Can I Get An MRI?

[Goggled101]

I don't know how I stumbled across this forum and ended up here. First off I'm not a doctor. I fell down this rabbit hole because I was looking at getting an MRI because my sister has been diagnosed with MS and I've been displaying symptoms too (Vertigo, eye and facial twitching on one side, gait issues, random Bouts of trouble swallowing, tingling in my extremities, extreme Bouts of lethargy) and my doctor doesn't seem to think it's all that imperative to check me for MS. I happen to disagree. I still hold doubt that what's going on with me is MS but I think that an MRI is in order to at least eliminate it from the realm of possibilities.

When I hear hooves I don't normally think zebras I think horses... Unless I've already seen a few zebras lol.

But then I stumble in here and oh my freakin' goodness is this real life! I've been in a bunch of weird jobs that allow me to see behind the curtain but you all might be the worst (used to bounce at a strip club... I bet you'd love to know how your favorite dancer feels about you lol... They might be worse... But not by much)

My point is this; you went to school to learn this... We did not but we are the ones who have to live with your decisions. You've got to admit that is a frustrating situation to be in. I have the same frustration when my car breaks down because I don't know **** about cars... Except that this is my life.

People come in wanting help. We have lives to live. Maybe were unable to work or our lives are miserable and we want answers to at least put our minds at ease. Like a few years ago when I got mono. My doctor was perplexed and it was awful. Recurring fever for months followed by flu like symptoms. I just wanted to know I wasn't dying... Made me feel a lot better when he finally figured out what it was.

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[Janders]

I wouldn't tell you that getting an MRI to assess for MS is ridiculous.

I would tell you that getting a STAT MRI from an ER for symptoms that have waxed/waned for months is either impossible or an incorrect use of precious resources.

That said, IMHO if you are willing to pay for a test, you should have said test whenever you want... at, say, an outpatient MRI center.

But just like us, you are a pawn in a broken system.

 

[Siggy]

I don't know how I stumbled across this forum and ended up here. First off I'm not a doctor. I fell down this rabbit hole because I was looking at getting an MRI because my sister has been diagnosed with MS and I've been displaying symptoms too (Vertigo, eye and facial twitching on one side, gait issues, random Bouts of trouble swallowing, tingling in my extremities, extreme Bouts of lethargy) and my doctor doesn't seem to think it's all that imperative to check me for MS. I happen to disagree. I still hold doubt that what's going on with me is MS but I think that an MRI is in order to at least eliminate it from the realm of possibilities.

So the ED is full of horrible doctors because they won't let you do an end around around your primary care physician to get a non-emergent MRI at 2AM on a Sunday morning for a condition that, as described, isn't an emergent condition that needs instant treatment at 2am?

If you're unhappy with your current primary care physician, have you thought about going to another primary care physician?

Also, do you show up at Firestone at 2am wondering why someone won't come in and check the code that's triggering the check engine light on your car?

 

[e30ftw]

I don't know how I stumbled across this forum and ended up here.

Did you goggle it? (sic)

 

[meister]

MS is primarily a clinical diagnosis, not an imaging one. See a neurologist.

 

[tymont12]

I don't know how I stumbled across this forum and ended up here. First off I'm not a doctor. I fell down this rabbit hole because I was looking at getting an MRI because my sister has been diagnosed with MS and I've been displaying symptoms too (Vertigo, eye and facial twitching on one side, gait issues, random Bouts of trouble swallowing, tingling in my extremities, extreme Bouts of lethargy) and my doctor doesn't seem to think it's all that imperative to check me for MS. I happen to disagree. I still hold doubt that what's going on with me is MS but I think that an MRI is in order to at least eliminate it from the realm of possibilities.

When I hear hooves I don't normally think zebras I think horses... Unless I've already seen a few zebras lol.

