The Difference in Going to the Emergency Room With an Acute vs. Chronic Illness


Well, I have just had a revelation. I keep thinking about my asthma as if it was an acute illness! At some times it is acute. But, I keep thinking about eventually being OK, of recovering!

Perhaps this is 68 years of expecting medicine to be able to cure me. But with chronic illnesses, this just doesn’t happen!

My illness actually won’t be going away! But, I still keep thinking about it as if I am expecting to get well. That is the defining difference between an acute illness and chronic illness – the getting well and the not getting well.

Talk about finally seeing the elephant in the room! Well, that’s me! An acute illness has a “suddenish” onset and a short duration, e.g. breaking a bone, an asthma attack, getting the flu. Whereas a chronic condition is a long-developing illness or syndrome that doesn’t go away, e.g. asthma, fibromyalgia. Chronic illness isn’t easy to diagnose; its symptoms and treatment are likely to cause other symptoms  to occur. Thus, a chronic condition, because of its very nature, is very likely to be unrecognized or invisible when you front up to the emergency room.

Why did I suddenly become hyper-attuned to the elephant’s presence? Well, it was my experience at the emergency department here on the Gold Coast (Australia). I was having an acute episode of my chronic illness (asthma). Because it took so long to be seen, about 30-40 minutes from the time I left home, my symptoms had started to settle down. But, I was still in trouble. Yet, the emergency personnel were fairly dismissive of me. They even doubted I had a chronic illness at all!

 

Hospital emergency departments are really good at dealing with acute situations and acute illness. They can see every frightening aspect right there in front of them. I wonder if they are as good with chronic illness?My experience suggests they are not so good when it is chronic illness.

I may be judging them harshly and unfairly, but people with chronic illness usually do have an excellent understanding of their illness. Chronically ill people know their symptoms and know when they need medical help. They need to be listened to.

Instead, I was quizzed, asked how I knew I had an asthma exacerbation and hooked up to devices and told I was “probably having a panic attack as panic is so similar to asthma.” The doctor could detect no signs of “illness” and specifically, no signs of asthma! How amazing! I had to wait about 40 minutes in total, and I had already had 36 puffs of salbutamol. My asthma plan said at this point, “Go to the hospital.”

The problem seems to me to be procedural! You come in and have to tick all the boxes: medical history, allergies, what you have already done, why you have presented to emergency, blood tests, X-rays… I wish there was a way to carry a summary of your medical situation that could circumvent the acute medicine protocols and jump directly to dealing with the chronic condition! Has anyone else with a chronic condition had similar experiences at the emergency room?

Acute illnesses usually affect one area or system of the body and respond to treatment. In contrast, long-term or chronic illness frequently involves multiple systems and has an uncertain outcome. Acute and chronic illnesses are similar in that when dealing with any health problem, depending on the severity of the condition and the resources available, it can be very challenging for the sick person. Chronic illness usually requires more care and resources to maintain a positive lifestyle with more than one health professional involved. Acute illness seems to be much more visible. More visible to doctors, health professionals as well as family and friends. They seem to shunt the patient through the process in emergency and this process, from my experiences, is quite counter to the actual help the chronically ill person seems to be in need of.

With acute illness the doctor knows what to do once the diagnosis is made and a cure will mostly be effected. But with chronic illness, which often comes on very slowly and with a gradual increase in symptoms, diagnosis is never as easy nor as clear. I guess this same phenomenon occurs when you arrive at the emergency room with a flare-up of a chronic condition.

Chronic illnesses such as my asthma often have multiple causes. For example, with asthma, genetics can play a part as can lifestyle choices (smoking, lack of exercise, unhealthy eating habits). Environmental factors such as secondhand smoke or air pollution may also contribute to chronic illness. With so many different factors contributing to a chronic illness it can be difficult to find an effective treatment. My asthma took nine months to be diagnosed. There was a long list of possible contributing factors of which the specialist said there was no point trying to work out which one (or ones) it was.

Each chronic illness also has a set of symptoms caused by the illness itself, such as shortness of breath and fatigue due to asthma. In addition, there are also symptoms that are caused by other symptoms! For example, my shortness of breath requires the use of steroids which affects glucose metabolism and has now caused diabetes. Treatment of symptoms that then cause other symptoms can make treatment difficult and complex. Chronic illness may also end up producing frustration, helplessness and depression.

A trip to the emergency room where the staff do not acknowledge your chronic illness can be very dispiriting, very depressing, cause much anxiety and send you backwards with your ability to manage your symptoms. This is how it has been for me. Now that I see this elephant, I think I will carry a health summary with me and a plan from my GP. I will present these as well as my body! Maybe then I will get listened to rather than dismissed!

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Thinkstock photo via Spotmatik.


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