What to Know about Going to the Emergency Department with Dr. Alexis Halpern

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

No matter how severe the illness or injury, ending up in the emergency department of a hospital can be a stressful experience. But one way to ease our nerves is knowing what to expect during a visit to the ED.

This week, I spoke with Dr. Alexis Halpern, an Emergency Medicine physician at NewYork-Presbyterian and Weill Cornell Medicine — and a close personal friend. She gave us an inside look into the emergency department, including how to tell if a trip to the ED is necessary and how to have a more efficient visit.

Faith: Dr. Alexis Halpern, thank you so much for joining me.

Dr. Halpern: Thank you for having me. Faith.

Faith: So I am not going to call you Dr. Halpern, I don’t think, because it feels funny. I’m probably gonna call you Alexis or even Lex because you are one of my best friends for, I think it’s almost 15 years. You have danced at my wedding.

Dr. Halpern: I have.

Faith: You held my hand when I gave birth to my first baby, my son, at NewYork-Presbyterian.

Dr. Halpern: Your hand—and your knee.

Faith: I don’t know what you held, but thank you. I spent one of my most memorable Memorial Day weekends in your care in the ER.

Dr. Halpern: It’s been a road for us, right?

Faith: It has, and what I love about the chance to talk to you today is that I, I know so many things about you, but I wanna have a conversation that involves questions I’ve never asked you. Would you describe your day-to-day work in the emergency room? I mean, presumably it’s different every day, but what is it like generally to be an attending ER doctor?

Dr. Halpern: Well, that’s an interesting question because people always think that if you’re in the ER you’re constantly dealing with gunshot wounds and car accidents and major heart attacks. And there are those things which happen sometimes, and sometimes they happen a lot and sometimes they happen all at once, but a lot of times it’s abdominal pain and chest pain. And my ankle hurts, and I have a headache, and it varies every day.

We have four different areas in our emergency department. It’s very large, which people often don’t know when they’re there. Really it’s spanning the entire building. And I work with a team that includes residents, that includes PAs, meaning physician assistants, nurse practitioners.

I mean, the day really is just: see a patient, talk about the patient, make a plan, move on to the next patient, talk about the patient, make a plan, go back to the prior patient, follow things up, talk to the patient again. And it’s just a, a cycle of replay, replay, replay.

Faith: It sounds breathless and exhausting and maybe even a little exciting.

Dr. Halpern: Yes, yes, and yes.

Faith: What is the difference between an ER and urgent care?

Dr. Halpern: An urgent care center, which is, say anything that you see outside of a hospital, a freestanding place, that’s where they’re dealing with minor type injuries. You go there if you have a cold, you go there if you cut your finger, you go there if you twisted your ankle. Things that are potentially more serious: you’ll be seen in an emergency department, and we call it an emergency department now—as opposed to an emergency room or an ER—because we do have an urgent care area of our department.

Faith: Okay, so should all of us be calling it an ED? Is that what you call it instead of an ER?

Dr. Halpern: Yes. We call it the ED.

Faith: Oh! So what should we expect when we get to the ED, step-by-step?

Dr. Halpern: If you come in via ambulance, you’re gonna get checked in by a nurse. They’re gonna take your vital signs. Sometimes they do an EKG right away, and if you come in through the walk-in, you’re gonna stop at a registrar, you’re gonna go right into a chair where you’ll take your vital signs and there’s a nurse there. There’s usually a physician assistant or nurse practitioner who’s gonna have an initial conversation with you so that they can get things started right away. To order things that it’s very obvious you need right off the bat: a chest x-ray, an EKG, some blood work, a urine sample, things like that. There’s often actually a physician, one of—myself or one of my colleagues up there to talk to you as well. So if something is really emergent and needs to get whisked into our sort of our real, real emergency room, like the room that we take care of those things, you can get whisked right in there. So you’ll see someone right away in that case.

Faith: How do we know when we should come into the emergency department?

Dr. Halpern: Well, I would say things that are very severe, like severe chest pain, like severe abdominal pain, and you’re vomiting, like you’re bleeding and you can’t stop it after you’re holding pressure, you’ve passed out, somebody’s fallen, they can’t get up by themselves. Um, a lot of people come in with just back pain where they truly can’t move—things where you, you realize that there’s just no way you’re going to be able to take care of this at home.

I think that a lot of times when there’s a question of do I need to go to the emergency department? Especially if you know your doctor, if they really know you and know your case, to ask them if it’s something that they could be seen for in the next day or two, if there’s something that they could try at home, or if they really needed to come in and see us right away.

NewYork-Presbyterian has a virtual urgent care, which is a really cool option, um, where you can actually go onto an app, and arrange for a virtual urgent care visit, between 8:00 AM and midnight. When you call on the virtual urgent care, you make an appointment, and you have a 15 minute slot for you.

