The ER is for EMERGENCIES. I understand that with our health care system, the ER the safety net for most peoples health care. But if you come into the ER for a freaking cold and you have to wait a few hours longer because we are taking care of real emergencies... like heart attacks, strokes, traumas, etc....then you need to freaking chill and be appreciative that you are even going to be seen. Here are a few non emergent middle of the night complaints from a previous shift:
1) A 55 year old Nigerian male who is studying to be a nurse came in for nasal congestion. He used to get allergy shots, but says he can't get them anymore b/c of school. So he wants me, the ER doc, to give him freaking allergy shots once a week. He is tearful b/c the nasal congestion is sooo bad that sometimes he wakes up in the middle of the night breathing out of his mouth. Grow some freaking balls man! I offered him a decadron shot and some decongestants, but of course he wasn't happy with that.
2) A 39 year old Hispanic female came in b/c she had TMD (Total Me Duele). She was off her Etolodac and wanted a refill. I sighed and thought "Fine let me refill this ladies meds and get her out of here." But no....she wanted more. She wanted a pain shot b/c the total body pain had gotten too mucho AND a B12 shot to give her energy. I told her it wasn't going to happen b/c it wasn't an emergency. She quickly stated it was an emergency to her and kept demanding the shots. In the end, she got nothing.
3) A 41 year old Hispanic female (could have been sisters with the above patient) came in b/c every time she goes outside her eyes water and she sneezes. Wow...what an emergency. Take some freaking allergies pills (over the counter ones of course) and get out of my fucking ER.
4) A 49 year old white male presented for wanting his blood pressure and pain meds refilled. At first I played along. He needed his Vicodin for his chronic back pain and Clonidine 0.3mg (huge dose) for his hypertension. He said had been out of them for 3 weeks bc he was in jail. Funny thing was, though, his previous ER visits did not list Clonidine as one of his meds.
"Sir, what did they give you in jail for your pain?" I asked.
He said they gave him Motrin for pain and nothing for his blood pressure. I said, "Great, so you have been off your Vicodin for 3 weeks now... you should continue the Motrin. And your blood pressure is normal today, so you can see a primary doctor for a refill on your BP meds."
That didn't go over well, and he continued to demand his Vicodin and Clonidine. Enough games I thought. "Look man, your not getting either. I am not dumb. I know what happens when you mix Clonidine and Hydrocodeine (you get a prolonged high). You are either going to get high yourself with it or sell it. I looked at your history and Clonidine isn't one of your meds. You aren't getting either, so get the hell out before I call the police!"
Such a rewarding career.
-ER Doc
8 comments:
I work in a small rural ER. Had gotten to lay down last night at 2am. Was awakened at 3am. Chief complaint "I can't sleep". Dude had private insurance. Explained to him the following facts.
1. No way in hell was his private insurance going to claim on an ER visit of insomnia and he was going to get a bill from the hospital. His reply, well I have restless leg also.
2. He was already on Xanax and Soma from his primary care doc for the above diagnoses and that them not working for a single night did not constitute and emergency. Also, his doctor has a call service which he failed to utilize.
3. He drove himself to the ER so even if I wanted to I could not give him anything to knock him out.
4. I would NOT give him the note to miss work he asked for as I was working all night and till 1pm in my office the next day and figured if I could make it he could to. He REALLY didn't like this and I suspect the whole matter was wanting a work excuse in the first place.
I did dispense ONE extra xanax for him to take at home so he wouldn't run out early of his home supply.
No, we don't have Press Ganey reports so I fell safe.
Bugs the crap out of me. I was amazed as a resident the first time I saw the 3 am "emergent" allergy patient. My allergies are bad all the time. Take a Benadryl and suck it up. Then go see your primary doc (or maybe urgent care the next day if you can't get in) to talk about other options.
Another excellent post...right on the money. Your examples are so spot on. I think some of our problem is that referring physicians are sending in their patients for chronic issues because they "don't have enough time" or "you'll get all your tests quicker, or the patient spoke to someone who made up their own rules in the office (we have a local famous secretary who sends in all of the office don't-wanna-sees...
Have a good day!
Hey Anon 0747 - how do you not have Press Ganey? I thought that was like the new JCAHCO. I took care of a 50 y/o lady last night with non specific abdominal pain, totally normal exam and normal HCG, CBC & belly labs. She stated she "felt like something was moving around in there" and complained because I didn't do an Xray to "look for parasites". WTF? These are the people that get PG surveys in my neck of the woods.
Sounds like my finance's ex-wife. She took their 6 year old to the ER because he had a fever of 100.5 coughing and throwing up. Uhm it's called give him children's Tylenol for the fever, put a wash cold wash cloth on him. He will be fine. Call the pediatrician in the AM if he's not feeling better. The ER is not where he needs to be.
I'm not a doctor but I've worked as a clerk at a busy trauma ER in a city's downtown core. Because I was a student I usually took the overnight shifts and was often stunned by the stupidity of people's complaints.
I remember two in particular
1) A girl accompanied by her mom and dad came in complaining that she had swallowed a fish bone at dinner and it was stuck in her throat. She walked in under her own power and showed absolutely no distress. After waiting for 10 minutes, during which not one but two traumas arrived, her mom approached and became abusive to both me and triage nurse saying "It is late and we must all get home to bed."
2) Someone come in late at night/early in the morning. She had had a sore throat for the last several weeks and opted to come in at 2 in the morning, during a snowstorm because she couldn't sleep and was bored.
When I moonlighted in a rural ED during my residency, a patient who "swore" there was a blueberry stuck in his throat got p***ed because I tended first to the patient who accidentally cut his index finger off. He was MAD. He could even see the arterial bleed from the room he was in. Literally he had to only wait 15 minutes for me to transfer the guy.
As an FP, there is nothing more I enjoy than cutting off narc seekers. It is so rewarding. I especially like catching the ones who are selling them - I feel like I should have a small police badge or something.
Good grief! I wouldn't even imagine going to the ER for med refills, or looking for narcs. Seriously....I go to my family doc for periodic ills, and maintenance of chronic conditions (including, duh, getting my meds refilled!)
You'll be happy to know that I did educate a visitor of one of my recent laboring mothers that she should NOT go to the ER for her sprained/strained wrist x 2 days (that she injured at work). She needs to fill out workman's comp at her job, and make an appointment with her family doctor (which, when asked, she DOES have one). I told her that the ER isn't going to do anything for her, but her family doctor WILL - like send her to physical therapy.
People out there are certainly not rocket scientists, are they?
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