Four Kid Family Plan

[docB]

Mom brings in 4 kids ages <5 for various cold and flu symptoms. The midlevel and I sort the kids out. Figure out who's got otits and who doesn't and who need Zofran etc. 40 minutes after hitting the room, been in the department for an hour and 30 minutes with the midlevel and mom is irate that it's taking so long. Mom then nearly blows a gasket when the nurse tells her it will be at least another 20 minutes before we can get done charting and writing the scripts.

How messed up is our system when you can drag your 4 non-emergent kids into an EMERGENCY ROOM for the sniffles all at no expense to yourself whatsoever and you feel entitled to be in and out in under an hour?

She got screwed by the nurse though. On discharge vitals 2 of the kids who didn't have fevers initially had developed fevers so the nurse forced her to stay to have the kids medicated and then document that the fevers had resolved. That took an extra hour. Note that I didn't ask for that. I specifically told the nurse not to keep them but she is convinced that if she discharges a kid with a fever she will... wait for it... You guessed it! "Lose her license." We must not be aware of it but clearly there is a whole division of the board of nursing devoted to pulling the licenses of nurses who commit felonious febrile discharge and other heinous nursing crimes.

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[WilcoWorld]

This reminds me of a Mom who recently stormed out of my ED when her son waited for almost 30 minutes at 11pm on a Saturday when he was brought in for Play Doh he'd put in his ear on Thursday.

The following relationship may already have an eponym, but if not, I'd like to propose Wilco's Rule:

The amount of time it takes parents to get upset with their LOS is proportional to the acuity of their child's illness.

On second thought, that's not very punchy. Let's call it something else.

 

[deleted109597]

Whats nice is maybe you'll get 4 bad press ganeys instead of only 1, since there were 4 patient encounters.

 

[Arcan57]

Mom brings in 4 kids ages <5 for various cold and flu symptoms. The midlevel and I sort the kids out. Figure out who's got otits and who doesn't and who need Zofran etc. 40 minutes after hitting the room, been in the department for an hour and 30 minutes with the midlevel and mom is irate that it's taking so long. Mom then nearly blows a gasket when the nurse tells her it will be at least another 20 minutes before we can get done charting and writing the scripts.

How messed up is our system when you can drag your 4 non-emergent kids into an EMERGENCY ROOM for the sniffles all at no expense to yourself whatsoever and you feel entitled to be in and out in under an hour?

She got screwed by the nurse though. On discharge vitals 2 of the kids who didn't have fevers initially had developed fevers so the nurse forced her to stay to have the kids medicated and then document that the fevers had resolved. That took an extra hour. Note that I didn't ask for that. I specifically told the nurse not to keep them but she is convinced that if she discharges a kid with a fever she will... wait for it... You guessed it! "Lose her license." We must not be aware of it but clearly there is a whole division of the board of nursing devoted to pulling the licenses of nurses who commit felonious febrile discharge and other heinous nursing crimes.

I took my 1yo to his scheduled check up and it still took over an hour just to see the doc. I think if these moms ever took their kids to the pediatrician they'd have a clearer understanding of wait times. Lack of responsibility breeds entitlement.

 

[EM_Rebuilder]

Are there documented cases of a nurse 'Losing their License' over doing something a physician requested?

I fortunately do not hear this lots of times, but it occasional comes up. I tend to roll my eyes and go with it to not cause un-needed nurse-doctor tensions...

 

[dchristismi]

I tell them that I know, they can chart "MD aware," and to send them home. Same for that blood pressure of 170/86 or whatever. Sometimes I just d/c them myself and cut that last set of vitals out of the picture.

My record is a seven-fer. 2 adults, 5 kids in minor MVC. The charting took forever with one kid's scraped knee here, one scratch from a seat belt there... they were at least nice about it.

And Wilco's Rule it is. You claimed it, you're stuck with it. (Just be glad it doesn't involve vaginal discharge!)

