As an emergency room physician with 20 years of experience, I’ve witnessed countless moments where patients come to the ER not because their symptoms demand urgent care, but because they lack understanding about their own medical conditions. These are not isolated incidents—they’re a systemic failure in communication that contributes to patient distress, health care inefficiency, and physician burnout.
This week alone, I had two particularly heart-wrenching encounters:
A 65-year-old man with metastatic lung cancer, convinced his shortness of breath was just pneumonia. When I explained the progression of his disease, he was shocked. No one had told him that his cancer was likely incurable.
A 97-year-old woman brought in for “failure to thrive.” She was frail, pale, and not eating—classic signs of the final stages of metastatic cancer. When I suggested hospice care, she seemed blindsided, as if this reality was completely new to her.
Both cases highlight a troubling trend: Patients often come to the ER not just for care, but for clarity. They don’t understand their diagnosis, prognosis, or treatment plan. And too often, these difficult but essential conversations—discussing terminal illnesses, setting expectations for recovery, or explaining post-operative symptoms—are deferred to the ER doctor, long after the opportunity for thoughtful, proactive communication has passed.
Why aren’t specialists having these conversations?
As an ER doctor, I’ve wondered: Why aren’t specialists addressing these issues before patients leave their care? Are the conversations happening but in vague or clinical language that patients can’t process? Are specialists relying too heavily on patients’ ability to retain information during stressful moments, or assuming that someone else—perhaps their primary care doctor—will pick up the slack?
I’m not here to point fingers. I know how demanding and time-constrained specialty practices can be. But I also know the consequences when communication fails. I see it every day:
- The post-op urology patient terrified by blood in their urine—a normal part of recovery they were never warned about.
- The cancer patient shocked to learn their disease is terminal because their oncologist never explicitly said so.
- The family unprepared for end-of-life decisions because they weren’t told hospice was an option before their loved one became critically ill.
These are more than communication breakdowns; they’re breaches of trust. They leave patients feeling abandoned and erode confidence in the health care system. And they funnel preventable visits to the ER, burdening a system already at its breaking point.
The ER as the catch-all—and the toll it takes
When specialists avoid these conversations, the responsibility often falls to ER doctors. But the emergency room is not the ideal setting for discussions about prognosis, palliative care, or recovery timelines. These conversations require time, sensitivity, and follow-up—luxuries we rarely have in a busy ER. Yet we take them on because someone has to.
For ER physicians, this is another layer of the emotional labor that contributes to burnout. We didn’t go into emergency medicine to manage the aftermath of poor communication. We are here to stabilize, treat, and save lives—not to break devastating news to patients who should have heard it long before they walked through our doors.
A call to action for specialists
This isn’t just about improving patient care—it’s about preserving the humanity of medicine. We owe it to our patients to be transparent, compassionate, and thorough in our communication. Here’s what I’m asking of specialists:
- Have the hard conversations. If a patient’s prognosis is poor, tell them. If a surgery has normal but alarming side effects, explain them. Don’t assume patients understand their condition just because you do.
- Check for understanding. Medical jargon can be overwhelming. Take the time to ask, “Do you have any questions?” or “Can you tell me in your own words what you understand about your diagnosis and treatment?”
- Provide clear instructions. Discharge summaries should include what symptoms are expected, what’s concerning, and when to seek help. Proactively addressing common questions can prevent unnecessary ER visits.
- Coordinate follow-up care. Ensure patients know who to contact for questions or concerns after they leave your office. Patients who feel supported are less likely to turn to the ER for reassurance.
A shared responsibility
The burden of communication should not rest solely on specialists—primary care doctors, ER physicians, and the health care system as a whole have a role to play. But as the experts managing complex conditions and procedures, specialists are uniquely positioned to set the tone for a patient’s understanding and expectations.
Better communication won’t just improve patient outcomes; it will strengthen the patient-provider relationship, reduce unnecessary strain on the health care system, and alleviate some of the emotional weight ER doctors carry every day.
Because at the end of the day, patients deserve more than the best medicine—we owe them the best humanity. And it starts with a conversation.
Pamela Buchanan is a board-certified physician, speaker, and thought leader dedicated to transforming health care and championing mental well-being. With more than 20 years of medical experience, she is a TEDx speaker known for her powerful talk on “Emotional Flatline,” which explores the emotional toll of high-stress professions, particularly in emergency rooms during the pandemic. As the author of The Oxygen Mask Principle and Emotional Flatline, Dr. Buchanan teaches self-care as a revolutionary act for working mothers, health care professionals, and high achievers.
In addition to her work as a physician advocate and ambassador with the Lorna Breen Foundation, her work extends to coaching and consulting, focusing on helping physicians navigate burnout and preventing burnout in medical students and residents. She strives to keep more physicians practicing. Dr. Buchanan’s mission is to help people break free from burnout, prioritize self-care, and live with purpose.
Dr. Buchanan is the founder of Strong Medicine and can be contacted for coaching, workshops, and speaking engagements. She can also be reached on TikTok and Instagram.
