Don?t come to the ER if?

[docB]

Your chief complaint in any way includes the phrase ?Just to get checked out.?

You wish to have injuries sustained in the past documented for your newest lawsuit.

You want a prescription for OTC Children?s Tylenol so that MediCal pays for it and you don?t have to forego one pack of smokes to buy it yourself.

You want me to sign off on your disability, social security, handicapped parking, school or sports physical or school or work excuse.

If your boss demands a doctor?s note to give you a sick day give me his number so I can chew him out and report him to your union and the state labor relations board.

Your pain is only relieved by 100 of Demerol and 25 of Visteril and you are allergic all other non-euphoric pain relievers.

Your child can?t sleep (I swear to God someone called 911 and came to the ER by ambulance last Saturday night).

You?re tired of taking care of your elderly family member and want them placed in a nursing home at 2am on a weekend night.

A doctor told you 15 years ago that you might need your back operated on and you decided that you want it done now (I?m not making this up. This guy drove 6 hours to get to my ER. ?Tonight?s the night.? he said.)

Your child may have had a fever a few days ago but he?s better now and you want to know what it was he had. (Again, not making it up)

You need a prescription for something and your primary doc refused.

You want Viagra.

---

Members don't see this ad.

 

[DrMom]

Very funny...until you remember that they are real.

 

[edinOH]

MediCal...

When I lived out there we jokingly referred to it as "Sacramento Mutual"

 

[jashanley]

If you feel a little constipated (after only one day)..........

You are 6 months pregnant and want to see your baby on ultrasound........

You took your blood pressure for the hell of it and found it to be 180/90 and thought it should be taken care of tonight.....

You heard the ER has a warm bed and some good eats....

 

[Dr JPH]

So...I hear cardiology is an interesting specialty.

Anyone else want to jump ship?

 

[bigfrank]

So, are these "real" reasons why many people claim the specialty of EM is become less and less competitive?

 

[mikecwru]

Originally posted by bigfrank
So, are these "real" reasons why many people claim the specialty of EM is become less and less competitive?

While the # of applications have went down some over the past few years, it wasn't a huge drop (like the # of apps to med school). So it's not a whole lot less competitive.

 

[DocWagner]

Less competitive? Maybe slightly, but nothing like other specialties, I mean the shear lack of call draws applicants in droves.
Sometimes I don't mind seeing a back pain when a "change of mental status" 90 year old comes in. The disposition is far easier with the back pain!
I don't think there is a specialty in the world that doesn't deal with bogus complaints (from ortho surg to FP).
It makes the evening interesting.

 

[docB]

Well, every shift provides new ones...

Don't come to the ER if...

Your chief complaint includes the phrase "second opinion."

Your hearing aid is not working.

Your primary doctor can't see you until tomorrow and you want me to call him and force him to see you today.

I don't know how to phrase this one but I swear the county jail sent me a patient yesterday because the nurse at the jail couldn't get a diastolic on the patient's BP (our nurse got it first try).

 

[Dr JPH]

Originally posted by docB

I don't know how to phrase this one but I swear the county jail sent me a patient yesterday because the nurse at the jail couldn't get a diastolic on the patient's BP (our nurse got it first try).

I suppose it's more honest than the nurse making up a number.

 

[Imhotep]

This patient walks in at 4 AM, clutching her left hand, writhing in pain ( she works at a local nursing home as a nurse's aide)
" What happened?" I say
"I was transferring an obese patient from one bed to another, and suddenly he pushed against me, I felt a crack.Now my left hand hurts like hell and I am in PAIN."
X ray was neg, I put a splint, wrote for some Cataflam, was about to send her on her way, when she said " Can I get a couple of days off, now that my hand hurts, I cant work."
NO, I said, " you can still answer phones."
She left in a huff.
As she was leaving, I happened to look into the Closed circuit TV, and I saw her push the heavy ER door.....with her left hand......without any difficulty......

 

[WonderBoy]

Originally posted by Imhotep
" Can I get a couple of days off, now that my hand hurts, I cant work."
NO, I said, " you can still answer phones."
She left in a huff.

