I am a "frequent flyer" and I'm sorry

[manda33]

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[DocEspana]

Concise.

 

[BoardingDoc]

Concise.

Before she deleted it, it was a lengthy post about how she has panic attacks and develops SOB/CP/other symptoms and despite trying to get her Sx under control with her regular PCP/psychiatrist she isn't always able to, at which point she goes to the ED because (like many people) she feels like she's dying when in fact she's just having a panic attack.

She was basically saying thanks for existing so she can get seen, and apologizing for "wasting our time."

I didn't really know how to respond when I first read it because A: I'm happy she could get the reassurance she needs but B: I wish I wasn't the one being forced to give it.

 

[DocEspana]

Before she deleted it, it was a lengthy post about how she has panic attacks and develops SOB/CP/other symptoms and despite trying to get her Sx under control with her regular PCP/psychiatrist she isn't always able to, at which point she goes to the ED because (like many people) she feels like she's dying when in fact she's just having a panic attack.

She was basically saying thanks for existing so she can get seen, and apologizing for "wasting our time."

I didn't really know how to respond when I first read it because A: I'm happy she could get the reassurance she needs but B: I wish I wasn't the one being forced to give it.

So what you're saying is... Not concise?

 

[BoardingDoc]

Verbose.

 

[GeneralVeers]

I would have more sympathy for these people if they would simply tell the triage nurse, and me "I'm having a panic attack, these are my usual panic attack symptoms", rather than having the complaint of SOB, CP then making me a do a huge negative workup and having to guess at the fact that it's a panic attack.

 

[WilcoWorld]

I think that feeling like you're going to die is a perfectly good reason to go to the ED, even if you know that the last 5 times you did the same you turned out to be OK. If Dr. General Veers can't rule out impending death without an ECG a blood pressure and a pulse Ox (which is about all I'll do on someone with recurrent panic attack symptoms and prior negative work up) than how is someone in the throes of a panic attack supposed to?

Like it or not, we are in the reassurance business. Someone like the OP (at least, as Boarding Doc describes it) is not a thorn in my side. Now, if he/she demands a million dollar workup over and over again for the same symptoms in spite of a compassionate and thoughtful discussion of why it's not needed…that's a very different story.

 

[GeneralVeers]

I think that feeling like you're going to die is a perfectly good reason to go to the ED, even if you know that the last 5 times you did the same you turned out to be OK. If Dr. General Veers can't rule out impending death without an ECG a blood pressure and a pulse Ox (which is about all I'll do on someone with recurrent panic attack symptoms and prior negative work up) than how is someone in the throes of a panic attack supposed to?

Like it or not, we are in the reassurance business. Someone like the OP (at least, as Boarding Doc describes it) is not a thorn in my side. Now, if he/she demands a million dollar workup over and over again for the same symptoms in spite of a compassionate and thoughtful discussion of why it's not needed…that's a very different story.

I'm perfectly fine with blood pressure, and pulse ox. I don't even need ECG to rule out impending death. All I ask is that they tell me this is similar to their prior panic attacks! It drives me crazy when a 40-60 year old patient comes in with c/o chest pain, doesn't say anything about panic attacks, I spend time (and money) doing a 2 hour negative workup, only to find out after the fact that there is a history of these.

 

[TrumpetDoc]

I'm perfectly fine with blood pressure, and pulse ox. I don't even need ECG to rule out impending death. All I ask is that they tell me this is similar to their prior panic attacks! It drives me crazy when a 40-60 year old patient comes in with c/o chest pain, doesn't say anything about panic attacks, I spend time (and money) doing a 2 hour negative workup, only to find out after the fact that there is a history of these.

At the same time, that's a double edged sword with the potential for anchoring bias with pts that do put that tag line upfront.

Not that we are not confronted with this cognitive landline one a hourly basis


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[GeneralVeers]

At the same time, that's a double edged sword with the potential for anchoring bias with pts that do put that tag line upfront.

Not that we are not confronted with this cognitive landline one a hourly basis


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Then by your logic taking a history and physical is not useful, and we should be slaves to the troponin, admit, stress on every chest pain EVEN if they tell us that it is their usual anxiety attack.

 

[TrumpetDoc]

Ha! Not at all not mentioning hx at all, just the fact when pts "think" that they are having their usual whatever...most of the time they do, but that is where anchoring is most common and a huge source of error.


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[WilcoWorld]

I'm perfectly fine with blood pressure, and pulse ox. I don't even need ECG to rule out impending death. All I ask is that they tell me this is similar to their prior panic attacks! It drives me crazy when a 40-60 year old patient comes in with c/o chest pain, doesn't say anything about panic attacks, I spend time (and money) doing a 2 hour negative workup, only to find out after the fact that there is a history of these.

Gotcha. That drives me crazy too.

 

[Birdstrike]

I'm a frequent flyer, and I too am sorry.

 

[BoardingDoc]

I'm a frequent flyer, and I too am sorry.

Meh, once you hit gold or better status it isn't so bad.