Physician’s Assistants Help Cut Costs in the Emergency Room

Due to increased need for all aspects of health care to cut costs, emergency rooms are relying more and more on the services of what are called physician’s assistants, (PAs.) PAs can diagnose and treat patients, and their lower cost can help keep the price of running an emergency room down while helping to speed up the turnaround time for patients.

Until recently most PAs worked in family practice medicine. However, between 1996 and 2008 the percentage of PAs working in this area decreased substantially from almost 40% to only 26%. The decrease is attributed to the move of PAs from family practice to emergency room practice as their presence in the emergency room became more accepted while patient use of emergency rooms went up during the same period by 32%.

Patients should always be aware who is treating them, and whatever diagnosis that is made should be verified with a staff physician.

Josyann Abisaab, MD is an emergency room physician practicing in the Columbia Presbyterian Medical Center in New York City.

Josyann Abisaab: The Most Common Reasons for Going to the ER

Symptoms of a Heart Attack

Sometimes it’s necessary, and sometimes it’s not, but it is certainly true that almost all of us have been to the emergency at one time or another. Maybe it was a broken leg, or the fear of one. Perhaps it was a poisoning or a burn. Whatever it was, we are certainly glad for the existence and accessibility of the ER, and we all want them to run as efficiently as possible.

Unfortunately many times people just don’t know the difference between a good reason to go to the ER, and a “not such a good reason” to go. The more people can tell the difference, the better the emergency rooms can service their patients.

Here are the five most common reasons people go the ER, whether they are good reasons or not.

1.    Stomach pain, cramps, and spasms- Severe stomach pain can be frightening. It is no wonder that this is the most common reason for visits to the ER. Stomach pain can also pose a more serious danger than simple food poisoning, so this is a reasonable reason to visit the ER.

2.    Chest pain and related symptoms- Since chest pains can mean the possibility of having a heart attack most people rush to the ER if they have this symptom.

3.    Fevers are the third most common reason for trips to the ER, but on the first day of a fever this is almost always not necessary. There are many reasons for people to exhibit a fever, from too much stress or even bad weather. However fever can be a sign of danger if it is already the third day of a fever which has not returned to normal, or if the fever is very high.

4.    Cough-There are many reasons a person can develop a cough, but almost always the cough is harmless, meaning that it does not present a threat to life in and of itself. Although coughs should definitely be checked by a doctor, especially persistent coughs; there is almost never a reason to go to the ER to do this. Just make an appointment with your doctor. An exception is if the cough is combined with blood or other symptoms. Then off to the ER with you.

5.    Headache- Head pain can be quite severe, and if it is people will go to the ER to get quick relief. But if your headache is not a recurrent symptom, it is most likely just a plain headache. Another thing to note; doctors can not treat a headache fast. If the only symptom is the headache, the doctor will want to run some tests to determine what is wrong.

Dr. Josyann Abisaab is an emergency room physician at the New York Presbyterian Hospital.

Asthma in Children:Josyann Abisaab

Often children with asthma sometimes find themselves in the emergency room where an emergency room doctor, such as Dr. Josyann Abisaab will treat them for the difficult breathing asthma sufferers experience.

Although the underlying cause of asthma is unknown it often runs in families. What happens is that certain substances which the person with asthma is sensitive to, such as dust, smoke, or animal fur irritate the lining of the bronchial tubes causing the production of phlegm, which blocks the air passageway. The increased level of mucus (phlegm) makes breathing difficult, causing the main symptom of asthma.

View this video to learn a bit about how asthma is often treated and which inhaler is right for children.

When is High Blood Pressure an Emergency?

There is no exact number which determines that someone with high blood pressure should go to the emergency room or dial 911. However, if there are other symptoms accompanying the high blood pressure reading, including severe headache with no known cause, back-pain, severe chest pain or impaired or blurry vision, or any other type of symptom connected to brain function, it is probably a good idea to go the emergency room or call 911.

Normal blood pressure readings are around 120/80. If you experience blood pressure where the systolic (first) number is at or above 180, or the diastolic (second) number is above 110, you should probably have it checked by a physician. If your instincts have a bad feeling about it, or its accompanied by any other symptoms, it is probably a good idea to go to the emergency room where a qualified emergency room doctor like Josyann Abisaab can check you and make a proper diagnosis.

ER Blood Tests: Dr. Josyann Abisaab

An informed ER patient is one who has a basic understanding of the workings of the emergency room, and so can better appreciate the complex and wide range of medical care that is provided. ER physicians, like Dr. Josyann Abisaab, explain that a visit to the ER frequently involves one or more blood tests, which helps the ER team to accurately diagnose the source of the patient’s symptoms.