But then I stumble in here and oh my freakin' goodness is this real life! I've been in a bunch of weird jobs that allow me to see behind the curtain but you all might be the worst (used to bounce at a strip club... I bet you'd love to know how your favorite dancer feels about you lol... They might be worse... But not by much)

My point is this; you went to school to learn this... We did not but we are the ones who have to live with your decisions. You've got to admit that is a frustrating situation to be in. I have the same frustration when my car breaks down because I don't know **** about cars... Except that this is my life.

People come in wanting help. We have lives to live. Maybe were unable to work or our lives are miserable and we want answers to at least put our minds at ease. Like a few years ago when I got mono. My doctor was perplexed and it was awful. Recurring fever for months followed by flu like symptoms. I just wanted to know I wasn't dying... Made me feel a lot better when he finally figured out what it was.

What you are failing to recognize is that these patients are usually demanding more 'comprehensive' imaging studies after a physician has already explained to them why their treatment plan is what it is.

Judges don't simply roll out of bed because someone thinks they need another trial...so why do you think an individual patient, usually a demanding one, deserves the whole medical system to up-end itself just for them? Do you tell your mechanic to replace something even though they say it's fine? I bet not.

 

[Colbert]

First off, it is absolutely against site policies to come here seeking medical advice.

If you feel that a test is in order and your PCP won't perform said test, then maybe consider getting a new PCP.

I am at a very rare site when I can get an MRI on demand. We're in the 1-2% of ERs in the country where it's possible. That being said, I tell people no to their requested MRIs almost every other day because of this. They hear that their friend got an MRI (stroke symptoms with neg CT, etc) and come in stating that they need one because they tweaked their knee. Or there back has hurt for 4 days. Or food tastes less salty. Or "my mind is just fuzzy, you know?" These are not reasons for an emergency MRI. If I were to oblige each MRI request we'd have a four day waiting list for MRIs and the truly emergent people would die in the waiting room never getting their studies.

 

[JustPlainBill]

...
People come in wanting help. We have lives to live. Maybe were unable to work or our lives are miserable and we want answers to at least put our minds at ease. Like a few years ago when I got mono. My doctor was perplexed and it was awful. Recurring fever for months followed by flu like symptoms. I just wanted to know I wasn't dying... Made me feel a lot better when he finally figured out what it was.

Hmm, I'm not so sure I believe that anymore --- When I was a naïve, not-so-young idealistic premed, maybe -- I had that "I just want to help people" mentality -- my first experience being detailed at a free-clinic while in med school opened my eyes a little -- doing a residency at a large county hospital really disabused me of that notion.

In my experience, patient's come in 3 flavors ---

1) Those that have "researched" i.e. googled some keywords and took the top 2 results of the search of their condition, watched an episode or 2 of Grey's Anatomy or House and come in thinking that's the equivalent of a medical degree + residency + years of clinical experience. Umm, No. I'm sorry, that does not make you my peer in terms of my profession. And no, this is not Burger King, you don't get it your way -- if I gave it to you your way, the next step in that routine is likely me dealing with some very pissed off family members who want to know why I, as a doctor could prescribe something that screwed you up so badly -- usually followed by threats of lawsuits, meetings with hospital admin, etc.

2) Those that know they're screwing themselves up but want me to make them feel good so they can continue with their ways and stave off the consequences of their behavior for a few more years -- think of the smoking COPDer with a cough/sinus infection that just won't go away demanding antibiotics or the diabetic with foot cellulitis who's already lost 2 or 3 toes but just keeps on eating fritos and washing it down with a diet coke (trying to lose weight don't cha know) right in your office as you're explaining WTF is causing this.

3) The one's -- and this is the minority -- who really do want to take care of themselves, are self motivated to at least try to eat right, exercise, recognize the ER is for --- all together now --- Emergencies -- and no, your cough of 3 days is NOT an emergency, and no, you're not important enough or sick enough to need a specialist for everything, and yes, you should go see your PCP regularly for your annual visits -- who use the medical system and resources appropriately.....

