Reasons for leaving the emergency department without being seen or against medical advice, with example quotes
| Reason | Quote |
|---|---|
| Stereotyping | “This doctor didn’t even know me. First thing he asked me was how much have you had to drink? What? I got up and walked out. I was so pissed off, like, I walked out, and I went to [rural hospital 5].” (SC1_04) “I’m going to speak on my own past experiences. A few years ago, I rolled my own vehicle, I was travelling late. By the time I got to the emergency, I was feeling dizzy. Instead of doing the proper evaluation, they brought in an addictions counsellor. They thought that I was on drugs or something in the waiting room. I asked them, ‘Who are you?’ They told me and asked if I am on anything. I never do that stuff. That’s not why I’m here. They locked me in the back. So, I said I don’t need that kind of treatment if that is all you can provide here, I need to see an actual doctor. So, as I was walking out of the emergency, my usual doctor, I have a family physician, seen me, and he knows I don’t go in, so he came up and he asks, ‘What’s going on?’ I rolled my vehicle on the highway, my head, and so he evaluated me right there and he says, ‘You have a concussion’.” (SC3_08) |
| Discrimination | “A lot is racism, in our area. And the lack of professionalism at times. We’ve had to have clients leave the hospital in [rural hospital 3] and [rural hospital 4] area and take off to a different hospital when they’ve had very sick children, because of the quality of care and attitude they were receiving. So we’ve had one that could’ve, well we’ve had a few that could’ve died if they didn’t go to a different hospital. And then they get flown out to Edmonton or Grande Prairie. And we’re dealing with the racism issue and the hospital is well aware of it and they are trying to fix that.” (HD19) |
| Overhearing racism | “I saw a girl who was First Nations who had abdominal pain and I was thoroughly convinced she had appendicitis. … And the physician who I was working with…was running her mouth about “Indians” like going on like a big racist rant. Like out loud at the nurses’ station in the emergency department. And the patient was in a bed that was just kitty corner to the desk and she can hear what was going on and she got up and she took the IV out of her arm and she was bleeding on the floor. … And she left. And I said to her, ‘Can you please go to another hospital? Like please, I understand why you’re leaving but please go somewhere else, you need to receive care’. And I don’t know what happened to her.” (P7) (60) |
| Long waits | “You go into emergency and its hours, people will end up leaving.” (SC3_06) “They are often left for hours waiting. It’s almost like they’re put somewhere to wait it out. And they wait and they wait and they wait. And like, I’m not quite sure what to say. But they’re basically left waiting so these people get frustrated and they walk out because they don’t feel important enough to be seen. … It can lead to different health repercussions.” (HD_18) “Sometimes it’s the patience and it’s individual, they don’t have patience to be waiting on a stretcher for 1 to 2 days. They don’t understand that there’s no beds available. They may feel ignored and not attended to.” (Cultural liaison) “We had a patient who started to get, uh, infection in the skin of his leg and he got a fever. Um, and then he, it turned out that he actually had HIV and [he] wasn’t on medications and we’d somehow missed that. And he hadn’t said anything. So I was thinking, well, this is really bad. Like he needs to go in right away and they need to see him. … I assumed they would see him right away, because this is an at-risk person. We got him stabilized on a medication. He wasn’t withdrawing, he wasn’t aggressive. He was fine. He was there for help. But he’s out there for 6 hours all by himself until he finally got tired of it and left and just went AWOL in [rural town]. And I’ve never seen him again. I don’t even know if he’s alive. So that was a huge missed case for something that was really serious. And I started to understand, like, there’s no point in sending people there. This is, if they can’t even treat somebody who’s actually really sick, what are they going to do?” (SC2_15, P) “And I’ve seen clients where they wait and wait and they say, forget it, and they leave. Sometimes they end up going back by ambulance. Like its just ridiculous. And that’s because they make them wait so long or they’re mistreated. And they say forget it. Especially a lot of our young people.” (HD_19) |
| Perceptions of being made to wait longer than others | “When you go through they’ll put you in a room and then you’re waiting there and waiting there, and that’s what I was saying. Someone else comes in and they’re of a different colour and then they’ll get treated right away.” (HD_19) “If I have been waiting for 3 hours and I see another person walk in and this person is checking in after half an hour, how would I feel, if I don’t know anything? It feels like discrimination. You take the White guy first of me, I’m sitting here for 3 hours? They’re not going to look after me so I’m just going to leave.” (HD_20) |