 

[lytesnsyrens]

don't come to the ER with back pain that you have had for 3 months......"and what makes tonight an emergency?" i probably hear that one every night.

also......if you can get yourself from your house into your car and drive all the way to the ER, how come all the sudden you are unable to get yourself from your car into the ER? I AM NOT PATIENT TRANSPORT!!! or once you get inside, you decide to lay down on the floor and refuse to move till we have to wheel out a gurney to triage to pick you up. (true story...and then they left 15 mins later...walking!)

oh the joys of EM...i love it!

 

[docB]

We have a frequent flyer in our ED that pretends to be blind. It's hilarious. We've seen him walk up to the door doing just fine. He'll then pull out his dark glasses and his white cane and stumble in. He knows that we all know he's FOS but he keeps it up.

 

[docB]

I now hold a new record at my institution - I discharged the same patient 4 times in one 12 hour shift. He's this homeless guy who just really wants to live in the ER. We've even paid for a taxi to take him to the shelter but when he got there he left and went to the nearest phone and called 911. After this marathon revolving door session one of our nurses made an astute observation. She said "That guy has spent more healthcare dollars in one night than my family of five will this year." So true.

 

[ERMudPhud]

-IF you have more than 3 chief complaints

-If you have been carrying heavy shopping bags and are worried the creases in your hands might be permanent

_oh and if you are a frequent flyer don't call 911 from your ER bed and ask to be taken to a hospital with better food (honest, it happened)

A friend once suggested we could save a lot of time and make a lot of money if we put an ATM machine in the waiting room which would give 4 vicodin and a work excuse for every $20 you put into it.

 

[arctic187]

If you were told to see a specialist at a certain hospital but felt the easiest way to accomplish that would be just to go to that hospitals ED (have seen this 2x) but only tell triage the general "belly pain"...then tell us the whole long story finished by and thats why my doctor send me here to see a GI doctor

If you need a bus token

 

[jashanley]

Originally posted by ERMudPhud

-If you have been carrying heavy shopping bags and are worried the creases in your hands might be permanent


This, in my opinion, wins the award for most ridiculous complaint ever.

 

[jdog]

I don't understand how so many med students choose ER based on the lifestyle. I just got off my 4th straight 6p to 2a shift. If that is a good lifestyle, my name is Brad Pitt. Someone please get me back to a normal schedule. I havn't seen blind date in 4 days.

 

[jashanley]

you do realize that you just did an 8 hour shift! Meaning you have 16hrs left in the day to sleep eat and play......hmmmmm, sounds crappy to me.

Yeah and 3-4 shifts a week, with 3-4 days off (12-16 shifts per month). Too much work for my blood. I'd rather go into surgery. I never liked my family anyway. Who needs to see their kids grow up? Its overrated. sense the sarcasm? Sorry. I'm still tired from my month of medicine wards.

 

[DrQuinn]

Originally posted by jdog
I don't understand how so many med students choose ER based on the lifestyle. I just got off my 4th straight 6p to 2a shift. If that is a good lifestyle, my name is Brad Pitt. Someone please get me back to a normal schedule. I havn't seen blind date in 4 days.

Haven't seen Blind Date in 4 days? Get TIVO my friend! It is quite the Godsend. Not only do I get every Blind Date on TV, but I also get Motorweek and Car and Driver, as I always forget what time they are on, on the weekends, as well as any Melrose Place reruns that show up on TV.

Thankfully, EM would give me enough off time to WATCH those shows. I suppose I could set up a TIVO in the OR while I'm doing my 10th herniorraphy of the day at 11 pm...

Q

 

[paramed2premed]

Ok, its easy to pick on the uneducated, mentally ill, and the rest of the detritus in our society. For our next challenge, shall we go dynamiting fish in a barrel, see if we catch anything?

I work as a paramedic in an ED, and while all the above examples are totally credible to me, the truly ridiculous behavior comes from people with >7 years of medical education. To wit;

- The FP who sent in a pt by ambulance because she was unable to obtain a UA spec in the office, and "she didn't have the time to deal with this." The pt peed in a cup in the ED, and was D/C in 1o minutes.

- The IM physician who wanted to send from his office to our ED a pt (with new-onset a.fib at 150 bpm and a SBP of 60, along with altered LOC) by private vehicle.

- The FP who tells a pt with a cough to go to the ED because "they can see you sooner." When they present at the ED with obvious viral URI, we confrint the pt; "Why didn't you call your doctor."

