Patients staying home instead of going to ER

Wishful thinking ‘not a valued therapeutic’

In a normal week when the world is open, emergency medicine practitioner Dr. Kari Sampsel can expect to see about 17 or 18 victims of partner violence, sexual assault or both coming through the Ottawa Hospital’s ER.

“Some days are busier than others,” the medical director for the hospital’s sexual assault and partner abuse care program said.

“Sometimes you get lots of patients. Some days you get none.”

But spread over time, they always come, week after week, year after year — until COVID-19 hit, and they largely disappeared.

“Our volumes are way, way, way, way down,” Sampsel said. “And when we speak with people across the province, everybody is seeing the same thing.”

Across Canada, emergency rooms remained remarkably quiet this week, according to doctors working in several provinces. They’re seeing fewer trauma patients. They’re sewing fewer stitches. They’re treating less and less of the minor ailments that often plague a busy ER.

On one level, that’s a good thing, doctors say. It means they have more time and more resources to dedicate to staying safe and fighting COVID-19. But the flip side, many doctors worry, is that patients who do need urgent care are now delaying or putting off treatment entirely because they’re afraid of coming in to the hospital.

“I usually go through an ER shift where I’m seeing 10 people with chest pain to rule out a heart attack,” said Dr. David Carr, who practices emergency medicine in Toronto. “(Now), I’m not seeing anyone.”

It isn’t just heart patients, either. Overall ER volumes in Ontario are down anywhere between 20 and 50 per cent, depending on the hospital, Carr said. Doctors are seeing fewer stroke patients, fewer patients with appendicitis. In Vancouver, Dr. Daniel Kalla, the head of the emergency department at St. Paul’s Hospital, is seeing fewer opioid overdose patients, even as the number of overdose deaths in that province continues to climb.

“The issue is, where the f-are all these patients?” Carr said.

There is nothing to suggest there are somehow fewer heart attacks happening in the community, or that social isolation is a miracle cure for appendicitis.

Instead, doctors believe, patients who are afraid of contracting COVID-19 are just waiting and getting sicker.

Patients who two months ago might have come in with chest pain are now waiting and arriving with permanent heart damage. Opioid users who would normally be getting high with friends may now be overdosing in isolation.

“That’s a definite fear of mine,” Kalla said.

For all kinds of vulnerable people — drug users, the mentally ill, the homeless — emergency rooms are a haven of last resort.

They are also where most victims of intimate-partner violence — as many as 85 per cent of them, according to Sampsel — first surface into the medical system. And right now, that’s not happening.

“We are seeing way lower volumes than we normally would be for both sexual assault and domestic violence,” she said.

Sampsel doesn’t believe that’s because less violence is occurring. “I think (victims) are staying at home and suffering, unfortunately,” she said. “I can’t imagine that the pressures of an abusive relationship are gone because we’re sheltering in place.”

Sampsel wants to get the message out to anyone experiencing violence at home that emergency rooms are still open in Ottawa, and across Canada, and that they’re safe.

“It’s really important for people to know that we’re available,” she said.

ERs have the tools and the systems in place to connect victims with the supports they’ll need to get a new place to stay, to reach out to the police or even just to get medical care.

THE ISSUE IS, WHERE THE F--- ARE ALL THESE PATIENTS?

“We are that port in the storm for everyone,” Sampsel said.

“For patients who are running out of a dangerous situation right now — and that happens at anytime of the day — we’re always open. The lights are always on.” That’s as true now, in a pandemic, as it was before.

Carr believes that same message needs to be getting out to anyone experiencing a medical crisis right now. “The ones with symptoms: You need to get your ass (to the ER),” he said. "Because you can’t delay the rule-out heart attack, the rule-out stroke, the severe abdominal pain. You can’t use wishful thinking. That is not a valued therapeutic.”

He understands why patients would be hesitant to go in right now. COVID-19 is scary. But he said he feels safe going to work and he thinks patients should too. “Patients are screened, people are isolated, physicians and nurses are wearing the appropriate equipment,” he said.

He knows there are patients and victims out there, suffering. He wants them to know they can and should come in to the ER. Because right now, he’s not seeing them and neither are his colleagues.

“We’re basically seeing catastrophic illness and then COVID,” he said. "But the question is where is everyone else?