angry, but you'll probably be happier if you focus on the gratitude.


The bill will come and probably be some measure of a headache (and the people above probably have better advice on that; I'd think that the hospital is a) allowed to make an incorrect diagnosis and b) is concerned about lawsuits, so the outcome will probably be about balancing those two things) but in answer to the question, how should I feel? the answer is as much as possible: grateful and relieved.

Also, sometimes for me, when something scares me, I get angry, so keep in mind part of your anger might be of the YOU SCARED ME variety. Not that you don't have the right or cause to be angry.
posted by A Terrible Llama at 3:32 AM on October 27, 2008

"The ER doctor consulted with a cardiologist and their suspicion was that the Urgent Care doctor had one of the EKG sensors on backwards, which essentially read the heart backwards, therefore showing “permanent damage” that, if true, would have shown up on future EKGs (which it did not)"

I can't imagine how this would be possible. Assuming that permanent damage means ST segment elevation, the doc would have had to put the chest leads on your husband's back rather than his chest.

Prinzmetal's angina would explain this all nicely. Episodic chest tightness and lightheadedness, ST segment elevation on ECG that's there one minute and gone the next, negative cardiac markers on blood tests.

I'M NOT trying to offer medical advice, I have no idea what's wrong with your husband. I'm just pointing out that you shouldn't be so quick to assume the first doc messed up.
posted by sero_venientibus_ossa at 4:59 AM on October 27, 2008

The anger and anxiety you're feeling may just be the adrenalin still boiling around inside you, and just giving vent to it could help you see things clearly. What you went through was horrifying, yes, but it doesn't sound like grounds for malpractice or anything like that -- more like a "shit-happens" kind of thing. But you went through all that furor and that adrenalin is still zinging along inside you, and you're not really seeing that now. Just letting that fade or letting yourself vent about the situation -- because boy-howdy, is this a situation I'd wanna vent about -- will help.

What I went through was something not even in the same ballpark, but I once was stage manager for a show that had a huge and crazy technical thing go wrong. Fortunately we all managed to fix it without the audience noticing anything was wrong, even though broken glass and the accidental ingestion of alcohol was involved.

After the show, I stormed backstage to read the cast the riot act for what I saw as their mistakes that lead to the incident, and when I got there, they immediately started yelling at me for what they saw was MY part. So we all yelled our heads off at each other for about thirty seconds -- "What the hell were you thinking?" "Didn't I tell you to watch out for that?" "I could have been seriously hurt, what the hell?" -- but then after that all boiled out of us, we all blinked, looked at each other, and all of us burst out laughing, because no one had really been at fault -- it had just been a perfect-storm outbreak of Murphy's Law -- and because now that we'd all vented, we saw that.

You may simply just need to find a trusted friend and rant to them about the dumb-butt doctor and what he made you go through -- and the bigger the vent, the better, speculating on whether he got his degree at Clown College, whatever -- and that may settle your mind enough to put things in perspective.
posted by EmpressCallipygos at 5:01 AM on October 27, 2008

Four or five years ago, my ex and I were at a clinic appointment when he mentioned he'd had a couple of episodes of faintness recently. The doctor loaded him into a wheelchair immediately and sent us off to the ER, where we waited (and waited and waited, 6 hours of waiting) until he was triaged into the back for an EKG. Nothing was wrong; it turned out to be a brush with vasovagal syncope.

I ended up catching viral pneumonia in the ER waiting room, which kept me out of work for more than a week. Although it was great fun to blame the doc who sent us down there as a CYA measure - it's still a running joke between us - I am grateful for the inconvenience (although not so grateful for the pneumonia), because his faintness could have been symptomatic of other heart or brain problems. I'd so much rather waste my time to find out everything's OK, than the other way around.

I hope he's feeling better. Stress is a bitch.
posted by catlet at 6:42 AM on October 27, 2008

Like sero_venientibus_ossa mentions, you may want to consider further exploration of the original problem, since it apparently wasn't solved despite your ordeal.
posted by odinsdream at 7:16 AM on October 27, 2008

I am feeling very anxious about what kind of bill we are going to receive for all of this.... Am I just supposed to wait around in anticipation a five-figure bill to drop in my mail slot any day?

