These are complicated times in medicine.
One of the most tangible and frustrating outcomes of the COVID era has been that large hospitals are full to capacity. This is partly because of those infected with coronavirus. However, it’s a complex problem, which is also the result of lack of staff and because we didn’t really plan for an event like this over the last decades as hospitals were being built and professionals trained.
While the staff in large hospitals do their best, there are other problems downstream from those centers. Specifically, small hospitals can have extremely sick patients who need to be transferred to specialists, but there aren’t beds in the bigger centers. This means that folks with very complicated problems can lie in small hospital emergency rooms, intensive care units or wards for days to weeks waiting to go to a place where they can have the specialty consult or high-tech procedure they need.
For instance, a patient who is on chronic kidney dialysis may miss a day or two and go to his local community hospital one evening only to find that he has a dangerously high level of potassium. However, the local facility can’t do dialysis, and he has to wait until a bed opens up in a larger hospital for transfer. This can take days and can be dangerous.
A patient with a pacemaker or defibrillator may have a complication and need a cardiologist. However, most small hospitals don’t have cardiologists.
Even those who have surgeries in large hospitals and go home to their communities can face troubles. They may have infections or complications, but the place where the procedure was done and their surgeon practices can’t take them back.
This is complicated by the fact that ambulances for transfer are sometimes hard to find because their paramedics are busy transferring critically ill patients, sometimes hours away. So if someone has a known, complicated medical problem that requires a specialist, it’s generally best to go directly to the ER in the place where that specialist practices or where that procedure was done.
It is easy to watch medical dramas on television and assume all hospitals have the same things, but they simply don’t, and we have to adapt to that.
Mind you, if a patient is having altered consciousness, high fever, chest pain, trouble breathing, abdominal pain, passing out, stroke-like or other serious symptoms, they should go to the first hospital they can find. But if there’s time, if it’s not emergent, one should probably just go to the hospital with the greater resources.
Before going to a hospital, it is increasingly a good idea to make sure of what resources they have, and what they don’t. Otherwise it can be a long, perilous wait for the care one needs.