 

[RustedFox]

Pathetic. Absolutely pathetic.

I'm in favor of signs with large lettering in the waiting room/triage areas detailing what is reasonable to expect, and what is unreasonable to expect in the ED. Anyone else think this is a good idea ?

 

[pinipig523]

You had a four-fer, I had a six-fer once.

That was something I do not want to relive. Good thing an intern and I tackled the room together. The intern interviewed while I typed the notes all at once.

 

[deleted109597]

During swine flu season in 2010 we had a 7-fer. Of spanish speaking only patients.

 

[deleted109597]

Are there documented cases of a nurse 'Losing their License' over doing something a physician requested?

I'm sure that there have been times doctors have ordered the wrong thing (or an allergy, or something) that the doctor was wrong, and they got onto the nurse for not "speaking up and being a patient advocate."

 

[la gringa]

partner of mine had an 8fer - all s/p MVC TWO DAYS prior. nothing objectively wrong with any of them. i think it destroyed the sanity of the nurse though.

recent 7fer for scabies included grandma, who spoke only Haitian Creole I believe, family happened to mention her dark stools to the PA. had PA do a rectal - positive -- later, Hb 8. one of my stranger cc vs admit dx ever! scabies --> GI bleed.

 

[AlmostJesus]

pathetic. Absolutely pathetic.

I'm in favor of signs with large lettering in the waiting room/triage areas detailing what is reasonable to expect, and what is unreasonable to expect in the ed. Anyone else think this is a good idea ?

+1

 

[EctopicFetus]

In residency I did a 9fer.. Recently I did an 8fer for possible CO exposure. No one had a single symptom. One of the kids had like an ear infection or something.

On the bright side 1) I had a scribe 2) they had medicaid so I billed for 8 visits.. 3) bed to dispo time for them all under 30 mins.
Downside too numerous to list..

 

[WilcoWorld]

Can anyone tell me if this is a no-no?

When I get a family of kids with viral symptoms I'll type one HPI and cut & paste it into all of their electronic charts. It'll read something like, "This child is brought in for evaluation of a cough that the whole family has been suffering from. Jack developed a cough and runny nose three days ago. Sally developed cough two days ago and has had one episode of post-tussive emesis. George was noted to have rhinorrhea this morning. None of them have had fevers, rash or diarrhea and all are tolerating fluids and making at least three wet diapers a day. Mom has not noted any alteration in mental status or difficulty breathing in any of the children...etc."

I've never been given a hard time about this, but I wonder if it could get me in trouble?

 

[AmoryBlaine]

Not a record but heinous:

4fer.

4 kids ranged from 6mos to 10years. All different dad's/last names. It was almost comedic, mom was white and had clearly sampled every flavor in the shop. All the kids took after their dads and had dad's last name.

6m/o had febrile uri, very well appearing. Mom checked all the others in for a "check-up."



In all honestly I think this crap would be nearly fixed by attaching a nominal, up-front fee to emergency care for non-resus patients i.e. $10.

 

[Pinner Doc]

Mom then nearly blows a gasket when the nurse tells her it will be at least another 20 minutes before we can get done charting and writing the scripts.

How messed up is our system when you can drag your 4 non-emergent kids into an EMERGENCY ROOM for the sniffles all at no expense to yourself whatsoever and you feel entitled to be in and out in under an hour?

Yeah, maddening. I tend to get annoyed inwardly but then tell myself that if they're really that pissed about waiting, want to leave, and have one foot out the door... then they can leave. And I'll document that they eloped.

My frustration the other morning was walking into an early morning shift, 15 min before it started, and being asked to "take a look" at a patient since he seemed "kind of sick" and the night doctor was almost off. The nurses brought me his EKG, which looked like a STEMI. I'm gearing up to go in and see this guy, when family from another room who had been waiting about an hour (the overnight guy had gotten slammed) comes out and gets in my face about, "You're about to lose a patient in here! He's going into shock again! You need to do something about it!" Now, mind you, I've JUST walked in... ten minutes now before my shift even starts, I've got a STEMI already in the other room to take care of... and it turns out that this other patient was just post-op pain in a narcotic tolerant patient (uses oxycontin at baseline, is 34 yrs old and otherwise healthy). Shock? About to LOSE him? Arg.

