Emergency! What Now?
by Dr Nachiket Kulkarni

Emergency - the word itself heightens our awareness! It brings anxiety and worry as prominent emotions. The more important question though is a Are the emotions the emergency or the event itself?

The start of the article is controversial; i concede. It was important though to highlight this aspect. It's paramount that every patient of Rheumatic diseases should be aware of all potential emergencies he can be at risk at. These should be discussed with your Rheumatologist at the length and all contingency plans be ready. Please do ask your Rheumatologist about what could be the first aid measures that can be kept at hand. The common symptoms that herald an onset of an emergency more commonly in Rheumatology are as follows:

• Difficulty breathing or shortness of breath
• Chest or upper abdominal pain or pressure
• Fainting, sudden dizziness, weakness
• Changes in vision
• Confusion or mental status changes
• Sudden or severe pain
• Uncontrolled bleeding
• Severe or persistent vomiting or
• Coughing or vomiting blood
• Suicidal thoughts
• Difficulty speaking
• Unusual abdominal pain
• Gangrenous changes of finger/toe tips

I do concede one more point a you should have an access to your Rheumatologist at the time of emergency. Please ask your Rheumatologist what could that be. It might not necessarily be his PRIVATE NUMBER! Many times the Rheumatologist would inform you the hospital where he is attached and report there if any emergencies. Hospitals do have a code of treatment and channels to contact the doctor. In other cases he may delegate any of his assistants for the same whose contact details might be at hand. Please do confirm with your doctor beforehand. There might be events where you do not get time to contact your doctor and rush to any nearby hospital. Please always be aware of hospital that can cater to advanced medical needs in your vicinity. Always carry a copy of your ongoing medications whenever you seek any medical opinion. Once primary care is initiated, your Rheumatologist can be contacted. It would help if your Rheumatologist and treating Physician discuss and plan the treatment.

The other aspects are the troublesome features of Rheumatic Diseases which haunt our patients much more a like persistent pain, persistent symptoms for which doctor has initiated/changed treatment, medicine related side effects, other treatment requirements(tooth extraction, surgeries, etc), fever or likewise. These are not Emergencies. They cause lot of discomfort and emotional turmoil but they are not Emergencies. They need urgent attention but they are not Emergencies. Please discuss with your Rheumatologist what should be the mode of communication in such cases. Your doctor might have a help line number, ask to leave a message with secretary, e mail, good old days ways like letters or notes. It would be wise to use the methods as advised by your doctor.

One last issue which many patients treat as emergencies lead to waste of time for the doctor such as rechecking medicine timings , appointments, rescheduling appointments, tests (especially when you are in front of the pathologist), others... The only criteria for these to be emergencies is that they cause a lot of nervousness. Please do not use emergency contact channels for these requirements. As earlier ask your doctor where can these queries be resolved.

Doctor is your friend and a friend in need really. Doctors do sometimes share their 'Private Number'. Please use it only for emergencies. Your friend do has his private life and other patients to attend to. Every time you call your doctor you are utilising time that could have helped some other patient or disturb him while attending one. Many a times patients do have a valid complaint that they are not able to get to his/her doctor in time of need. Your requirement of a doctors time is most understood and it's the responsibility of your doctor to respond. This article though should be helpful to prepare you for the same. We should never land in a situation highlighted by the heading of this article but prepare beforehand with our Rheumatologist by asking a'If Emergency, What Then?'

PS: Doctors might be knowing you personally but it is impossible to remember details of your prescription or your diagnosis. Please always keep the prescription, a plain paper and pen at hand while calling your doctor. Do not make changes on prescription.