"Time is brain."
The phrase is repeated like a mantra in the halls and classrooms of medical schools and hospitals throughout the country. The reminder to young trainees is that time is of the essence; the faster a diagnosis is made and treatment initiated, the less damage will have occurred.
Yet it is often the minutes and hours before a patient decides to seek medical attention that play the largest role in the ultimate outcome. Any doctor will tell you that, given the presence of certain concerning symptoms, "watchful waiting" is never the right approach.
Dr. Richard O'Brien, spokesperson for the American College of Emergency Physicians, says he often sees patients who have put off their trip to the emergency room for hours or days, ignoring worrisome symptoms. In many cases, these individuals had major symptoms which resolved. They ultimately seek help when the same symptoms return and don't go away, he says.
But why wait? It turns out that there are a number of barriers to keep people from seeking medical attention when they need it most -- such as concerns about missing prior obligations, high hospital bills, or inconveniencing others.
There's no doubt that going to the emergency room is inconvenient, both for the patient and those accompanying them. Often, says O'Brien, people end up waiting "because they don't want to bother anyone, especially their families."
Besides, if given the choice, few people would spend a nice Sunday afternoon in the emergency room.
However, often it is a simple unawareness of the gravity of the situation that keeps people from seeking medical care. The key is to know those symptoms that are worrisome and require prompt evaluation.
While crushing chest pain is hard to ignore, many concerning symptoms are not as obvious. So, what are those symptoms that represent something potentially serious, something that shouldn't wait until morning, or even until the end of the Red Sox game?
Some of the most important symptoms are those that portend the future -- they can be thought of as "red flags" that are letting us know that something is brewing.
For example, strokes are often preceded by a TIAs, also known as a "mini-stroke." In these cases, people experience neurologic symptoms -- such as weakness, difficulty speaking, blurry vision, or confusion -- that resolve spontaneously.
"TIA is a warning sign of impending stroke and should be taken seriously as an opportunity to stop a massive stroke in its tracks," says Dr. Wendy Wright, an intensive care neurologist at Emory University Hospital. She has had numerous patients who had symptoms and then went to bed or took a nap to literally try to "sleep it off," often with disastrous results, later waking up with irreversible neurologic damage.
"It is a tragedy to think that something could have been done in the meantime," she says.