- The ED doc and nurses who, while trying to restrain a thrashing and grunting trauma pt who fell off his harley at 70 mph, and now has a big dent in his frontal area, repeatedly yell "Relax!" without any apparent beneficial effect.

Does this resonate with anybody?

 

[docB]

Clearly you are the only intelligent person in your ER if not your entire community. Perhaps you could start teaching classes for the ER docs and nurses and community docs how not to be so stupid. Barring that you might consider that trying to communicate with an agitated, head-injured patient while you?re drawing up meds and preparing to intubate really doesn?t have a downside. As for the outside referrals, the community docs do abuse the ER using it as an overflow and after hours clinic. We could start a new thread called ?Dumb PMD referrals to the ED? but then they could start one called ?Patients the ED sent home to die.? Lastly, about your comment that we are shooting fish in a barrel when we joke about silly patients, so what? This is a good environment for commiseration with others in the field. It is therapeutic and appropriate.

 

[lizzied2003]

Originally posted by docB
We have a frequent flyer in our ED that pretends to be blind. It's hilarious. We've seen him walk up to the door doing just fine. He'll then pull out his dark glasses and his white cane and stumble in. He knows that we all know he's FOS but he keeps it up.

we had a similar guy who would leave the ED proper and wander through the hospital...someone tape a dollar bill on the floor and you can guess what happened.

also the parent who brings in their young kids for a 'ear check' and then tells you how because he is here with his children he is not able to make his own doctors appointment to get his backpain evaluated--'so do you think you could write me a prescription for vicodin?'


my most current favorite patient admitted via the ED took gazillion amitrytilline and trazadone and then drove to his mothers house so she could call 911 and she didn't think he had a 'problem'.

 

[Evisju7]

And if someone comes in with severe pain, you're not really able to identify a cause, they're just simply scared ****less because they've never experienced such excruciating pain before (but don't want drugs..), what do you do then? Do you throw them in the barrel of societal scum? Or do you objectively treat each patient as an individual?

I'm in no position to judge any of you, but please be careful when over-generalizing. I know you know, and I do too, that it can be dangerous.

 

[Siggy]

And if someone comes in with severe pain, you're not really able to identify a cause, they're just simply scared ****less because they've never experienced such excruciating pain before (but don't want drugs..), what do you do then? Do you throw them in the barrel of societal scum? Or do you objectively treat each patient as an individual?

I'm in no position to judge any of you, but please be careful when over-generalizing. I know you know, and I do too, that it can be dangerous.

1. It depends on the physical exam. Just because they're in pain doesn't mean that they're getting admitted, and just because they're in severe pain doesn't mean they're going home with a prescription for Dilaudid.

2. The last time someone replied to this thread was shortly after you watched Agent Cody Banks (or was it Piglet's Big Movie?) premier in the movie theater.

 

[Perrin]

How about,

Don't reply to this thread IF....

You are a self righteous premed.
You do not understand humor as a way to deal with stress.
You were still watching after school cartoons when the last person replied to this thread.

 

[Evisju7]

How about,

Don't reply to this thread IF....

You are a self righteous premed.
You do not understand humor as a way to deal with stress.
You were still watching after school cartoons when the last person replied to this thread.

I didn't realize how old this thread was until after I posted.

I'm not condemning anyone. I clearly stated "I'm in no position to judge..". Just because I haven't experienced the same kind of stress as you, doesn't mean I don't understand stress, or how to cope with it. My point wasn't meant to taken the way it clearly was; overall this thread is hilarious. I just wanted to point out a concern/observation.

BTW, I don't own a tv and didn't grow up with one. so... no cartoons.

 

[Evisju7]

You've kind of illustrated my point. This comment is so focused on the negative stereotype of "bum; chronic condition; suddenly worsens; seeking opioids", that it ignores the possibility of someone fitting that stereotype (at first glance), but seeking actual emergency attention. I'll rephrase what I said earlier: pre-judging a person, based on their fitting of a stereotype, can make you miss important details.

1. It depends on the physical exam. Just because they're in pain doesn't mean that they're getting admitted, and just because they're in severe pain doesn't mean they're going home with a prescription for Dilaudid.

2. The last time someone replied to this thread was shortly after you watched Agent Cody Banks (or was it Piglet's Big Movie?) premier in the movie theater.