When a blood test is performed, the patient’s blood is placed into different colored tubes, each with a specific additive that relates to the test in question. A CBC (complete blood count) test uses a purple-top tube. The CBC measures the numbers of each of the three types of bloods cells: red blood cells, white blood cells, and platelets, in order to help diagnose specific illnesses and health conditions. A serum (the liquid/non-cellular part of the blood) test uses a tube with a red top, while a blue-top tube is used to test blood clotting.

When to Visit the ER

People often make the mistake of going to the ER when their condition is not an emergency. Not only is this a waste of time and money, it also causes stress and unnecessary disorder in the emergency room. Doctors such as Dr. Josyann Abisaab recommend that you think objectively about the condition you encounter, before making that decision. Here is a general list of symptoms which may need to be dealt with in an ER:

  • Loss of consciousness
  • Poisoning
  • Signs of a stroke such as numbness or sudden weakness in one side of the body such as in the face, an arm or a leg; sudden loss of vision, especially in one eye; loss of speech, trouble talking or understanding; sudden memory loss; unexplained dizziness or sudden falls
  • Serious traumatic injury (to the head, for example)
  • Instant, severe, inexplicable pain
  • Bleeding which does not cease after ten minutes of direct pressure
  • Signs of a heart attack such as a feeling of pressure, squeezing, fullness or tightness in the chest for over two minutes; burning or aching under the breast bone; chest pain accompanied by lightheadedness
  • Sudden severe/ persistent vomiting

Traumatic Brain Injuries from Basketball Increasing: Dr. Josyann Abisaab

A new study published recently in Pediatrics highlights that more children and teenagers are suffering traumatic brain injuries while playing basketball.  Taking a ten year range from 1997 to 2007, researchers looked at visits to emergency rooms like the one where Dr. Josyann Abisaab works.  They found that, for people under the age of 20 treated for basketball related injuries, the number of traumatic brain injuries had shot up by 70%.

Overall, the traumatic brain injury proportions doubled for boys and tripled for girls during this time, said senior study author Dr. Laura B. McKenzie.

Certainly, doctors like Josyann Abisaab, researchers and centers like the Brain Trauma Foundation encourage coaches, athletes and parents to understand what causes traumatic brain injuries and to recognize the signs of a possible concussion.

Learning about Lyme Disease: Dr. Josyann Abisaab

Lyme disease is an infection which is often misunderstood by parents and misidentified by the health community.  One of the reasons for the confusion is that Lyme disease manifests in many different ways in the body.  Another reason is that it varies so widely from state to state.

The most classic symptom of Lyme disease, and the one that most doctors like Dr. Josyann Abisaab, will ask you about is a rash.  The circular rash occurs at the site of the tick bite approximately 7-14 days after the initial bite. The rash actually resembles a bulls-eye.  Other symptoms are commonly flu-like symptoms including fever, muscle aches, chills, headache, fatigue and joint pains.

Unfortunately, when Lyme disease goes untreated, it can cause many problems including continued fever and fatigue, swollen glands, pink eye, aseptic meningitis, Bell’s palsy, arthritis and concentration problems.

If you live in an area where Lyme disease is more common, like in the Northeastern area of the United States, and you are exhibiting these types of symptoms, you should seek attention from a medical professional.

Josyann Abisaab on Protecting Your Children from Falls

One of the main reasons that children end up in the E.R. is because of falls. The more precautions you take in the home, the less likely it will be that you’ll experience a dangerous fall. For very small children, this means never leaving a child unattended on the bed, sofa or changing table.

Advice on Small Children & Falls with Josyann Abisaab

Once your child is between 6 and 12 months old, make sure that all furniture is away from windows so that they can’t climb up on the furniture and fall out of the window. Put window guardrails on all second-story windows and above. Obviously, one of the most tragic things that emergency room doctors like Josyann Abisaab see is children who have fallen from windows in the home. Make sure to put safety gates at the top and bottom of each staircase.

Older Children & Falls Advice with Josyann Abisaab

Finally, for slightly older children, make sure to keep the stairways clear so that no one trips over toys, clothing and other items. Also place rubber pads under any loose rugs so that they don’t slide across the floor and cause accidents.

Josyann Abisaab on Children’s Health Care

Children’s Health Care: Is it an Emergency?

Certainly, there are times when a child gets hurt badly enough that you know they need to go to the emergency rooms. There are other situations, however, that aren’t as clear cut.  During these times, you have five main options.

You can handle the problem at home.  Minor illnesses and cuts, some rashes, minor coughs, colds, bruises and the like can all be handed with over the counter treatments and love.  If you aren’t sure what your child needs, you can always call your primary care physician.  The doctor or nurse can help you to figure out what steps need to be taken.