A lot of times people use that for the same things they’d use in urgent care for. And sometimes people, when they call in, they really do need to be sent to the emergency department. People sometimes call to say, “Do I need to go to the emergency department?”

And that’s a really good way to figure it out. People calling with chest pain, more often than not, I’m gonna say to go in, but there are certain things that we can say, you know, let’s try this, and I think you can wait and call your doctor, or maybe I’ll send a message to their doctor and we’ll figure out how to handle certain things without them having to go in, in person.

Faith: Does a virtual urgent care option, does that count as a doctor’s visit?

Dr. Halpern: Yes, it does. So if you make an appointment with us, there is a charge. You can put it through your insurance and if you see me, it’s like seeing any other doctor in an office setting. So it is an official doctor’s visit that is considered by your insurance company to be a visit.

Faith: For in-person ED visits, how long will someone wait to be seen? What are the factors that go into that?

Dr. Halpern: How long you would wait to be seen really depends on what’s going on with you and what else is going on. So there’s not one straight answer for that. When you come in, you’ll talk to a nurse, you’ll be triaged. So vital signs play a big role in triage. Your medical history plays a big role in it. Oftentimes things are ordered for you in advance, so a nurse from that area will probably come over, start talking to you, draw some blood work if that’s what was ordered. Sometimes people get whisked away for radiology that was ordered from triage before we’ve even had a chance to talk to them.

Like I said, it’s a team. So you’ll speak to probably a resident or a physician assistant or a nurse practitioner. You may also speak to a senior resident after that. And then you will typically speak with an attending afterwards—attending being the head doctor.

As far as how long is everything going to take? You may have to wait for probably no more than 15 to 30 minutes in our waiting room unless it’s really crazy. And it all has to do with how many people are in each bay. And really safety factors as to where we’re gonna put people, where is there space. There is definitely an idea of an emergency department that you’re going to wait for, you know, 12, 14, 16 hours for everything to be done. There is a wait. Not everything is gonna take that long.

Faith: What should a patient or their loved ones be prepared to bring before coming to the ED?

Dr. Halpern: It’s really important to have a medication list for the patient. It’s really important to have a medical problem list to know what their medical problems are, if they’ve had any surgeries, if anything has changed recently, to have the doctor’s name and phone number is really helpful because all of those things help us to be able to take care of people faster.

Faith: That’s really helpful. So that’s something we should know about ourselves. The names of our doctors, the medications. We’re taking our own history, and then the people who care for us should also either know that or have access to someplace where we’ve written it down.

Dr. Halpern: Absolutely. Some, a lot of people, actually, I love this. They come in these, these, you know, 90-year-old people and they go into their wallet and they have a tiny little folded up piece of paper that has all of their medications and doses on it, and when they take it, and it’s brilliant. This is just like a tiny little tip for people who have any kind of heart disease. Sometimes people make a tiny little copy of their EKG like that so that they can say, “This is what it normally is.” All of that kind of information is helpful for us.

Faith: You know, for many people, coming into the ED is one of their worst days. And if they’re not getting answers right away, they might understandably feel frustrated or even ignored. Can you tell us what is happening from your point of view while a patient is waiting?

Dr. Halpern: I want everybody to know that they are never being ignored. We’re talking about you, we’re ordering things on you. We’re calling people about you. We’re checking up with radiology about why it hasn’t been done yet. We’re calling the lab to make sure that things are there. We’re reviewing the information and it might not be until that time that we really come back and have another conversation. And what I can say is I’m sorry that it feels like a long time but please don’t ever feel ignored because there are so many things going on like, behind the scenes that you’re not seeing that have to do with your care. We wanna take care of you. That’s why we’re there.

Faith: Yeah, that’s so important for people to know to, to let them breathe and their loved ones breathe easier.

Dr. Halpern: Yes. And I think sometimes we would love to have the, the opportunity to just walk around the entire emergency department and pop our heads in and say, “This is what’s happening for you. This is what’s happening for you.” Actually, if I’m walking by someone and I see them, I say, “Oh, this is where we are with that, and this is what we’re waiting for.”

Please don’t ever think that because somebody is addressed before you are, it means that your problem is not a concern to us. We’re surprised all the time by things that we thought were gonna be minor and turn into something else. We’re always doing our best to get things done for you as quickly as we can.

Faith: Dr. Alexis Halpern, thank you for being someone who chooses to show up for people on what’s often their worst day or their scariest day. And you’ve done this for decades, including for me and my family. So thank you for talking with us today.

Dr. Halpern: You’re very welcome. Thank you for having me.

Our many thanks to Dr. Alexis Halpern

I’m Faith Salie.

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