What fraction of ER visits concern actual medical issues?

[Lord Humongus]

I'm tentatively interested in EM and have been browsing this forum for a while. It seems that one of the complaints folks in the field have is dealing with drug seekers/crazy people/low-functioning people.

My own interest in medicine stems primarily from liking the science and wanting to treat real, tangible medical problems related to human physiology. I am definitely not into psychology or social work and have little interest in trying to talk obese people into dieting or smokers into quitting and stuff like that. With that said, I'm curious if the residents and attendings here could share what fraction of your patients & time is spent dealing with real medical issues and what fraction is devoted to drug seekers and crazies.

Sorry for the rather impolite way of describing the patients but I just wanted to get my point across in the fewest words possible lol.

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[DeadCactus]

Medicine is an interpersonal field. Radiology, anesthesiology, or pathology may fit your desires but if your post is an honest reflection of your desires medicine as a whole may be a poor fit for you.

 

[hoot504]

More like Lord Humongus Douche. Amirite fellas?

No but seriously, the optics of this question coming from a pre-med such as yourself are so poor that you just aren't going to get any good answers. Go focus on getting into med school, being a decent human being, etc etc etc.

 

[Angry Birds]

I'm tentatively interested in EM and have been browsing this forum for a while. It seems that one of the complaints folks in the field have is dealing with drug seekers/crazy people/low-functioning people.

My own interest in medicine stems primarily from liking the science and wanting to treat real, tangible medical problems related to human physiology. I am definitely not into psychology or social work and have little interest in trying to talk obese people into dieting or smokers into quitting and stuff like that. With that said, I'm curious if the residents and attendings here could share what fraction of your patients & time is spent dealing with real medical issues and what fraction is devoted to drug seekers and crazies.

Sorry for the rather impolite way of describing the patients but I just wanted to get my point across in the fewest words possible lol.

A very high percentage.

Whether they need to come to the ER for said medical issue is another story.

 

[VentJockey]

I actually don't think there is anything wrong with the sentiment expressed by the OP. I agree--it sucks to deal with social and behavioral issues. ER and Internal Medicine both have some of that...but you can minimize it with good turfing skills. I send all my fibro to rheum. I send all my chronic pain to a pain specialist. Sometimes we get stuck with social admissions--I let the social worker deal with those headaches. Do you feel sad and hopeless? I'll call psych for you. Are you demented and your family wants to take your car keys? Sounds like a Geriatrics consult to me...

As long as you're not a psychiatrist, you can skillfully minimize the time you spend on non-medical stuff. The art of a skillful turf is something you have to learn, but once you learn it, it is powerful...

 

[Birdstrike]

I'm tentatively interested in EM and have been browsing this forum for a while. It seems that one of the complaints folks in the field have is dealing with drug seekers/crazy people/low-functioning people.

My own interest in medicine stems primarily from liking the science and wanting to treat real, tangible medical problems related to human physiology. I am definitely not into psychology or social work and have little interest in trying to talk obese people into dieting or smokers into quitting and stuff like that. With that said, I'm curious if the residents and attendings here could share what fraction of your patients & time is spent dealing with real medical issues and what fraction is devoted to drug seekers and crazies.

Sorry for the rather impolite way of describing the patients but I just wanted to get my point across in the fewest words possible lol.

In any clinical specialty where one sees patients, you will deal with a tremendous amount of psychosocial pathology gumming up the clean and concise "real medical issues" that we all found so interesting as pre-meds and medical students. EM sees its share and then some. It can't be avoided unless your patients are dead (pathology) or in another building (radiology).

Choose a specialty where you can have a normal life: Good 9-5 hours, little or no call, with little if any night, weekend or holiday work. All other considerations are ancillary distractions and trap doors. I think this is a reason so many doctors are miserable and disgruntled. They risk it all for what they see as the "ultimate career" as if the career itself is the end, rather than the means to the end. It's blasphemy to many on here, and many are likely to vehemently disagree, but this is what I've found likely to be true.

Yet, as much as I know these things to likely be true, I am conflicted. As much as many of us know these things to be true, we do the opposite.

Why?

Is the 1,000th 3am appendectomy and backbreaking sleep deprivation worth it?

Is the midnight shift on Christmas, taking care of the violent, assaultive drug addict that spits in your face, worth it?

Is it worth telling the prescription pill addict for the tenth time he needs to seek help, choosing the uncomfortable tense conversation when we could have chosen the easy route and enabled him with a fresh and "customer satisfying" prescription?

The answer is that it's a calling. Much like one who chooses to be an artist, a musician or a clergyman often times the choice isn't entirely rational from the outside looking in. Yet we do it because we were meant to. If you have to ask, and if you must have an answer to these questions, you possibly are not being called in the same way.