 

[GeneralVeers]

Yeah, maddening. I tend to get annoyed inwardly but then tell myself that if they're really that pissed about waiting, want to leave, and have one foot out the door... then they can leave. And I'll document that they eloped.

My frustration the other morning was walking into an early morning shift, 15 min before it started, and being asked to "take a look" at a patient since he seemed "kind of sick" and the night doctor was almost off. The nurses brought me his EKG, which looked like a STEMI. I'm gearing up to go in and see this guy, when family from another room who had been waiting about an hour (the overnight guy had gotten slammed) comes out and gets in my face about, "You're about to lose a patient in here! He's going into shock again! You need to do something about it!" Now, mind you, I've JUST walked in... ten minutes now before my shift even starts, I've got a STEMI already in the other room to take care of... and it turns out that this other patient was just post-op pain in a narcotic tolerant patient (uses oxycontin at baseline, is 34 yrs old and otherwise healthy). Shock? About to LOSE him? Arg.

Gotta love hysterical patients who use inappropriate medical jargon to describe their non-emergency. Like the non-sick young person with a cold who is afraid that their body is "shutting down". Still not sure what that means medically, but it sounds bad.

 

[RustedFox]

"Going into shock! About to LOSE HIM! My body is SHUTTING DOWN!"

I want to slap all these patients. I do enjoy the occasional 'education' session where I say - "that's not what shock is".

... and the "my (body part) is shutting down". Yep. No idea what that means. Its like they think that their kidneys/liver/whatever just decided of its own volition to pack it up and leave town.

 

[GeneralVeers]

"Going into shock! About to LOSE HIM! My body is SHUTTING DOWN!"

I want to slap all these patients. I do enjoy the occasional 'education' session where I say - "that's not what shock is".

... and the "my (body part) is shutting down". Yep. No idea what that means. Its like they think that their kidneys/liver/whatever just decided of its own volition to pack it up and leave town.

Kind of like when Padme Amidala "Lost the will to live" in Episode 3?

 

[theseeker4]

"Going into shock! About to LOSE HIM! My body is SHUTTING DOWN!"

I want to slap all these patients. I do enjoy the occasional 'education' session where I say - "that's not what shock is".

... and the "my (body part) is shutting down". Yep. No idea what that means. Its like they think that their kidneys/liver/whatever just decided of its own volition to pack it up and leave town.

To be fair, doctors use the term "shutting down" all the time. For example, my wife's friend's grandmother just died, and the doctor had told the grandson that her "organs were shutting down one by one." I was told the same thing about my grandmother years ago. How medically relevant that comment is compared to the complaints you hear I have no clue (I would bet the complaints you hear are far less accurate), but it is a phrase commonly used by doctors....

 

[Pinner Doc]

"Going into shock! About to LOSE HIM! My body is SHUTTING DOWN!"

I want to slap all these patients. I do enjoy the occasional 'education' session where I say - "that's not what shock is".

... and the "my (body part) is shutting down". Yep. No idea what that means. Its like they think that their kidneys/liver/whatever just decided of its own volition to pack it up and leave town.

They tried the whole "he's about to go into shock again!" while I was at the bedside examining him. To which I calmly replied, "You're not going into shock. I see your vital signs. You're in pain, but you're OK." Who knows if it placated them. They seemed to shut up about it afterward. Such drama!

 

[WilcoWorld]

To be fair, doctors use the term "shutting down" all the time. For example, my wife's friend's grandmother just died, and the doctor had told the grandson that her "organs were shutting down one by one." I was told the same thing about my grandmother years ago. How medically relevant that comment is compared to the complaints you hear I have no clue (I would bet the complaints you hear are far less accurate), but it is a phrase commonly used by doctors....