I find it rather interesting that my mother survived WWII in Germany and rarely needed a doctor -- it's only as she's crossed into her 80s that she's started needing meds for common complaints -- has been to the ER 3 times in her life -- 1 to have me, 1 after a fainting spell at work and 1 for abnormal heart beat --- vs campers that are in the ER at 11:00pm because their blood pressure is 140/90 with no symptoms....

Your mileage may vary, no warranties expressed or implied, car driven by a professional driver on a closed circuit track ---

 

[deleted547339]

Yay, you know more than your doctor. Hang a shingle and start seeing patients.

 

[Xerxes1729]

My point is this; you went to school to learn this... We did not but we are the ones who have to live with your decisions. You've got to admit that is a frustrating situation to be in. I have the same frustration when my car breaks down because I don't know **** about cars... Except that this is my life.

It's completely reasonable to expect a physician to explain to you why you're having a test or not having it. If your physician won't, consider finding a new one.

But at the same time, our world and lives are too complicated for us to understand and manage everything ourselves. At some point we all have to just trust people who know more than us. If you were accused of a serious crime, would you do whatever felt right, or would you do what your attorney said? You trust the engineers that design the buildings and bridges you use every day to put up structures that won't collapse. Sometimes trust is misplaced and an appeal is misfiled, a bridge collapses, or a diagnosis is missed. Overall though you've got to admit the professionals do much better than lay people would do.

 

[DocEspana]

I've been in a bunch of weird jobs that allow me to see behind the curtain but you all might be the worst (used to bounce at a strip club... I bet you'd love to know how your favorite dancer feels about you lol... They might be worse... But not by much)

I sort of assume that my favorite dancers are quite fond of me.

I live next to a higher-end strip club and basically just take my coworkers out and buy them their first lapdance if they want one at all. I don't think i've ever bought one for myself in my life (have had two "for free" before). But I just sit there and talk to my buddies and coworkers and chill. The handful of ladies that recognize me just sit next to me and chat and ask me for doctor stories. I ask them about how their family is doing (a few of them are south american and so we talk in spanish and it goes over well) and usually buy them a shot or a beer if they're taking time out to hang with me and my friends (who dont pay for that many either) when they could be earning money much quicker with people who actually are interested in lap dances as oppose to me just getting two gin and tonics and seeing if anyone i recognize is around.

I basically have like 40 free entry cards to the place. Every time I go they just give me like 4 or 5 more. Think they think highly of me? Or do they just think Im cheap by taking up a seat and never wanting that $20 farce they are selling?


yes. this thread is now about the behind the scenes of the strip club. Because we are seriously bordering on giving medical advice here.

 

[WilcoWorld]

I sort of assume that my favorite dancers are quite fond of me.

I live next to a higher-end strip club and basically just take my coworkers out and buy them their first lapdance if they want one at all. I don't think i've ever bought one for myself in my life (have had two "for free" before). But I just sit there and talk to my buddies and coworkers and chill. The handful of ladies that recognize me just sit next to me and chat and ask me for doctor stories. I ask them about how their family is doing (a few of them are south american and so we talk in spanish and it goes over well) and usually buy them a shot or a beer if they're taking time out to hang with me and my friends (who dont pay for that many either) when they could be earning money much quicker with people who actually are interested in lap dances as oppose to me just getting two gin and tonics and seeing if anyone i recognize is around.

I basically have like 40 free entry cards to the place. Every time I go they just give me like 4 or 5 more. Think they think highly of me? Or do they just think Im cheap by taking up a seat and never wanting that $20 farce they are selling?


yes. this thread is now about the behind the scenes of the strip club. Because we are seriously bordering on giving medical advice here.

True, but favoring Gin & Tonics over lap dances is pretty sound medical advice.

 

[Brigade4Radiant]

I don't know how I stumbled across this forum and ended up here. First off I'm not a doctor. I fell down this rabbit hole because I was looking at getting an MRI because my sister has been diagnosed with MS and I've been displaying symptoms too (Vertigo, eye and facial twitching on one side, gait issues, random Bouts of trouble swallowing, tingling in my extremities, extreme Bouts of lethargy) and my doctor doesn't seem to think it's all that imperative to check me for MS. I happen to disagree. I still hold doubt that what's going on with me is MS but I think that an MRI is in order to at least eliminate it from the realm of possibilities.

