When to go to a hospital for health concern and when not to amid COVID19 crisis

When to go to a hospital for health concern and when not to amid COVID19 crisis

Amid COVID19 epidemic, going out of the house, by both patients and physicians, is a risk by itself. That is why an enhanced community quarantine has been imposed by the government. Going to the hospitals carries a greater risk to both patients and physicians because hospitals are considered contaminated with COVID19 as confirmed and probable cases have gone in and out of the hospitals.

Thus, to avoid the risk of getting infected with COVID19, patients and physicians prefer or should stay away from hospitals as much as possible.

AS MUCH AS POSSIBLE means if there is NO STRONG INDICATION or URGENT NEED to go to the hospitals, patients should stay home and just have telemedical or online medical consultation.

There are practically no outpatient specialist-doctors’ clinics, both in private and government hospitals, to serve patients amid COVID19 epidemic crisis and enhanced community quarantine in Metro Manila (I can only speak of Metro Manila but I assume this statement is also applicable in Luzon and in the entire Philippines).

The only area in a hospital that is still open to serve the public with a health problem is the emergency room or emergency medicine department.

To be seen in the emergency room in the midst of COVID19 crisis is a BIG and BIGGER HASSLE than before the advent of COVID19 and it entails MORE EXPENSES especially in private hospitals’ emergency rooms.

BIGGER HASSLE – aside from the checkpoints on the way to the hospital, before entering the emergency room of the hospital, there are a lot of uncomfortable screening procedures for COVID19.

MORE EXPENSES – COVID19 screening procedures are charged to the patients even if found clear of COVID19 and the personal protective equipment worn and used by the emergency room staff to examine patients are also charged. A medical technologist extracting blood sample for laboratory examination and a radiological technologist doing x-rays in case one needs one wear personal protective equipment that are also charged to the patients. Before the advent of COVID19, there was no need for the hospital personnel to use extensive and expensive personal protective equipment and therefore, no expenses on the part of the patients.

Thus, AS MUCH AS POSSIBLE if there is NO STRONG INDICATION or URGENT NEED to go to the hospitals, patients should stay home and just have telemedical or online medical consultation.

What are the strong indications for going to the hospitals? Before answering this, take note of this advice first: if one is not sure whether there are strong indications or there is urgent need, do a telemedical or online medical consultation as soon as possible and let an online physician do an initial quick evaluation. The physician will advise whether there is a strong indication or urgent need to go to a hospital. He/she may even recommend which hospital to go to.

So, what are the strong indications for going to the hospitals for medical concerns?

The key answer here is the definition of MEDICAL EMERGENCY.

There are so many definitions of MEDICAL EMERGENCY, both from the perspectives of the physicians and lay people (patients). The perception or concept of MEDICAL EMERGENCY of the lay people (patients), most of the time, if not all of the time, also differs from that of physician.

Let’s resolve first the confusion between the lay people and physicians by giving more weight to the concept of MEDICAL EMERGENCY of the physicians, since after all, they are the experts.

Having said that, let’s now try to resolve the confusion among the physicians on the concept of MEDICAL EMERGENCY. At the very least, let’s try to come out with an operational definition that will be useful to the lay people in deciding whether there is a strong indication or urgent need to bring a patient to the hospital’s emergency room.

A definition of medical emergency by Free Dictionary:

https://medical-dictionary.thefreedictionary.com/medical+emergency

A medical or behavioural condition, the onset of which is sudden and manifests itself by symptoms of sufficient severity, including severe pain, such that a prudent layperson could reasonably expect the absence of immediate medical attention to result in:

(1) placing the health of the afflicted person with such a condition in serious jeopardy;

(2) serious impairment to the person’s bodily functions;

(3) serious dysfunction of any bodily organ or part; or

(4) serious disfugurement.

A definition of medical emergency condition by Medicaid (USA):

https://www.health.ny.gov/health_care/medicaid/emergency_medical_condition_faq.htm

A medical condition (including emergency labor and delivery) that manifests itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:

· Placing the patient's health in serious jeopardy;

· Serious impairment to bodily function; or

· Serious dysfunction of any bodily organ or part.

A definition of medical emergency in Philippine Republic Act No. 8344, August 25, 1997:

https://lawphil.net/statutes/repacts/ra1997/ra_8344_1997.html

A condition or state of a patient wherein based on the objective findings of a prudent medical officer on duty for the day there is immediate danger and where delay in initial support and treatment may cause loss of life or cause permanent disability to the patient.

A definition of MEDICAL EMERGENCY that integrates the above 3 definitions which makes it most comprehensive:

A medical or behavioural condition, including emergency labor and delivery, the onset of which is sudden and manifests itself by symptoms of sufficient severity, including severe pain, such that a prudent lay person could reasonably expect the absence of immediate medical attention to result in:

(1) placing the health of the afflicted person with such a condition in serious jeopardy;

(2) serious impairment to the person’s bodily functions;

(3) serious dysfunction of any bodily organ or part; or

(4) serious disfigurement.

A list of medical emergencies is shown below and can be used as a guide:

· Bleeding that will not stop

· Breathing problems (difficulty breathing, shortness of breath)

· Change in mental status (such as unusual behavior, confusion, difficulty arousing)

· Chest pain

· Choking

· Coughing up or vomiting blood

· Fainting or loss of consciousness

· Feeling of committing suicide or murder

· Head or spine injury

· Severe or persistent vomiting

· Sudden injury due to a motor vehicle accident, burns or smoke inhalation, near drowning, deep or large wound, or other injuries

· Sudden, severe pain anywhere in the body

· Sudden dizziness, weakness, or change in vision

· Swallowing a poisonous substance

· Severe abdominal pain or pressure

• Include emergency labor and delivery

Source: American College of Emergency Physicians – Warning signs of emergency

https://medlineplus.gov/ency/article/001927.htm

ROJ@20apr25