How to Advocate for Yourself During an Emergency Room Visit
Dr. Cwanza Pinckney, an ER doctor in Houston, offers tips on how to champion yourself in a pandemic
In search for more insight on how to navigate the U.S. health care system during the coronavirus outbreak, ZORA spoke to Cwanza Pinckney, MD, a board-certified emergency medicine physician. Dr. Pinckney is currently treating patients who have the virus while working at several hospitals in the Houston, Texas, metro area.
This interview has been edited and condensed for clarity.
ZORA: There are directives on how and when to see a doctor if you are developing symptoms, but they aren’t always clear. When should you go to the emergency room?
Dr. Cwanza Pinckney: The coronavirus follows a typical pathway. It typically starts off with flulike symptoms — fever, chills, body aches. If you are stable overall but not feeling well — meaning you’re not having shortness of breath or chest pains, not severely weak or dehydrated, not vomiting and don’t have diarrhea — I don’t recommend going to the emergency room. Use a screening facility or a telemedicine option. Those medical professionals can recommend next steps. The key indicator in going to the ER is high fever accompanied by shortness of breath. Meaning if you’re a healthy person and now you’re out of breath walking across the room, then you need to go to the ER. And anyone coming into the hospital with preexisting conditions, including hypertension, diabetes, pulmonary problems, and lupus, if you fall into that tier, we are more judicious about your screening at the hospital.
There is a lot of conflicting information about who can get tested and where.
Until we can facilitate more widespread testing, then testing limitations will occur. The most important thing is for patients to understand [that] you have to be your best advocate. So, if one facility can’t provide testing, try another site. Call ahead, and tell the medical providers your symptoms and ask if you can come in to be screened.
As doctors, we want to service as many people as possible, but there are limited supply options. We’re forced to deal with the sickest patients first and trail backwards. It’s not ideal, but we’re doing the best we can.
Being able to plan ahead is the most proactive thing you can do.
Let’s talk more about advocating for ourselves. How can we best do that during the pandemic?
A lot of challenges already exist that we must consider, particularly for many women. Women, a lot of times, care for children, for spouses, and even for elders. It’s not easy for them to step away from the family if they are sick. When I think of all of that, I really urge people to preplan. Talk to your doctor; inquire about telemedicine in case you get sick. And if so, know the info and how that is set up. Know where the closest testing facility is. Know what hospitals are near you. Also, if you have to self-isolate, do you have adequate childcare? Being able to plan ahead is the most proactive thing you can do.
I also recommend, and this is very important, keeping a written documentation of your medical history and medicines. What we tend to do, culturally, is when we are asked if we have medical problems, we may not tell the whole story. And then, upon further discussion, doctors will find that the patient is taking medication for blood pressure or diabetes, which means there are chronic medical problems. But sometimes people don’t acknowledge that as such. It’s a shift in mindset to understand that if you are taking medication for something, that is technically considered a medical problem. Also, if we look at the history of racial disparities in health care, providers have spent less time with African American patients. Be transparent if your provider is not proactive in asking you detailed questions.
If there is something you do not understand, ask the provider to explain it to you in language you can understand. We know communication barriers exist.
What kind of documentation should we keep if we start to experience symptoms?
Keep a journal. Start documenting the symptoms from the very first day you start having them. Check your temperature, and write it down. Take notes on how you’ve been feeling. Take notes on any travel you’ve done and if you’ve come into contact with someone who was sick. Those are details we need. The more information you can provide, the better. We’re in a pandemic, so it’s even more important to accurately provide a good description of how your health is as a whole.
People talk about the week two crash. You get sick, feel a little better, and then are sicker than you were days before. Should we tough it out or head to the ER?
That crash is real. In the first week, it’ll be flulike symptoms, maybe a little pneumonia on the chest X-ray, but you’re okay. You feel a little bit better, and then 10 days later, boom, you’re critically sick. That’s why it’s important to track how you’re feeling. You don’t want to wait until it’s too late to reach out to your provider. If by day 10 to 14, you’re not getting better, and you’re getting worse, that is a strong indication you need to be reevaluated.
Are you seeing symptoms appear more in certain racial groups than others?
I can’t direct the symptomology to racial lines. Among patients I’m seeing, it’s the same course of illness as to what is being widely reported. Everyone is at risk, but the most vulnerable — older people, the immunocompromised, and individuals with preexisting medical conditions — are most affected.
If we do end up at the ER with severe symptoms, what can we expect?
What most people need to understand is that, right now, most hospitals have a no-visitors policy. What that means is we’re not allowing visitors to accompany patients inside the hospital. So be prepared for that.
Provide a good contact so that we can reach out to go over the care plan with your contact and give them updates.
Once you’re in isolation at the hospital, we do not allow any visitors at all. Period. All communication is through phone communication. Isolation in the hospital can be mentally taxing. It’s exhausting, even if you’re just waiting on test results. For patients who are sicker — in [intensive care unit] settings — family members are not allowed. I advise getting the name of the doctor treating you and ask them how they will communicate with your contact so that they receive medical updates. If you can effectively plan, set a call schedule for the same time every day so the doctor can expect to speak with you at that time. I also recommend that the person handling the communication with the doctor is emotionally well enough to do so and able to make informed decisions on your behalf.
Definitely bring your phone charger to make sure your phone is fully charged so you can communicate with your loved ones. Bring pertinent hygiene items. Hospitals have the basics, but if there’s a lotion that makes you feel good, bring it. Bring a book to pass the time. Keep your mind occupied. I love music, so I also suggest bringing headphones. You could be there a day or longer. But there’s no need to bring a whole suitcase of items. Keep it to a minimum.
What can we do if we feel that we are not getting adequate care at the hospital?
Ask to speak to a nurse manager or patient advocate, which a lot of hospitals have. If you feel you’re not getting adequate care, the advocate can come in to help and will talk to the provider to bridge the gap. It’s perfectly fine to ask for that if you’re not getting adequate service.
The virus has sparked social distancing and isolation. That can be hard for people who don’t have partners or families at home. What guidance can you give individuals who are sick and live alone?
I worry about people who are alone. It’s scary if you don’t have someone to lean on. And even if you do, it’s still scary. Utilize technology. Use it to connect. There’s Zoom, Skype, and FaceTime. I encourage people to check in with folks who live alone. Help them have some interaction while they isolate. Also, it’s valuable for people to develop tools to manage stress and anxiety so that when we get sick, we can lean on those. Maybe that’s listening to sermons or your favorite artists. Something that will bring you peace and positivity and make you feel less isolated. It’s forward thinking — and part of the preplanning I mentioned earlier — instead of being reactive. The people I worry about the most are people who do not have internet access. They may live in a rural area where cell service is bad, and they just can’t reach out and call someone.
Thank you for your time and your service in providing care for sick people.
It is a trying process. I’ve never seen anything like this in my career. We are here for you. Even when we’re not at the hospital, we are doing callbacks and providing education to patients and their families as best as we can. Our goal is to do the best we can to make good treatment decisions for you. Most people will do just fine. For the noncritical patients coming in, we are sympathetic to your needs, and we thank you for your patience while we tend to the people who are sicker.