When I hear hooves I don't normally think zebras I think horses... Unless I've already seen a few zebras lol.

But then I stumble in here and oh my freakin' goodness is this real life! I've been in a bunch of weird jobs that allow me to see behind the curtain but you all might be the worst (used to bounce at a strip club... I bet you'd love to know how your favorite dancer feels about you lol... They might be worse... But not by much)

My point is this; you went to school to learn this... We did not but we are the ones who have to live with your decisions. You've got to admit that is a frustrating situation to be in. I have the same frustration when my car breaks down because I don't know **** about cars... Except that this is my life.

People come in wanting help. We have lives to live. Maybe were unable to work or our lives are miserable and we want answers to at least put our minds at ease. Like a few years ago when I got mono. My doctor was perplexed and it was awful. Recurring fever for months followed by flu like symptoms. I just wanted to know I wasn't dying... Made me feel a lot better when he finally figured out what it was.

No one really cares what strippers think of them.

 

[BoardingDoc]

I don't know how I stumbled across this forum and ended up here. First off I'm not a doctor. I fell down this rabbit hole because I was looking at getting an MRI because my sister has been diagnosed with MS and I've been displaying symptoms too (Vertigo, eye and facial twitching on one side, gait issues, random Bouts of trouble swallowing, tingling in my extremities, extreme Bouts of lethargy) and my doctor doesn't seem to think it's all that imperative to check me for MS. I happen to disagree. I still hold doubt that what's going on with me is MS but I think that an MRI is in order to at least eliminate it from the realm of possibilities.

When I hear hooves I don't normally think zebras I think horses... Unless I've already seen a few zebras lol.

But then I stumble in here and oh my freakin' goodness is this real life! I've been in a bunch of weird jobs that allow me to see behind the curtain but you all might be the worst (used to bounce at a strip club... I bet you'd love to know how your favorite dancer feels about you lol... They might be worse... But not by much)

My point is this; you went to school to learn this... We did not but we are the ones who have to live with your decisions. You've got to admit that is a frustrating situation to be in. I have the same frustration when my car breaks down because I don't know **** about cars... Except that this is my life.

People come in wanting help. We have lives to live. Maybe were unable to work or our lives are miserable and we want answers to at least put our minds at ease. Like a few years ago when I got mono. My doctor was perplexed and it was awful. Recurring fever for months followed by flu like symptoms. I just wanted to know I wasn't dying... Made me feel a lot better when he finally figured out what it was.

At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.

 

[GeneralVeers]

Patients always forget what an "emergency" is. I tell people all the time that they may have a medical condition that is causing pain, anxiety, etc, but that we will be unlikely to determine the cause with the limited testing available in the ER. If your condition requires an MRI to diagnose, it is *almost* never an emergency. The only exceptions being spinal cord compression, cauda equina, or epidural abscess.

 

[njac]

At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.

Excellent reference.

 

[Spinach Dip]

At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.

....And doctors wonder why their patients have no respect for them....

Perhaps you should attempt being nice to your patients and try to resist the desire to call them idiots for being concerned about their own health.

Just a thought.

 

[pulmoblast]

....And doctors wonder why their patients have no respect for them....

Perhaps you should attempt being nice to your patients and try to resist the desire to call them idiots for being concerned about their own health.

Just a thought.

Real patients with real problems do acknowledge and respect the people who treat them. Nobody gives a rats ass to the opinions of keyboard warriors and Google PhDs like the OP (or you)...

 

[TooMuchResearch]

....And doctors wonder why their patients have no respect for them....

Perhaps you should attempt being nice to your patients and try to resist the desire to call them idiots for being concerned about their own health.

Just a thought.

Cough Billy Madison look up the quote cough

 

[gman33]

It's easy to get an mri.