I think that's the point. Most of us don't mind it when people use common language to express concern. It's when medical jargon is misused that we're peeved, because it only muddies the situation.
"My dad stopped breathing!" "My son's turning blue!" "My wife is freaking the eff out!" are informative statements and will get a prompt and appropriate response from me. "My sister is coding!" "I'm going into shock!" or "My body is shutting down!" have medically relevant meanings, but these phrases rarely accurately describe the situation when used by laypersons, so they usually serve to frustrate rather than inform.

 

[gutonc]

I think that's the point. Most of us don't mind it when people use common language to express concern. It's when medical jargon is misused that we're peeved, because it only muddies the situation.
"My dad stopped breathing!" "My son's turning blue!" "My wife is freaking the eff out!" are informative statements and will get a prompt and appropriate response from me. "My sister is coding!" "I'm going into shock!" or "My body is shutting down!" have medically relevant meanings, but these phrases rarely accurately describe the situation when used by laypersons, so they usually serve to frustrate rather than inform.

This.

Of course, nurses and other "medical" "professionals" also routinely misuse these terms as well. A week or two ago a nurse calmly strolled into the doc's office in our oncology clinic and asked "does anybody have time to come take a look at this guy with apnea in the infusion unit?" Four of us jumped up and dashed down the hall to find a guy drinking a Sprite with a pulse ox on his finger reading 99% on room air.

Us: "Where's the apneic patient?"
RN: "Right here."
Us: "This guy satting 99 and drinking a soda?"
RN: "yes, he was coughing a lot a few minutes ago when he choked on his drink and had a hard time catching his breath."
Us: "Do you even know what apnea means?"
RN: "Difficulty breathing?"
Us: "No." Shake heads and walk away.

 

[Tiger26]

Gotta love hysterical patients who use inappropriate medical jargon to describe their non-emergency. Like the non-sick young person with a cold who is afraid that their body is "shutting down". Still not sure what that means medically, but it sounds bad.

Had the lady this week who cried "contrast killed my kidneys" when refusing a CT angio after acute onset of CP, back pain, and unstoppable vomiting . . . with a 3 vessel CABG only a month ago . . . and a creatinine of 1.2 . . .

Then, given her massive aspiration risk, refused intubation for a TEE to rule out dissection.

Hmmmm, why are you here then???

 

[EctopicFetus]

Maybe its that I work for a private group but knowing Ill get compensated for seeing these clowns gets me through it. Im still annoyed but I tell myself.. hey at least they are paying (or medicaid is)..

I never check insurance cause then I would be really annoyed with the self pays.

 

[TrumpetDoc]

Kind of like when Padme Amidala "Lost the will to live" in Episode 3?

Love the SW reference!


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[docB]

Maybe its that I work for a private group but knowing Ill get compensated for seeing these clowns gets me through it. Im still annoyed but I tell myself.. hey at least they are paying (or medicaid is)..

I never check insurance cause then I would be really annoyed with the self pays.

I have to check on dispo because it determines who admits them or what clinic they get referred to.

 

[la gringa]

Maybe its that I work for a private group but knowing Ill get compensated for seeing these clowns gets me through it. Im still annoyed but I tell myself.. hey at least they are paying (or medicaid is)..

I never check insurance cause then I would be really annoyed with the self pays.

i know this feeling well!!!

i only ask b/c of f/u and rx choices, at the end of a visit, if it it germane.

 

[Pinner Doc]

Maybe its that I work for a private group but knowing Ill get compensated for seeing these clowns gets me through it. Im still annoyed but I tell myself.. hey at least they are paying (or medicaid is)..

I never check insurance cause then I would be really annoyed with the self pays.

Not to be a debbie downer (waaa-waaaaaa), but as we learned in WA state, can't always count on this!

