Emergency room doctor: ER ins and outs
Laurie Marbas, M.D.
When you or a loved does not feel well in the middle of the night, you might consider going to the Grand River Hospital emergency room. Sometimes you might wonder if you should even go or wait until morning and be seen by your primary care doctor. We are very lucky to have excellent emergency room physicians and staff at Grand River Health so we, as a community, can feel confident in the care we receive there. Dr. Matt Skwiot was kind enough to answer some common questions that patients might have.
What would you like the general public to know about our ER?
We are a level four trauma center that provides excellent urgent and emergent medical care for our community. We have truly excellent physicians, nurses and support staff that I would have take care of myself and my family.
When should a patient come to an ER?
Anytime they think they might have an urgent or emergent medical condition.
What should they do when they aren’t sure if they should go to ER or not?
Ideally, they should discuss it with their primary care provider or the on-call physician for their group. They can help to determine if the condition needs to be further assessed or treated immediately or can wait until he patient can be seen by their doctor.
Tell us about a typical day in the ER.
The beauty of emergency medicine is that there is no typical shift. This is even more so at Grand River, as we see great fluctuations in the severity and volume of patients.
What are you doing when patients are waiting for hours to be seen?
I am either taking care of people that have already arrived in the ER or that have more urgent or emergent problems. There is a saying in emergency medicine: It is much better to have to wait to see the doctor than to have him/her rushing into your room. In emergency medicine, we have a principal called triage. This was developed during times of war when trying to do the greatest good for the greatest number of people with various injuries and having limited resources. In the ER, this means having a nurse perform an initial gathering of information about you and your problem and discussing it with the emergency physician. Then, based on the potential severity of your illness and the patients currently in the ER or waiting to be seen, you will be seen accordingly. Basically, we have a duty to see the sickest patients first.
What are the main problems that people have when they come to the ER that should have gone to a clinic?
Two things come to mind: Problems that need one provider to perform repeat evaluations, such as chronic pain conditions or chronic wound care, and using the ER as a convenience instead of their primary care provider.
What are some serious symptoms that patients should call 911 for?
Basically, if you think you have a medical emergency that overwhelms your resources, if you think you have any emergency, such as stroke, heart attack or if you find someone who is unresponsive.
What about patients with chronic pain, what is your advice for them?
There is no question, the best management for chronic pain is done in the primary care physician’s office. They have the tools required to treat chronic pain. Frequently, this will require a multidisciplinary approach, including medications, physical therapy, behavior health and plans to manage flare-ups.
Should everyone have a primary care doctor? Why can’t patients just go to the ER for acute minor illnesses?
The best approach to managing your health is to have a regular doctor with whom you have a good relationship. They know you and can coordinate any other care you might need. When you go to the ER, it is our role to rule in or out urgent or emergent conditions. This often requires testing that is more extensive and expensive than would be done at your doctor’s office. This may not seem like a big deal for someone who has insurance, but this cost is spread among all of us who have insurance and/or pay taxes.
What is your favorite thing about working in the ER?
I love quickly establishing a relationship with my patients and diagnosing and treating them. Often, many conditions present themselves initially in the ER, so we get the first shot at the diagnosis. Going back to my days as an emergency medical technician on the Western State College Mountain Rescue Team in Gunnison, I very much enjoy being a part of the safety net and doing my best to make something good out of a bad situation.
What can patients do to stay out of the ER?
Number one thing by far is to have a personal care physician and work with them on your preventative heath care.
What are some basic safety precautions patients should be taking with summer coming?
Summer is trauma season in the ER. We often see combinations of bad judgement and bad luck. You can not control luck, but you can do your best to use good judgement. Easy decisions to make are don’t drink and drive, bike, ATV, etc. Always wear your seat belts. Wear your helmets and make sure your children wear theirs. It is very sad for me to have a young child as a patient with severe head or facial trauma that could have been prevented by a helmet. I am known as the helmet officer in the cul-de-sac! You also should wear sunscreen and be sure to drink plenty of water while enjoying our great outdoors.
Advice for parents about when to bring their kids to the ER?
If you or their doctor think they may have an urgent or emergent condition. A large part of my pediatric practice is offering reassurance, and I am happy to do this. As a parent, I am happy to do this. There are few things more stressful than not knowing if your child is sick or not.
At what temperature should adults and children be worried?
I would say there really are few hard and fast temperatures that you would need to go to the ER. If a newborn child of a month old or less has a fever of 100.5 Fahrenheit, they should be seen in the ER. If a child or adult has a temperature greater than 104, especially if it does not resolve with evaporative cooling, with luke warm water, acetaminophen and ibuprofen, they should be seen in the ER.
What can the patient expect when coming to our ER?
You can expect our ER physicians to do their best to help you and your family members with your urgent and emergent needs. When I see a patient in the ER, I try to figure out and do what is best for them at that time with that problem. I also try to provide care that I would want myself and for my family.
Dr. Laurie Marbas is a family physician at Grand River Hospital and Medical Center in Rifle.
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