 

[The White Coat Investor]

If you have a terrible dislike dealing with patients who have psychiatric issues, whether that is the reason they came in or not, DO NOT UNDER ANY CIRCUMSTANCES choose emergency medicine. 50% of patients have some kind of psych issue.

That probably applies to most specialties in medicine, although the percentage might be a little lower.

 

[emergentmd]

If you have a terrible dislike dealing with patients who have psychiatric issues, whether that is the reason they came in or not, DO NOT UNDER ANY CIRCUMSTANCES choose emergency medicine. 50% of patients have some kind of psych issue.

That probably applies to most specialties in medicine, although the percentage might be a little lower.

I agree. If you really dislike this, don't go into EM. Actually don't go into anything with patient care. People in general have alot of Psych issues.

Gas, rad, path would be good choices. Even if they have Psych issues, you don't really have to talk to anyone much.

 

[Lord Humongus]

Thanks for the replies. Reading over my OP again I realize I could have phrased it a lot better. I have no issues with talking to patients or even with dealing to some extent with psych issues. I simply don't want psych/behavioral issues to occupy the plurality of my mental space in my practice of medicine. I've had exposure to dysfunctional people growing up outside of any medical context, and at some point you realize that for many of them, they're not going to change, it's not anyone's fault but their own, no amount of money thrown at them will matter and there is nothing you can personally do to make a difference in the way they lead their life. In fact, your best bet is to leave them be and focus on something else lest you become dysfunctional yourself lol.

 

[emergentmd]

Thanks for the replies. Reading over my OP again I realize I could have phrased it a lot better. I have no issues with talking to patients or even with dealing to some extent with psych issues. I simply don't want psych/behavioral issues to occupy the plurality of my mental space in my practice of medicine. I've had exposure to dysfunctional people growing up outside of any medical context, and at some point you realize that for many of them, they're not going to change, it's not anyone's fault but their own, no amount of money thrown at them will matter and there is nothing you can personally do to make a difference in the way they lead their life. In fact, your best bet is to leave them be and focus on something else lest you become dysfunctional yourself lol.

That is a beauty of EM. You deal with alot of psych and social stuff. But once you d/c them, you never have to see them again unless they return again. I could not imagine being a PCP and having to see these patients over and over for the same somatic complaint.

I think we all realize that most of these patients (drunks, drug seekers, psych) will not ever be fixed. That is why I find the national hysteria about not being able to find a solution to all of they Psych mass shootings. There is just no fixing these pts.

 

[link2swim06]

EM sometimes feels like trying to herd cats. I don't think you would like EM.

 

[GeneralVeers]

I don't generally deal with the psychs. If you have psych complaint and aren't suicidal, homicidal or a threat to yourself, I discharge you. If you have any of the prior three issues, then I medically clear you and have the appropriate psychiatric service evaluate them. I never talk to them about why they are sad, paranoid, suicidal, or any other issue. I explain to them that I am only a medical doctor and not qualified to talk about those things with them, and that my job is simply to evaluate any "medical" complaints they might have. Usually I can get out of the patient's room without having to have lengthy discussions about their psycho-social makeup or their poor life decisions.

 

[emergentmd]

I don't generally deal with the psychs. If you have psych complaint and aren't suicidal, homicidal or a threat to yourself, I discharge you. If you have any of the prior three issues, then I medically clear you and have the appropriate psychiatric service evaluate them. I never talk to them about why they are sad, paranoid, suicidal, or any other issue. I explain to them that I am only a medical doctor and not qualified to talk about those things with them, and that my job is simply to evaluate any "medical" complaints they might have. Usually I can get out of the patient's room without having to have lengthy discussions about their psycho-social makeup or their poor life decisions.

Psychs and drunks are the easiest pts. They take not thinking. Drug seekers on the other hand takes alittle more out of me.

I spend less than 1 min with the psych pts and usually don't check on them again.

Me - Sir, whats going on. Are you suidical.
Him - Yeah, I want to kill myself.
Me - OK, we will make sure you are medically clear and get you some help.
Me - Call Social worker and I am done.

I can honestly say I barely touch them. They are breathing, talking, have no physical complaints.

 

[Arcan57]

It's not the straight up "I'm sad/depressed/suicidal/off my meds pt" that's an issue. It's the player that's got Axis II issues or a compensated Axis I disorder that's presenting with somatic complaints. They exist in all branches of medicine with pt contact and the prior post about efficient turfing becomes a critical survival skill re: maintaining sanity.

As a point that I didn't at all appreciate in medical school, treating medical diseases in general is not a satisfying long term occupation. I can't speak for surgical pathology (I imagine fixing things with your hands stays satisfying longer). The best, most satisfied doctors treat patients. It sounds like wankery but if making people's lives better doesn't do it for you then medicine is the wrong road. Very few of your best moments are going to be mentally dismantling a disease and "fixing" things. It's much more common that the soft stuff ends up having a bigger impact.