Go to a privately owned imaging center with $5000 in small unmarked bills.

 

[d2305]

I can think of 4 free standing mri centers around here. Cost about a grand for a look inside the skull. I would be cheaper to fly to Thailand and get it done there than an ER mri.

 

[BoardingDoc]

....And doctors wonder why their patients have no respect for them....

Perhaps you should attempt being nice to your patients and try to resist the desire to call them idiots for being concerned about their own health.

Just a thought.

 

[RustedFox]

I can think of 4 free standing mri centers around here. Cost about a grand for a look inside the skull. I would be cheaper to fly to Thailand and get it done there than an ER mri.

I had my TMJs MRI'ed last year out of pocket. 360.00 USD. That was it.

 

[VA Hopeful Dr]

I had my TMJs MRI'ed last year out of pocket. 360.00 USD. That was it.

Yeah, non contrast here is 500ish per body part

 

[d2305]

When one gets an mri at a hospital, the cost is 4 x a mri center. The open mri studies have poor resolution. http://www.nerdwallet.com/blog/health/how-much-does-an-mri-cost/

 

[Old Grunt]

....And doctors wonder why their patients have no respect for them....

Perhaps you should attempt being nice to your patients and try to resist the desire to call them idiots for being concerned about their own health.

Just a thought.

I guess I missed the part where she was a patient of someone on this forum. No doctor/patient relationship exists here, as much as the OP would like it too. Using this forum to solicit medical advice is poor form. Giving medical advice on a forum is bad medicine.

Also, I can't actually figure out if the OP wants medical advice or just "stumbled in here from da' Google" to tell us what a bunch of bad, bad people we are because her doctor won't order an MRI for her.

Because we have something to do with that or something.

 

[Spinach Dip]

Real patients with real problems do acknowledge and respect the people who treat them. Nobody gives a rats ass to the opinions of keyboard warriors and Google PhDs like the OP (or you)...

Cough Billy Madison look up the quote cough

I guess I missed the part where she was a patient of someone on this forum. No doctor/patient relationship exists here, as much as the OP would like it too. Using this forum to solicit medical advice is poor form. Giving medical advice on a forum is bad medicine.

Also, I can't actually figure out if the OP wants medical advice or just "stumbled in here from da' Google" to tell us what a bunch of bad, bad people we are because her doctor won't order an MRI for her.

Because we have something to do with that or something.

Yes, I got the quote and/or reference. But good on you guys for being clever and posting some memes. Well played.



The problem as I see it is that there are posters with titles of "resident"/"physician" making stupid posts and calling the OP out for being an entitled snot. Whether she is or not means nothing. The fact that you are willing to call her out in public (newsflash: internet forums are public!) is merely one factor of why physicians have such a bad name in this day and age.

Go ahead and call me stupid or misinformed or opinionated. I don't care. It's no hair off my tits. But next time your admin calls you into his office to discuss your slightly-lower-than-optimal patient ratings, do me a favor and look in the mirror. You have no one to blame but yourself.



And serious thanks to everyone who actually kept this on track (by suggesting the OP find a new PCP or pay for it herself at an independent imaging center). You guys added to the thread without offending anyone. GJ!

 

[pulmoblast]

There is a reason why medical advice is not given on forums like these

There is a reason why unnecessary imaging is discouraged

There is a reason why walking into an ER should not be like walking into Burger King, where you throw in extra fries to keep your customer happy and satisfaction scores up.

Will you deal with the consequences of an incidentally detected adrenal lipoma in this scan?

 

[Brigade4Radiant]

Yes, I got the quote and/or reference. But good on you guys for being clever and posting some memes. Well played.



The problem as I see it is that there are posters with titles of "resident"/"physician" making stupid posts and calling the OP out for being an entitled snot. Whether she is or not means nothing. The fact that you are willing to call her out in public (newsflash: internet forums are public!) is merely one factor of why physicians have such a bad name in this day and age.