 

[la gringa]

Not to be a debbie downer (waaa-waaaaaa), but as we learned in WA state, can't always count on this!

my state is one of the highest Medicaid reimbursers in the nation (something like 80-90% of medicare - not that anyone's getting rich off of it, but it's not the $15/visit like NY), so i try to just smile and not bitch too much about the "my baby felt warm, oh and big sis threw up once yesterday, and i have vag dc" visits.

 

[Zanegray]

Pathetic. Absolutely pathetic.

I'm in favor of signs with large lettering in the waiting room/triage areas detailing what is reasonable to expect, and what is unreasonable to expect in the ED. Anyone else think this is a good idea ?

I've always thought we need a public service announcement - what to expect in the ED. Or maybe an after school special....
"you can expect us to rule out life threatening illness. We likely will not provide a diagnosis, and you may not get your pain killer of choice, and even if you have somewhere to be, you may still have to wait. Thank you, and have a nice day."

 

[med2UCC]

Yes, my current favorite is the woman who came in to demand my name and license # because she was going to formally complain to the college for her long wait in the ED. She had been there less than 2 hours on a weekend day for a narcotic prescription refill and I had been in the department less than 5 minutes. Before I saw her I put a cast on a colles fracture, saw an asthmatic child with virtually no air entry and an 88 yo chest pain (so nothing important really). Fortunately the nurse documented that, because she did report me to the college for humiliating her by explaining how an emergency department works (i.e. the triage system) and the department policy regarding narcotic refills. I documented it all very carefully as she called me a f+cking b*tch as she stomped out so I knew she might not be the most satisfied customer ever. Seen in under 3 hours on a very busy shift in a single coverage shop but completely unacceptable treatment. Oh well,
M

 

[GeneralVeers]

Yes, my current favorite is the woman who came in to demand my name and license # because she was going to formally complain to the college for her long wait in the ED. She had been there less than 2 hours on a weekend day for a narcotic prescription refill and I had been in the department less than 5 minutes. Before I saw her I put a cast on a colles fracture, saw an asthmatic child with virtually no air entry and an 88 yo chest pain (so nothing important really). Fortunately the nurse documented that, because she did report me to the college for humiliating her by explaining how an emergency department works (i.e. the triage system) and the department policy regarding narcotic refills. I documented it all very carefully as she called me a f+cking b*tch as she stomped out so I knew she might not be the most satisfied customer ever. Seen in under 3 hours on a very busy shift in a single coverage shop but completely unacceptable treatment. Oh well,
M

You can bet you'll get a survey, she'll give you all "1's" and destroy your average. Then if you work for a group like mine, you can kiss goodbye the Press-Ganey bonus for a year.

 

[ensuii]

This.

Of course, nurses and other "medical" "professionals" also routinely misuse these terms as well. A week or two ago a nurse calmly strolled into the doc's office in our oncology clinic and asked "does anybody have time to come take a look at this guy with apnea in the infusion unit?" Four of us jumped up and dashed down the hall to find a guy drinking a Sprite with a pulse ox on his finger reading 99% on room air.

Us: "Where's the apneic patient?"
RN: "Right here."
Us: "This guy satting 99 and drinking a soda?"
RN: "yes, he was coughing a lot a few minutes ago when he choked on his drink and had a hard time catching his breath."
Us: "Do you even know what apnea means?"
RN: "Difficulty breathing?"
Us: "No." Shake heads and walk away.

"Lindsay Lohan update.

We have more specifics. We're told Lindsay wasn't feeling well after complaining of exhaustion, she called someone from the "Liz and Dick" production team early this morning, and the team sent a private doctor to check on her. Before arriving, the doctor called the hotel and asked someone to check on Lindsay. Someone from the hotel went to her door, "checked on her" and determined she was "unresponsive." The hotel then called 911."

 

[EctopicFetus]

i know this feeling well!!!

i only ask b/c of f/u and rx choices, at the end of a visit, if it it germane.

