Wednesday, September 1, 2010

Chief Ccomplaint of the Week

Last Sunday, working in Psych ER. Here is a word for word transcription of triage nurse's note (with drug names deleted/altered).

"49 year old white male presents for evaluation for treatment of insomnia. He went to his VA clinic Friday, where he received prescriptions for (mood stabilizer) and (sleep aid). He filled the prescription for (mood stabilizer), but did not fill the prescription for (sleep aid). Wants something to help him sleep."

I swear I'm not making this up. In case you don't know why this humors me so, let me count the ways:

1. Insomnia is neither a medical or psychiatric emergency.
2. The guy has access to regular, routine psychiatric care. Why burden an ER?
3. Why not fill the sleep aid Rx? Believe me, it wasn't a financial issue, because it would cost him 80-100 times LESS than the mood stabilizer if he paid cash. Probably 5 times less if he filed it with his insurance.

Don't ask me what happened. I had to see some patients that were actually in need of care that day. He was punted to the next shift. He probably waited 12 hours to see a doctor and went home sometime around 2 or 3 am. His sleep would have been jacked up anyway. And by 8 am, he coulda just called his clinic.

-Psych Doc


Anonymous said...

I know that in our ER, co of insomnia usually meant paranoia/mania/etc. & usually got a fast track to the psych unit.

Anonymous said...

"Insomnia is neither a medical or psychiatric emergency."

The patient who can not sleep may feel on edge enough to kill themselves or others. This may make it a psychiatric (preventive crime- like most involuntary psychiatry) emergency.

SerenityNow said...

It still not considered an emergency. Hell anything may "may make it a psychiatric emergency." Someone might get so depressed from having a STD that they go kill themselves, so do we APOWW all of them. Come on. And no you don't screen every patient for being suicidal after a diagnosis either.

Use your friggin clinical judgement

ER Doc

Anonymous said...

"2. The guy has access to regular, routine psychiatric care. Why burden an ER?"

Because he has psychiatric problems and insomnia he is clearly not thinking straight. The clue is in the question... He is not thinking about your time and budget, he is looking for help.