You can always visit an urgent care center if you have a non-emergency at night or on the weekends.  You can usually have X-rays taken, have stitches done, and have care for minor injuries that require medical attention but that aren’t life threatening.

The last two actions are more extreme and they include visiting the ER where emergency room physicians like Josyann Abisaab will care for you, or calling 911.  Many serious conditions require a visit to the emergency room including head trauma, dehydration, meningitis, breathing issues and more.  Sometimes, you may feel that you need the help immediately and that you’ll need the help on the way to the hospital. In this situation, it’s best to call 911 and to get the care that you need immediately.

Josyann Abisaab on Chest Pains

Chest Pains: A Leading Cause of Er Visits

Josyann AbisaabAccording to AHRQ News and Numbers which is based on data in Emergency Department Visits for Adults in Community Hospitals from Selected States, 2005, chest pains are one of the leading reason that people visit the emergency room.  Chest pains that did not appear to be a heart attack upon examination accounted for 1.6 million visits in 23 states in 2005.

The top four reasons to visit the emergency room, as reported by this study were: sprains and strains (2.4 million visits), bruises and superficial injuries (2 million), abdominal pain (1.7 million), and then chest pains at 1.6 million.  In less than 5% of the cases, the patient was actually admitted to the hospital.

Five additional conditions that were seen a great deal by the emergency room were: back problems (1.4 million), leg and arm open wounds (1.3 million), headaches (1.2 million), nose and throat infections (1.1 million), and skin infections/urinary tract infections (1 million).

Josyann Abisaab on Emergency Room Overcrowding

In an interesting study in 2008, Dr. Manya Newton, an emergency room physician at the University of Michigan, and others, authored a paper explaining some of the reasons that emergency rooms are so overcrowded.  While many of us make the assumption that the uninsured are coming to the emergency room too frequently for non-essential visits, they found this to be a myth.  They found that, while 17% of the people in American were uninsured at the time, they only accounted for 10-15% of the visits to the ER.

One factor that they did find to explain the overcrowding is that the population at large is getting older and sicker.  More people are legitimately coming to the ER for real emergencies.  In addition, with fewer primary care doctors available, it’s harder to get an appointment.  If you call your doctor’s office and are put off, you might consider going to the ER instead.

These are a few of the interesting findings that these emergency room doctors reported.

Josyann Abisaab on ER Follow Up

When someone has been in the emergency room for care, they often don’t bother to follow through afterwards.  They might be happy to be feeling better the next day, or they are exhausted from their ordeal and don’t have the energy to follow through.  The follow through, however, is as important as is the emergency room care itself.  What does this mean?

Usually, when you are discharged from the emergency room you’ll be given follow-up instructions from the doctor.  You’ll often receive a written summary of how you should continue your care, when you should visit your primary care physician, what you should do if symptoms return, and more.  Before you leave the emergency room, make sure that you understand all instructions that the doctors and nurses give to you.  Don’t leave feeling that you still have questions that haven’t been answered!

Then, make sure to follow through.  Go and see your primary care physician the next day to give them the paperwork from the emergency room and to have them follow your care.  Get your prescriptions filled and take the medicine that the emergency room has recommended.  Pay attention for recurring symptoms, and more.  Just because you’ve left the emergency room, and the emergency doctor’s care, doesn’t mean that you shouldn’t continue to be careful about your treatment and your follow-up care at home.

About Dr. Abisaab

Doctor Josyann Abisaab Dr. Josyann Abisaab is an Assistant Attending Physician at New York Presbyterian Hospital in New York City. In addition, she is an Assistant Professor of Clinical Medicine in the Department of Internal Medicine at Weill Cornell Medical College in New York City.  She has held both of these positions since 1992.

Educated at the American University of Beirut in Lebanon where she received a Bachelor’s of Science Degree, Dr. Abisaab went on to complete her medical degree at the University of Rochester School of Medicine.  Her numerous academic honors included receiving the Janet H. Glasgow Memorial Achievement Citation and being part of the Alpha Omega Alpha Honor Society.

She is board certified by the American Board of Internal Medicine, the American Board of Emergency Medicine and by the State of New York. She is affiliated with the American College of Emergency Physicians (ACEP), the American Medical Association (AMA), and the American Board of Emergency Medicine (ABEM).

Dr. Abisaab, along with N. Nevadunsky and N. Flomenbaum, published an article which appeared in the November, 2004 issue of the Annals of Emergency Medicine: “Emergency department presentation of bilateral carotid artery dissections in a postpartum patient”.