 

[Siggy]

You've kind of illustrated my point. This comment is so focused on the negative stereotype of "bum; chronic condition; suddenly worsens; seeking opioids", that it ignores the possibility of someone fitting that stereotype (at first glance), but seeking actual emergency attention. I'll rephrase what I said earlier: pre-judging a person, based on their fitting of a stereotype, can make you miss important details.

So you missed the entire "depends on the physical exam" statement, right? That chronic back pain patient with no red flags is likely not getting a CT and is definitely not getting an MRI from the ED. The really useful medications requires follow up care, which is something that the ED isn't equipped to provide.

 

[Evisju7]

So you missed the entire "depends on the physical exam" statement, right? That chronic back pain patient with no red flags is likely not getting a CT and is definitely not getting an MRI from the ED. The really useful medications requires follow up care, which is something that the ED isn't equipped to provide.

sorry, you're right. I didn't miss that part, it just wasn't the main point of your post.

 

[Siggy]

sorry, you're right. I didn't miss that part, it just wasn't the main point of your post.

Actually, it kinda of is since you're main objection is not considering that chronic pain patients may be having an emergency, when many emergencies (like caudia equina syndrome in low back pain patients) can be ruled out by a good history and physical (hence why pain clinic patients don't get imaging every visit). Your problem is that we are objecting to the ED being used for something it isn't designed to handle... namely chronic pain patients requiring follow up.

Also, if I was really concerned that a patient was simply drug seeking, it's easy enough to run a state controlled drug database search (CURES in California) and see what pain prescriptions the patient currently has.

 

[Perrin]

I'm in no position to judge any of you, but please be careful when over-generalizing. I know you know, and I do too, that it can be dangerous.

I'll be a little less snarky.

I try very hard not to generalize or stereotype my patients. I frequently remind my mid levels and nurses that drug seekers and chronic pain patients get sick, have MI's, or appendicitis just like other people.

 

[Evisju7]

my point is to remain objective. The chronic pain example was just to make that point.

I seriously have no authority on this subject, so don't get offended by my comments. Take them or leave them, but don't write off what I'm saying solely on my inexperience in medicine.

 

[Evisju7]

Thanks

That makes me REALLY glad. You're absolutely right. (that you remind yourself and staff to try to be objective)
And it is hard not to stereotype, for anyone. It's human nature, and often it makes things easier. (For example, someone is having a heart attack: you don't sit there and objectively analyze why he's in pain, why he's acting that way, what's going on in the environment.. you make a quick judgment, subconsciously place him into "heart attack" stereotype/category, and act.)

 

[Birdstrike]

Your chief complaint in any way includes the phrase ?Just to get checked out.?

You wish to have injuries sustained in the past documented for your newest lawsuit.

You want a prescription for OTC Children?s Tylenol so that MediCal pays for it and you don?t have to forego one pack of smokes to buy it yourself.

You want me to sign off on your disability, social security, handicapped parking, school or sports physical or school or work excuse.

If your boss demands a doctor?s note to give you a sick day give me his number so I can chew him out and report him to your union and the state labor relations board.

Your pain is only relieved by 100 of Demerol and 25 of Visteril and you are allergic all other non-euphoric pain relievers.

Your child can?t sleep (I swear to God someone called 911 and came to the ER by ambulance last Saturday night).

You?re tired of taking care of your elderly family member and want them placed in a nursing home at 2am on a weekend night.

A doctor told you 15 years ago that you might need your back operated on and you decided that you want it done now (I?m not making this up. This guy drove 6 hours to get to my ER. ?Tonight?s the night.? he said.)

Your child may have had a fever a few days ago but he?s better now and you want to know what it was he had. (Again, not making it up)

You need a prescription for something and your primary doc refused.

You want Viagra.

You've got it all wrong Docb.

These are all easy level three E&Ms. That's how you should view them. These cases make your job easier. A shift with 40 straight, "Need Viagra refills" is the easiest paycheck you'll ever earn. You are bound by the full force of Federal law says to give every one of these a MSE. Good luck trying to get EMTALA over thrown or "educating America" to only use the ED like an ER doctor would. Every shift will have these patients. The mentality that these are somehow wrong headed, a thorn in your side or patients to be annoyed by is just begging for frustration. Make peace with the fact that these patients are the easy, low stress, low liability filler-cases between the "3-year-old accidentally run over by dad, must notify horrified frantic family, must take 5 minute vomit-cry break in bathroom" and "suicidal violent, psychotic murdering drunk/high spitter with spit net over head, blood spraying haldol/geodon/RSI-drugs won't stop him, will be psych hold in my hallway all night" patients.