This, at least, should be easily solved. On the back of your card should be a customer service number -- call them up and explain the situation to them. (Also, make sure that the visit doesn't need to be reported to them within a certain time frame, as someone upthread mentioned.) Our insurance, for example, has a flat $100 co-pay for everything associated with any ER visit. Its their job to answer questions like this.
posted by anastasiav at 7:36 AM on October 27, 2008

he woke up Saturday morning still feeling chest tightness and some lightheadedness

Don't forget your part in this. You reported these symptoms.

IANAD and this is not medical advice, but these symptoms could be due to indigestion, stress and/or maybe a little dehydration. I don't know at all. Neither did you and neither did the doctor. You were RIGHT to go for urgent care where the chest was involved, and the doctor was RIGHT to take the reported symptoms seriously.
posted by JimN2TAW at 8:13 AM on October 27, 2008

I can't imagine how this would be possible. Assuming that permanent damage means ST segment elevation, the doc would have had to put the chest leads on your husband's back rather than his chest.

Not necessarily. Permanent damage might have been deep q waves or st segment depressions. Neither would necessarily be acute, but both are possible with misplaced leads. Unfortunatly misplaced leads happen, fortunately, most of the good EKG machines will tell you if it detects operator error.

The doctor at urgent care could have considered a second EKG. I've personally done 3 EKG's in quick succession for a doctor just to triple check what was going on. EKG's are just a snap shot.
I don't want to come down too hard on the urgent care doc though because I wasn't there and honestly chest pressure alone is an emergency room trip, chest pressure + lightheadedness + EKG changes = get to the ER and possibly the cath lab.

Ikkyu2 is right. It's better to overreact and be wrong.
posted by brevator at 9:27 AM on October 27, 2008

Insurance companies don't like paying for medical errors any more than you do. If you believe a doctor performed a procedure wrong and that costs were incurred because of it, the insurance company will be happy to look into it. They'll scrutinize the records, and will dispute any charges they consider medically unnecessary. For what it's worth, I successfully got charges removed from an urgent care bill by showing that they were the result of a medical error. But the facts were different than in your situation.

BUT. Don't do this today. A person's career could be at stake. Sit on it for at least a week or so until the upswelling of emotions over your husband's health and safety has clearly dissipated. Once you're able to think objectively about what happened that day, mentally review it. If you still think a serious error was committed, that's the time to call.
posted by nakedcodemonkey at 9:48 AM on October 27, 2008

If there had really been something wrong, you would have been angry that they didn't do anything about it. You have to understand that doctors can't just know something isn't wrong right off the bat. There are a number of scenerios to cover. You seem to be upset at the doctor for taking you seriously. Imagine how angry you would be if he asked you if you wanted another test and told you how much it would cost every time he did something.

If the doctor had done nothing more based on one test, most people in your situation would have probably been itching to sue him.
posted by onepapertiger at 9:51 AM on October 27, 2008

Also, think of Tim Russert, who was working right up until he dropped dead.
posted by onepapertiger at 9:53 AM on October 27, 2008

A possible way to gain some positivity from the situation: As of right now, your husband has not been diagnosed with anything wrong, but you had a sort of dry run. Which means that now is a great time to review your "what if" scenarios and make sure you're all set up for various worries. How is your health insurance? How would it have handled this situation, had it really been a heart attack? Should you upgrade or downgrade your package? How are your doctors? Do you feel you have the right relationships with them to feel taken care of in the event of an emergency? Have you both been going to yearly baseline appointments? Did you go to the right hospital, or is another one better that may be slightly farther? Did you have the right numbers in your phones and identification info in your wallets to manage the paperwork? Are you set up at home with medical record-keeping in case finding out what's wrong becomes drawn-out or transferred between multiple practitioners? If you're interested in disability and/or life insurance, now would be the time to get it, while you're still healthy and have no diagnoses on record.
posted by xo at 10:11 AM on October 27, 2008

Here's another way of looking at it: last year I injured myself, and didn't go to the ER, and didn't get all the tests run, and didn't see an expert - all because I thought I was fine, because I have internalized from my family an attitude that unless there is blood gushing everywhere, you aren't *really* hurt, and because the nurse on the phone line told me that my foot wasn't broken.

It was broken. But I didn't find this out until ONE MONTH LATER when I happened to be at my PCP for my annual checkup and I asked her for a PT referral and told her about the foot, and she took one look at it and sent me to an orthopedist.