Go ahead and call me stupid or misinformed or opinionated. I don't care. It's no hair off my tits. But next time your admin calls you into his office to discuss your slightly-lower-than-optimal patient ratings, do me a favor and look in the mirror. You have no one to blame but yourself.



And serious thanks to everyone who actually kept this on track (by suggesting the OP find a new PCP or pay for it herself at an independent imaging center). You guys added to the thread without offending anyone. GJ!

Patient satisfaction is correlated to higher patient mortality.
Newsflash you are only a patient if you are being treated. Physician doesn't carry the glamour it used to have because people are more skeptical of people in positions of power(i.e cops, teachers, lawyers scientists and professors). Instead of being pushovers we should fight for our rights and the reasons why we are not like other "customer service" professions. Also the admin calls you into the office because those metrics are the only thing that gives their mostly unnecessary jobs meaning.

 

[JustPlainBill]

Patient satisfaction is correlated to higher patient mortality.
Newsflash you are only a patient if you are being treated. Physician doesn't carry the glamour it used to have because people are more skeptical of people in positions of power(i.e cops, teachers, lawyers scientists and professors). Instead of being pushovers we should fight for our rights and the reasons why we are not like other "customer service" professions. Also the admin calls you into the office because those metrics are the only thing that gives their mostly unnecessary jobs meaning.

Ah, yes --- nothing like being treated like a red jacket waiter or orderly --- actually had one patient argue upon presentation with 4 days of cough/rhinitis that ---

1) they'd already seen 2 physicians for this (with me being the second) and couldn't afford, timewise, to see another
2) were 4 days into Zpack and not getting better
3) Wanted -- and this is the way it was said -- "a shot of 1 gram of rocephin, a steroid shot of 4mg of dexamethasone and 40 of depo-Medrol, another Zpack, a Medrol dose pack and codeine cough syrup AND a note for work" ---
4) I argued that based on PE, it was viral and they didn't need all of that -- patient started becoming hostile and argumentative --- they left with a few things for symptom control.

I daily catch myself singing lightly,"Hold the pickles, hold the lettuce, special orders don't upset us, all we ask is that you let us service your way...."

some days, it just doesn't pay to gnaw through the restraints....

 

[shoal007]

Ah, yes --- nothing like being treated like a red jacket waiter or orderly --- actually had one patient argue upon presentation with 4 days of cough/rhinitis that ---

1) they'd already seen 2 physicians for this (with me being the second) and couldn't afford, timewise, to see another
2) were 4 days into Zpack and not getting better
3) Wanted -- and this is the way it was said -- "a shot of 1 gram of rocephin, a steroid shot of 4mg of dexamethasone and 40 of depo-Medrol, another Zpack, a Medrol dose pack and codeine cough syrup AND a note for work" ---
4) I argued that based on PE, it was viral and they didn't need all of that -- patient started becoming hostile and argumentative --- they left with a few things for symptom control.

I daily catch myself singing lightly,"Hold the pickles, hold the lettuce, special orders don't upset us, all we ask is that you let us service your way...."

some days, it just doesn't pay to gnaw through the restraints....

Gawd. Thought I had it bad. Don't give them what they want, you're damned for sure. Gonna get a complaint letter. But give them what they want, still screwed. Don't understand why we have to conform to this PG BULL****. Its very frusterating.

Sent from my VS986 using Tapatalk

 

[Psai]

Ah, yes --- nothing like being treated like a red jacket waiter or orderly --- actually had one patient argue upon presentation with 4 days of cough/rhinitis that ---

1) they'd already seen 2 physicians for this (with me being the second) and couldn't afford, timewise, to see another
2) were 4 days into Zpack and not getting better
3) Wanted -- and this is the way it was said -- "a shot of 1 gram of rocephin, a steroid shot of 4mg of dexamethasone and 40 of depo-Medrol, another Zpack, a Medrol dose pack and codeine cough syrup AND a note for work" ---
4) I argued that based on PE, it was viral and they didn't need all of that -- patient started becoming hostile and argumentative --- they left with a few things for symptom control.