I ask for rx when it matters.. Otherwise it doesnt for us. We intermittently have this insurance determine the admitting service too.

Not to be a debbie downer (waaa-waaaaaa), but as we learned in WA state, can't always count on this!

Maybe not always but I can today.

my state is one of the highest Medicaid reimbursers in the nation (something like 80-90% of medicare - not that anyone's getting rich off of it, but it's not the $15/visit like NY), so i try to just smile and not bitch too much about the "my baby felt warm, oh and big sis threw up once yesterday, and i have vag dc" visits.

FWIW arizona is at 105%.. not gonna get rich off that but most of those that we see with medicaid come in with UC complaints cause a lot of the UCs dont take medicaid/medicare here.

You can bet you'll get a survey, she'll give you all "1's" and destroy your average. Then if you work for a group like mine, you can kiss goodbye the Press-Ganey bonus for a year.

We no longer use press-ganey where I work but I was told that they dont go to anyone with a dc dx of chronic pain, rx refill and a few others.. there are gamaes to be played with PG.

 

[BushDoc20]

man i really feel for you guys....i think they need to start breeding americans tougher....at the hospital i've mainly had parents bring their infants or toddlers in if they refuse liquids, don't sleep and have a slight temp. i do the vitals on kids under 5 purely because nursing staff have been known to take their bad shift out on kids when they won't sit still or start screaming.

we have signage and ads on tv about going to the ER for colds and flus

 

[GeneralVeers]

man i really feel for you guys....i think they need to start breeding americans tougher....at the hospital i've mainly had parents bring their infants or toddlers in if they refuse liquids, don't sleep and have a slight temp. i do the vitals on kids under 5 purely because nursing staff have been known to take their bad shift out on kids when they won't sit still or start screaming.

we have signage and ads on tv about going to the ER for colds and flus

Don't forget that at some time in the last decade it was determined that to be a good parent you had to bring your kid IMMEDIATELY to the ER if they fell and had even the slightest bump on the head.

 

[8654Marine]

Don't forget that at some time in the last decade it was determined that to be a good parent you had to bring your kid IMMEDIATELY to the ER if they fell and had even the slightest bump on the head.

Does it seem that every office practice seems to send in their patients to the ED to be "checked out for a concussion"?

I've had folks sent in immediately, days and even weeks after a head injury. With no other symptoms.

 

[med2UCC]

You can bet you'll get a survey, she'll give you all "1's" and destroy your average. Then if you work for a group like mine, you can kiss goodbye the Press-Ganey bonus for a year.

Fortunately, I work in Canada where we don't use Press-Ganey scores. However, it did result in a college complaint, which is still grinding through the tedious and unnecessarily long process of investigation. Fortunately the insurance company is on my side, and my bonus is strictly on patients seen and acuity. But it still all sucks. Cheers,
M
PS: Canadian parents have been brainwashed into bringing their kids with a minor bump, low grade temp for 30 minutes (don't even try tylenol) and all the other minor complaints you are detailing here. However, when I see them in the office in follow-up I reinforce that they should come to me 1st and avoid emerg like the plague. It is slowly sinking in. More PCP's need to do the same.
Of my last 14 patients sent into emerg from my office, 13 were admitted, one saw cardiology the next day. All required further work-up to make the diagnosis (admittedly, in one the further work-up consisted of her initial O2 sat - 78%).

 

[8654Marine]

Med2UCC, good luck.

We need more primaries like you. Thanks.

 

[med2UCC]

Thanks. I try.

 

[Apollyon]

PS: Canadian parents have been brainwashed into bringing their kids with a...low grade temp for 30 minutes.

Do the parents actually mention it? I have seen in my career more than I could ever remember of "s/he had a fever". "Did you measure it, with a thermometer?" "No, s/he felt hot to my touch."

So, well appearing tactile fever non-febrile kid. Thanks.