You're looking at it all wrong. You should pray for a shift with 30 "need handicap sticker" patients in a row. All chip shot level 3's. Do you really want a shift with nothing but 100% unstable vitals petechial rash 3 yr old coding, MI stable now V-fibbing, kidney stone seemed simple now septic and can't get line, neighbor's pregnant wife checked in little tummy ache now pre-eclampsia seizing status can't get her stopped oops this sucks and is looking real real bad, finally an easy one febrile seizure looks bad now is shaken baby case get social services on the phone right lets call the chopper now before I lose it-type shifts?

Don't be a moth to the flame,

 

[RustedFox]

I officially propose a ban on the adjective "excruciating" on this forum; as that seems to be the only adjective that patients know in relation to pain.

Not "severe", not "intense", not "exquisite"... and certainly never "moderate".

I never want to hear that word again.

 

[Evisju7]

You must have heard the word too many times and therefore it's lost it's meaning. But to me, it implies emotional stress along with pain. Something the word "severe" does not do. It's simply a measurement.

I officially propose a ban on the adjective "excruciating" on this forum; as that seems to be the only adjective that patients know in relation to pain.

Not "severe", not "intense", not "exquisite"... and certainly never "moderate".

I never want to hear that word again.

 

[smq123]

You must have heard the word too many times and therefore it's lost it's meaning. But to me, it implies emotional stress along with pain. Something the word "severe" does not do. It's simply a measurement.

You have to remember....this is a medical forum for practitioners in that specialty to talk and discuss about their work. Yes, almost every doctor who deals with chronic pain patients has heard the word "excruciating" far too many times. But that's why this forum exists...for those doctors to vent a little steam. Not for pre-meds (or patients) to tell us that that word means something different for them.

 

[DocEspana]

You must have heard the word too many times and therefore it's lost it's meaning. But to me, it implies emotional stress along with pain. Something the word "severe" does not do. It's simply a measurement.

I would appreciate it greatly if next time you had a thought..... You just didn't.

Just let it go.

 

[DocEspana]

Helpful tip: if every punctuation except for . , ? and ! is randomly changed to ?, then you know you're about to necro-bump a thread that happened before you went from Tanner 1 to 2.

 

[Arcan57]

You must have heard the word too many times and therefore it's lost it's meaning. But to me, it implies emotional stress along with pain. Something the word "severe" does not do. It's simply a measurement.

It's not a measurement. It has no objective meaning. There are things that are painful, but the experience of pain is so subjective as to render any attempt to measure it at the individual patient level meaningless. And so much of the negative experience of pain isn't mediated through mu receptors. Much of what keeps chronic pain patients functional has little to do with opioid dosing and more to do with social support, aligning expectations with reality, and self-perception of disability.

 

[DocEspana]

It's not a measurement. It has no objective meaning. There are things that are painful, but the experience of pain is so subjective as to render any attempt to measure it at the individual patient level meaningless. And so much of the negative experience of pain isn't mediated through mu receptors. Much of what keeps chronic pain patients functional has little to do with opioid dosing and more to do with social support, aligning expectations with reality, and self-perception of disability.

I'm waiting for the direct to consumer advertising for total body dolor

 

[RustedFox]

You must have heard the word too many times and therefore it's lost it's meaning. But to me, it implies emotional stress along with pain. Something the word "severe" does not do. It's simply a measurement.

Daily. Every other patient uses that word. I'm not exaggerating.

Think about that.

When someone describes their abdominal pain as "excruciating", while busily texting back their (whoever) about their harrowing experience in the "ER!"... and you're the one trying to make sense of them while assuming all of the risk/responsibility in the situation...

... get back to me.

 

[Evisju7]

Daily. Every other patient uses that word. I'm not exaggerating.

Think about that.

When someone describes their abdominal pain as "excruciating", while busily texting back their (whoever) about their harrowing experience in the "ER!"... and you're the one trying to make sense of them while assuming all of the risk/responsibility in the situation...