I daily catch myself singing lightly,"Hold the pickles, hold the lettuce, special orders don't upset us, all we ask is that you let us service your way...."

some days, it just doesn't pay to gnaw through the restraints....

"Sorry this is the emergency room and that's not an emergency. Goodbye."

 

[gman33]

Ah, yes --- nothing like being treated like a red jacket waiter or orderly --- actually had one patient argue upon presentation with 4 days of cough/rhinitis that ---

1) they'd already seen 2 physicians for this (with me being the second) and couldn't afford, timewise, to see another
2) were 4 days into Zpack and not getting better
3) Wanted -- and this is the way it was said -- "a shot of 1 gram of rocephin, a steroid shot of 4mg of dexamethasone and 40 of depo-Medrol, another Zpack, a Medrol dose pack and codeine cough syrup AND a note for work" ---
4) I argued that based on PE, it was viral and they didn't need all of that -- patient started becoming hostile and argumentative --- they left with a few things for symptom control.

I daily catch myself singing lightly,"Hold the pickles, hold the lettuce, special orders don't upset us, all we ask is that you let us service your way...."

some days, it just doesn't pay to gnaw through the restraints....

A list of detailed demands like above is ridiculous.

I have recently changed my approach to patients of this type.
I now try to validate their complaint and sometimes even play it up some.
That way they believe that I understand their concern and am on their side.

I then tell them we need to do things that will get them better and I tell them what I think will work.
If they are still asking for abx or other stuff that won't work, I tell them we can do that but it will likely only cause diarrhea and not help their problem.
But if they really want that, I tell them we could do it.

I doubt this approach would have worked in someone who came in with such an agenda.

 

[Doctor Bob]

patient started becoming hostile and argumentative ---

"You have received your medical screening exam as required by law. Based on the exam, no emergent medical condition exists. Your nurse will bring in your discharge paperwork momentarily. I recommend you follow up with your primary care doctor for further treatment of your non-emergent condition."

 

[GeneralVeers]

"You have received your medical screening exam as required by law. Based on the exam, no emergent medical condition exists. Your nurse will bring in your discharge paperwork momentarily. I recommend you follow up with your primary care doctor for further treatment of your non-emergent condition."

Agree completely. I don't waste my time on these patients, when I have an ER full of other people to see. If they become argumentative and start demanding tests that they don't need and aren't indicated, I'll give them one explanation as to why I'm not ordering it. If they still persist with being annoying, I discharge them and move on to the next patient.

 

[Auvelity]

"Sorry this is the emergency room and that's not an emergency. Goodbye."

Can you really do that? tell the patient to leave because that isnt an actual emergency, that continue with fluids and OTC meds to treat his 2 days cough and if he needs everything else he should contact his PCP? or you could be sue by telling the patient nicely that it isnt an emergency and he should go home?

 

[b-real]

Can you really do that? tell the patient to leave because that isnt an actual emergency, that continue with fluids and OTC meds to treat his 2 days cough and if he needs everything else he should contact his PCP? or you could be sue by telling the patient nicely that it isnt an emergency and he should go home?

Why would I be sued? Because I didn't give the pt what they asked for, even though it's ridiculous? My job is to provide an MSE to see if an emergency exists. Once it's determined no such emergency exists, my obligation is fulfilled. D/c home.

 

[Dre8]

Can we all agree the symptoms were likely caused by neurosyphilis?

 

[styphon]

We had a provider who would give the patient whatever they wanted: abx, steroids, controlled substances, benzos, etc in the name of "patient satisfaction" and "customer service".
Later I found out that he has some of the most complaints in the group, and looking online he was the only one mentioned by name, and it was always negative.

So here is a guy who goes out of his way for "customer service" yet everyone still complained.

Also of note, we have now established a "complaint department"! Next think you know we will have a customer service desk!