But the 30 min temp is like the people with transient nausea for 10 or 20 minutes, without vomiting, and now with no current complaint. Thanks again!

 

[med2UCC]

Do the parents actually mention it? I have seen in my career more than I could ever remember of "s/he had a fever". "Did you measure it, with a thermometer?" "No, s/he felt hot to my touch."

So, well appearing tactile fever non-febrile kid. Thanks.

But the 30 min temp is like the people with transient nausea for 10 or 20 minutes, without vomiting, and now with no current complaint. Thanks again!

Of course they don't measure it - where would be the fun in that?
We do actually have parents here who have thermometers and know how to use them, but they tend also to be the ones who use their PCP's as well. Sadly there is a subset who know how to use the thermometer but don't know how to interpret the results, so they come in because little Johnny has a temp of....37.5! Oh no! Febrile seizures cannot be far behind!
Best ever was the mom who brought in her 6 month old because they were at a wedding and her cousin, who had a cold, kissed her. "So, how long ago did this happen Ma'am?" "Half an hour ago." "And what to you want us to do?" "Well, I just thought she should be checked out." Guess she thought the cousin had a super virus that could penetrate the kid's immune system in under an hour causing potentially lethal illness that would be readily apparent to the trained observer. Fortunately for humanity, said virus doesn't currently exist.
Oh well,
M

 

[la gringa]

i had a woman bring an apple to the ED once... she had bitten into it and there was a worm in it, and she wanted to know if it was harmful. i think the nurses refused to register her.

 

[EctopicFetus]

People are funny. about 10 minutes prior to the end of my shift they bring in a 20 something pregnant girl with a bug in her ear. She is screaming like im moving her open femur without meds.. Anyways I get the thing out and she asks "what kind of bug is that?" my reply.. "i dont know I didnt go to school for that".

 

[AmoryBlaine]

Had the lady this week who cried "contrast killed my kidneys" when refusing a CT angio after acute onset of CP, back pain, and unstoppable vomiting . . . with a 3 vessel CABG only a month ago . . . and a creatinine of 1.2 . . .

Then, given her massive aspiration risk, refused intubation for a TEE to rule out dissection.

Hmmmm, why are you here then???

Dilaudid!

 

[The White Coat Investor]

Fortunately, I work in Canada where we don't use Press-Ganey scores. However, it did result in a college complaint, which is still grinding through the tedious and unnecessarily long process of investigation. Fortunately the insurance company is on my side, and my bonus is strictly on patients seen and acuity. But it still all sucks. Cheers,
M
PS: Canadian parents have been brainwashed into bringing their kids with a minor bump, low grade temp for 30 minutes (don't even try tylenol) and all the other minor complaints you are detailing here. However, when I see them in the office in follow-up I reinforce that they should come to me 1st and avoid emerg like the plague. It is slowly sinking in. More PCP's need to do the same.
Of my last 14 patients sent into emerg from my office, 13 were admitted, one saw cardiology the next day. All required further work-up to make the diagnosis (admittedly, in one the further work-up consisted of her initial O2 sat - 78%).

Yes, and how about the last 14 your office sent in without you knowing about it?

Most of the patients "sent in by doc" weren't. I know. I call the doc.

 

[med2UCC]

Yes, and how about the last 14 your office sent in without you knowing about it?

Most of the patients "sent in by doc" weren't. I know. I call the doc.

My Secretaries know better than that! They ask me about the ones they're not certain of and if I'm still not sure I talk to them. Usually they come to the office and get squeezed in. Occasionally they go to emerg from there, but usually we can sort them out from there. One elderly gentleman refused to come to the office and refused to let me do a housecall at the end of the day - he went to emerg with his pancreatitis instead. I have sent one straight to emerg over the phone - he was having an NSTEMI (very suspicious sounding retrosternal chest pain, confirmed by trops).
And yes, I still do housecalls, frequently instead of lunch on my office days.
Cheers,
M