Almost one year later and I am still dealing with the fact that waiting for treatment and not taking the injury seriously means that my foot never healed right.

This was just a foot. Not a heart. But put it through that scenario instead.
posted by micawber at 10:26 AM on October 27, 2008

You did what you needed to do under the circumstances, and hindsight is always 20/20, but I remember on one occasion waiting at an Urgent Care Clinic (one associated with a major area hospital) that had had three cardiac patients turn up in the hour I sat in the waiting room and who were all ultimately taken by ambulance to the hospital. (I know they were cardiac patients by virtue of the accompanying relative who ran in screaming "He's having a heart attack! Help!") When the doctor finally saw me (I'd tripped and fallen with my leg crushed beneath me the night before, and now it was causing me to limp), he sighed and said that Urgent Care was meant for sprains, muscle pulls, cuts requiring stitches, strep throat, things like that. This clinic had one EKG machine, no cardiologist on duty at the time, and three heart patients demanding attention at the same time. He told me that those people had lost valuable time by not going directly to the ER.

I would definitely suggest that your husband see his regular doctor for some follow-up testing. The chest tightness and light-headedness could be symptomatic of many things (I'm no doctor, but Raynaud's Syndrome is one thing that comes to mind) that can only be determined via a detailed case history and many tests.
posted by Oriole Adams at 10:41 AM on October 27, 2008

I'm pretty sure that you should be grateful.

Your concerns were taken seriously, you're both fine.

The money will all even out in the end. Yes, you should be more aware of the policies and procedures required for your health insurance. But you have health insurance. How awesome is that?
posted by sondrialiac at 10:46 AM on October 27, 2008

By the way, lead reversal on EKGs is common enough that I was 'pimped' (taught) about it in medical school and my internship, especially how to recognize common reversals. It happens on EEGs too and I know what that looks like too, because even the very best techs occasionally make mistakes.

(as brevator said, it doesn't change the J-point or ST-segment; it just puts a lot of Q's where they can't be.)
posted by ikkyu2 at 11:06 AM on October 27, 2008

I don't know what kind of insurance you have, and you should definitely follow the advice to call them, but I was in a situation this summer where I had to be rushed by ambulance to the local ER, transferred to another hospital 40 miles away by ambulance, and admitted there for 3 days. I have a PPO (Blue Cross Blue Shield of Illinois) and the total cost for everything was ~$2000. More than 25% of that was the ambulance trip from one hospital to the other.

It's also true in my case that the tests found nothing (this was neurological, not cardiac) and I was also upset at having been put through 4 days of testing for "nothing." I suspect I would feel differently if I'd had a brain tumor or spinal cord injury (which was the first thing they suspected).

Anyway, it's been nearly 4 months and I'm at peace with the situation. Don't freak out about the bills, especially if your insurance is as good as mine. You can always make payment plans with the hospital, too.
posted by desjardins at 11:14 AM on October 27, 2008

Wow, I expected helpful and reassuring answers from this great community, but I am overwhelmed with the variety of wonderful answers that have addressed all of my concerns and feelings. Thank you. I am going to keep reading over them as I reflect on this experience. Many of the things said above really ring true: perhaps displaced anger, adrenaline, the need for gratitude, understandable human error, better safe than sorry, etc.

It's impossible to pick a best answer, but know that each one has helped me process this. Truly, thank you.
posted by jay dee bee at 11:23 AM on October 27, 2008

In my experience, it is very difficult to reverse leads on and ECG machine. The machines that I have used (one being over 10 years old) indicate when I've mistakenly placed a lead in a position that generates unexpected results. The little screen that displays all the system information and allows you to start an ECG or change any of the settings displays a message like, "arm leads may be reversed, proceed anyway? Y/N" If you choose to proceed anyway, the ECG printout will have a statement to this effect.
posted by battlecj at 12:49 PM on October 27, 2008

Your experience sounds pretty limited to me, battlecj. In fact, studies suggest that if you are not aware how frequently it happens, you are probably doing it and not noticing it. The computer may notice some common reversals like left limb for right limb, but it is not always so good at other kinds of errors, especially when the underlying QRS complex is not normal to begin with.
posted by ikkyu2 at 11:53 PM on October 27, 2008