 

[Psai]

We had a provider who would give the patient whatever they wanted: abx, steroids, controlled substances, benzos, etc in the name of "patient satisfaction" and "customer service".
Later I found out that he has some of the most complaints in the group, and looking online he was the only one mentioned by name, and it was always negative.

So here is a guy who goes out of his way for "customer service" yet everyone still complained.

Also of note, we have now established a "complaint department"! Next think you know we will have a customer service desk!

Rofl

 

[Old Grunt]

Ah, yes --- nothing like being treated like a red jacket waiter or orderly --- actually had one patient argue upon presentation with 4 days of cough/rhinitis that ---

1) they'd already seen 2 physicians for this (with me being the second) and couldn't afford, timewise, to see another
2) were 4 days into Zpack and not getting better
3) Wanted -- and this is the way it was said -- "a shot of 1 gram of rocephin, a steroid shot of 4mg of dexamethasone and 40 of depo-Medrol, another Zpack, a Medrol dose pack and codeine cough syrup AND a note for work" ---
4) I argued that based on PE, it was viral and they didn't need all of that -- patient started becoming hostile and argumentative --- they left with a few things for symptom control.

I daily catch myself singing lightly,"Hold the pickles, hold the lettuce, special orders don't upset us, all we ask is that you let us service your way...."

some days, it just doesn't pay to gnaw through the restraints....

Yeah. Good luck explaining to a patient that the things they want are actually bad for them and you are a BAD doctor for giving them what they want. Kind of like the lady I had the other day that came to the ED with all sorts of weird neurologic symptoms and got a large work up. Turns out, it was the fact that her blood sugar was 500 because she had been put on a medrol dose pack for back pain.

 

[Old Grunt]

"Sorry this is the emergency room and that's not an emergency. Goodbye."

My humble advice after only doing this for a little while is to never say something like that. I also never diagnose someone with "narcotic seeking behavior" (unless there is something quantifiable - like catching the patient using a false identity).

My reasoning is that I've been humbled enough times by people I thought had nothing wrong with them who ended up having something very wrong with them, and if you miss something awful on a patient that you've verbalized is not having an emergency, it's going to be a very bad day.

Other's may disagree. That's just my opinion though. I also never lead with "What is your medical emergency today?" - no point in starting off the encounter on a hostile footing.

One thing I have found to be helpful when talking to patients who I can't quit get a grip on is asking them something like: "what was your main concern in presenting to the emergency department tonight?"

I've found that it's often times something very simple that can be solved by simple reassurance and doesn't require a full septic work up + MRI/MRA + CT Pan Scan + LP = 6 hour painful patient encounter for all persons involved.

 

[Old Grunt]

Can you really do that? tell the patient to leave because that isnt an actual emergency, that continue with fluids and OTC meds to treat his 2 days cough and if he needs everything else he should contact his PCP? or you could be sue by telling the patient nicely that it isnt an emergency and he should go home?

You can't be sued for simply telling someone there is no emergency. However, it's probably not an exact quote that you would ever want to find being read back to you in a deposition.

 

[Old Grunt]

<duplicate post>

 

[Old Grunt]

Yes, I got the quote and/or reference. But good on you guys for being clever and posting some memes. Well played.



The problem as I see it is that there are posters with titles of "resident"/"physician" making stupid posts and calling the OP out for being an entitled snot. Whether she is or not means nothing. The fact that you are willing to call her out in public (newsflash: internet forums are public!) is merely one factor of why physicians have such a bad name in this day and age.

Go ahead and call me stupid or misinformed or opinionated. I don't care. It's no hair off my tits. But next time your admin calls you into his office to discuss your slightly-lower-than-optimal patient ratings, do me a favor and look in the mirror. You have no one to blame but yourself.



And serious thanks to everyone who actually kept this on track (by suggesting the OP find a new PCP or pay for it herself at an independent imaging center). You guys added to the thread without offending anyone. GJ!

Thank you for your useful contributions to this thread.

 

[GeneralVeers]

Please State the Nature of Your Medical EMERGENCY!