| Transportation | “Even your ride, you may get dropped off, [and the person who drove you] says, ‘Ok, I have a few things to do, I’ll come in and pick you up in an hour,’ you didn’t get through triage yet, you’re still waiting [but you think] ‘Ok, my ride’s leaving back, my home is 1.5 hours away, how am I going to get home if I wait it out?’ So there’s those things that come back again. And it’s really those social determinants that sort of come into play at that time.” (HD_21) |
| Communication | “Once they see the doctor, maybe there’s a lack of communication between the patient and the doctor. Because sometimes they come in there and they walk right out. They see you, they talk to you, and then they walk out without like, and then you’re kind of like, ‘Ok, am I done?’ So sometimes there’s that lack of complete communication. Like I’ve been told, ‘We’re going to do chest x-rays,’ and then I’m waiting and then they’re like, “Oh no, you need to come back for those.’ Like I’m waiting and the nurse comes into change the room and says, ‘Oh, we thought you were done.’ And I’m like ‘I’m waiting for chest x-rays,’ and she’s like ‘Oh no, the doctor wants you to come back for those in a few days. We’ll give you a call.’ I’m like, ‘Ok well that would’ve been nice to know a half hour ago’.” (HD_18) |
| Responsibilities | “Other First Nation families walk down the hall just with their head down. And I just know that feeling, that wondering. And when you have other kids to take care of too, how that role is really challenging. And then you have your work, school, whatever else, your personal goals that you’re still trying to achieve as well. So, I really can connect to one of the families that have to navigate through the daunting administration process that they have, and it’s always, always, a fight for us to access services and benefits.” (SC2_09) “This mom, a single mom with 4 children went in. Her 14-year-old was sick … it was a headache and sore bones … they told her, ‘You have to go to the clinic.’ And this was emergency. And so, she went to the clinic and they said, ‘No, you can’t come to the clinic, you have to go to emergency.’ Like, and [I] didn’t know why the client was sent all over. So she went back to the emergency, meanwhile the 14-year-old could barely walk, he was so sore, he was walking all over the hospital. And plus, the mom was scared because of COVID. She doesn’t want him walking all through, all over the place. She phoned me, she was just crying. She was worried and she’s got all her kids walking through the hospital and the baby is only 3. So they went to [rural town], which is half an hour away, and then she had to get some medication and stuff for her son.” (HD_19) |
| Not receiving needed care | “My experience with emergency is mental health … going to emergency when I felt suicidal. It was the first time in [rural town], and they just made me wait. No one was asking me questions about how I was doing, they just made me wait there. And I was tired of waiting with all these thoughts. I was tired of waiting. I’m just, I’m just putting myself in this situation where no one cares that I’m going through this, so I left. … I needed emergency care now, I needed someone to tell me to not go off the ledge at that time. … I don’t go to the emergency anymore for those situations. There’s nothing created there to help our people with emergency and there’s been so many suicides in our community.” (SC3_12) “The other thing that the health director and I were talking about yesterday is a lot of the staff, either I don’t know if they’re not trained, or they just don’t know how to deal with mental health issues. We have community members … with some mental health concerns and when they do go into the emergency, whether it’s addictions, druginduced, any kind of slightly off behaviour, they’re either ushered out or just give them something to calm down, which is not fair.” (SC3_06) “When I had COVID, I went to the hospital and they told me to leave the hospital because they had families to protect. I also did as well. I was really, really sick. And one nurse told me if I could, make it to Calgary. And at that time, I was just really, I felt like I was beaten down already. So I didn’t go. But that nurse told me to come back tomorrow because this doctor isn’t on. So, I did, I went back the next day. I got [inaudible] and fluids. I couldn’t believe the way that they, they turned me away. I was really, really sick.” (SC2_17) |
| Negative experience of emergency department environment | “I think it’s that they’re rushed. A lot of people, umm, I guess they’re uncomfortable with the, everyone coming to them and all the questions asked and… and the rush. The urgency. And they just want to rest and recover and they’re disturbed, you know? They’re constantly disturbed or disrupted by what’s going on around. And it can be stressful for them as well. … So, they want to leave, you know. … I have a lot of clients that are left without being seen. … It can be many factors, it could be um, not coping, withdrawal … they don’t feel that it’s fair, others are seen and not them …” (Cultural Liaison) |
Note: AWOL = absent without leave, HD = First Nations Health Director, IV = intravenous, P = physician, SC = Sharing Circle.