... get back to me.

Yeah, this would get obnoxious. I think I'd have a rule on the word: if you use it, that pain better be your main focus... if you can text, you're not in "excruciating pain".

Side note: I'm leaving this thread. I don't think I'm welcome.. not my intention to piss everyone off. Adios

 

[RustedFox]

Yeah, this would get obnoxious. I think I'd have a rule on the word: if you use it, that pain better be your main focus... if you can text, you're not in "excruciating pain".

Side note: I'm leaving this thread. I don't think I'm welcome.. not my intention to piss everyone off. Adios

You're welcome in the thread.

Just be open to learn.

I was once a lot like you. I really, really, was. Hate to admit it. Self-assured pre-med with a really good GPA and the idea that there's nothing that I can't master quickly (!) because it was easy to ace that cell-bio final after 2-nights of cramming and even with a moderate hangover on teh (sic) day-off. Therefore, my opinion is more-than-already-validated.

I made that mistake. Several times. And then some more.

Now: I know... what I don't know. And I know enough, to listen up.

 

[The White Coat Investor]

This was a great thread until a certain post....

In an effort to get back on topic,

Don't check in to the ER because your wife thinks she gave you one extra pain pill, then called you in the waiting room to let you know that you actually got the right dose. It's been two hours, you are alert, oriented, not sleepy at all, and breathing just fine.

Sorry, that's my only ridiculous one for today. The other 15 were legit.

 

[DocEspana]

This was a great thread until a certain post....

In an effort to get back on topic,

Don't check in to the ER because your wife thinks she gave you one extra pain pill, then called you in the waiting room to let you know that you actually got the right dose. It's been two hours, you are alert, oriented, not sleepy at all, and breathing just fine.

Sorry, that's my only ridiculous one for today. The other 15 were legit.

In peds today:

Don't bring your 8 month old in for "body bumps" that turn out to be a singular 3x3mm wart on the foot that is entirely non painful.

Don't bring your 6 month old in for non traumatic "lower back pain". I don't even know how to begin retelling how the mother decided that her infant had lower back pain.

 

[Evisju7]

You're welcome in the thread.

Just be open to learn.

I was once a lot like you. I really, really, was. Hate to admit it. Self-assured pre-med with a really good GPA and the idea that there's nothing that I can't master quickly (!) because it was easy to ace that cell-bio final after 2-nights of cramming and even with a moderate hangover on teh (sic) day-off. Therefore, my opinion is more-than-already-validated.

I made that mistake. Several times. And then some more.

Now: I know... what I don't know. And I know enough, to listen up.

I actually struggled a lot in highschool. I had to leave because of health issues and wasn't motivated to continue. Now, I do very well in school (college), but it took a huge amount of effort to get where I am.
I don't take any of it for granted. My grades are a reflection of overcoming (and still overcoming) struggles. Thankfully, because of what I've been through, I've learned a lot about "life". That's why it's almost painful to hear some of the people here talk about bums as if they're trash. I know some of the cases you see are ridiculous, users of the system. (I wish someone, not necessarily in healthcare, would ask why there is so many people doing this.. maybe there's a solution. Poor behavior is the result of some deeper flaw. Complaining about the behavior doesn't fix the problem. I am just as frustrated and complain too.. I'm a hypocrite.) But each person should be treated as an individual, not a member of a bad stereotype.


Wasn't I leaving!?

 

[DocEspana]

I actually struggled a lot in highschool. I had to leave because of health issues and wasn't motivated to continue. Now, I do very well in school (college), but it took a huge amount of effort to get where I am.
I don't take any of it for granted. My grades are a reflection of overcoming (and still overcoming) struggles. Thankfully, because of what I've been through, I've learned a lot about "life". That's why it's almost painful to hear some of the people here talk about bums as if they're trash. I know some of the cases you see are ridiculous, users of the system. (I wish someone, not necessarily in healthcare, would ask why there is so many people doing this.. maybe there's a solution. Poor behavior is the result of some deeper flaw. Complaining about the behavior doesn't fix the problem. I am just as frustrated and complain too.. I'm a hypocrite.) But each person should be treated as an individual, not a member of a bad stereotype.


Wasn't I leaving!?

My favorite fallacy of all, the contrarian: