A little bit of a meltdown

[thegenius]

<vent>

I had two small meltdowns in front of patients the other day:

1) mom brought in her 2 yo daughter because of fever for 2 hours. That's it. She felt hot at home. Temp was 100.9 in ED. Everything is normal. After I looked at the daughter for 5 seconds, listened to lungs for 5 seconds, pushed twice on the belly, I spent the next 7-8 minutes using the Google Translate app from English to Spanish explaining how this isn't the right use of the ER, nobody in their right mind is going to workup a fever for 2 hours, she is fine, and loads of other stuff. I remember saying "no child in the history of mankind has died after having a fever for 2 hours". then i said "Seriously! Maybe once like 200 years ago. 1 child died right after having a fever for 2 hours." Then I said "There is no doctor that is going to workup a fever for 2 hours." "There is nothing to do." Then I said "I will only consider trying to figure this out if she has a fever for 5 days." then I quipped "Do you understand what I'm saying?"

She said "yes".

I left the room. I think Mom was upset with me.

2) 45 yo woman comes in with epigastric pain for 45 minutes. It resolved prior to coming to the ER. Every vital sign was normal, and her exam was normal. The description was such that it was either hepatobiliary or gastric, not cardiac. Nonetheless the EKG was normal. I wouldn't have even ordered labs but they were ordered by triage. Normal. I again spoke to her (and her son translated from English to Spanish) that she must have made an immediate decision to go to the ER the moment she had this pain because it takes time to drive and come to the ER. Did she bother taking any meds? Did she bother to say "maybe I should just wait and see what happens?" 98% of all doctors are out in the world, not in the hospital, and you need to see them. They are there for a reason. The hospital and ER are only here if you are dying. Literally dying like you are in a car accident and there are bones sticking out of your body. Or if you are unconscious. If you are unconscious then I hope you get yourself to an ER and get treated for that. There are 100 things that can cause her transient upper abdominal pain and I'm not going to do anything about it because it went away. I can't test for all of these 100 things. Honestly next time this happens take some tylenol and motrin and lay down in bed. Just wait a little bit. then I said "I'm not trying to be dismissive here...but no doctor is going to do anything about having pain for 45 minutes that just goes away."

</vent>

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[JacobMcCandles]

You need a day off. Those are easy dispos.

 

[bravotwozero]

Can’t say I can hold it against you. You work in the ED long enough, you will have those days. I try to emotionally disengage, but everyone will have their limits tested at some point.

I had EMS bring in a drunken a hole the other night, because he got drunk and accidentally lacerated his index finger (small) with a pocket knife. He was being a complete screaming jackass, when we tried to examine his wound, wouldn’t sit still with blood oozing out of his finger and about to spray us with his blood. I cussed him out in front of everyone right then and there.

He later tried to light a cigar in his room (3rd fuggin time security failed to check his belongings here where someone was caught with a lighter. The other 2 occasions, patients burned down their room with it), and I straight up geodon’d his @ss and made him a day shift problem.

Every Friday night. Literally.

Sometimes patients need to be made angry and uncomfortable, as in your case. Failure to adult, when you are an adult, should come with consequences. Fortunately, I’m at a place where I can get away without having to babysit people too much.

 

[southerndoc]

Every time I feel frustrated at a patient, I simply remind myself that it's job security and a few RVUs to talk to them. People sometimes spas out about things, and we can't hold them to our standard much like a neurosurgeon can't hold us to their standard.

I agree with @JacobMcCandles : you need a day off (or week).

 

[RustedFox]

Can’t say I can hold it against you. You work in the ED long enough, you will have those days. I try to emotionally disengage, but everyone will have their limits tested at some point.

I had EMS bring in a drunken a hole the other night, because he got drunk and accidentally lacerated his index finger (small) with a pocket knife. He was being a complete screaming jackass, when we tried to examine his wound, wouldn’t sit still with blood oozing out of his finger and about to spray us with his blood. I cussed him out in front of everyone right then and there.

He later tried to light a cigar in his room (3rd fuggin time security failed to check his belongings here where someone was caught with a lighter. The other 2 occasions, patients burned down their room with it), and I straight up geodon’d his @ss and made him a day shift problem.

Every Friday night. Literally.

Sometimes patients need to be made angry and uncomfortable, as in your case. Failure to adult, when you are an adult, should come with consequences. Fortunately, I’m at a place where I can get away without having to babysit people too much.

Discomfort is often the only suitable motivator for behavioral changes.

 

[RuralEDDoc]

First off - I’m sorry. I’m sure you’ve been through a lot lately.
Second - you’re right - these should not be ER visits.
Third - to take a step back, if you’re ranting at someone using a Spanish translator, then you’re probably choosing the wrong audience. That person (probably) has the least control of their healthcare resources and job flexibility.
Finally - agree with some time off if you can swing it. All of our jobs are asking us for more more more and it’s a recipe for burnout (not our fault) and the occasional rant at a patient. It’s not you, it’s the system.

 

[thegenius]

Every time I feel frustrated at a patient, I simply remind myself that it's job security and a few RVUs to talk to them. People sometimes spas out about things, and we can't hold them to our standard much like a neurosurgeon can't hold us to their standard.

I do this 98% of the time (then vent when I get back to the doc box). Occasionally...a few times a year...I let it out.

 

[thegenius]

Funny I had a vacation just a month ago.

I haven't been sleeping well. Usually what happens is I vent, then everything gets better for the 6 months or so.

 

[RustedFox]

I don't see you as being in the wrong.
People need to be told that what they're doing is not just wrong, but highly inappropriate; or else they'll just keep it up.

My wife once screamed at me for hanging my towel on the closet door, and was insistent that "I should have known better."

If she never told me that it upsets her (I see nothing wrong with it), then I would never know.

I pointed this out to her. Somehow, I was still wrong.

 

[Tiger26]

Yeah take some time off and head out of town.

When I start getting edgy, I remind myself that this is a very humbling field and the universe seems to punish me when I think I can't be wrong. That kid with the 2 hours of fever might be the one with meningitis the next day. The abdominal pain might be cholangitis in 12 hours. Maybe I'm just not as good of a doctor but I try to take a step back and have some grace so I don't make a jerk out of myself when in reality I'm just seeing something that hasn't become bad enough yet to be obvious.

That said, I've been working admit a 1.75 FTE this summer because we're short and I've had an instance or two where I've told someone that I wouldn't do antibiotics for myself or a family for their BS allergic reaction bug bite but I'd be happy to prescribe them if they feel like it's necessary based on Google and their cousin who's an EMT.

 

[emergentmd]

Everything stated is what we all should do but sometimes we as humans just lose it. If you want to avoid doing this in the future, you need to figure out what outside of work has put you on edge. Work rarely put people on edge but something outside set you up to tip over from work b/c you are able to "lose it" to strangers. What I have found is that something at home created stress, guys esp keep it in, and at work they use it as an outlet.

Only my spouse/kids create stress for me b/c they matter and I can't just "ignore it"

We/I have had the 3am chronic abd pain that has been thoroughly worked up, 3am dental pain, 3am insomnia (yes I have). Just think logically. You can chose door #1, look at it as a quick dispo or #2 get mad and make the situation/your health worse.

Don't pick #2 and let the 3am pt win.

 

[Rekt]

Too much feel good nonsense up in this thread.

#1 is for sure one of the most annoying cases in all of emergency medicine. I don't blame you at all. It's an exorbitant amount of time spent unecessarily and a severe waste of resources. It doesnt matter their SES, culture, language, etc it's as simple as not being a dumb ****ty parent that can at least rub two brain cells together.

 

[GonnaBeADoc2222]

We should normalize the (polite and frank) education of patients who abuse the ED.

 

[JacobMcCandles]

I don’t get frustrated at those who just want reassurance. I’ll generalize a bit but nearly all Spanish speaking patients I’ve had that come in with clearly benign etiology are typically very thankful. They’re also usually worried about something specific but for whatever reason never tell you that right off the bat.

The kid with the fever likely has parents that just don’t know any better. They just need reassurance and education. I can’t fault them for being worried and trying to do right by their child.

As far as drunks and chronic abdominal pain that comes in 5 times a month, all bets are off.

 

[WilcoWorld]

I think part of the frustration is the conflict between 2 facts:
You are correct that these patients did not need to come to the ED
Your job in no way facilitates your telling them this fact

That you were able to recognize that your interactions didn't go as well as you'd hope is a good sign, IMO.

 

[AMEHigh]

Can you use an actual translator instead of Google translate?
Honestly, some people really don’t know.

I was just talking to my friend who owns a dog about how I know nothing about dogs. If I owned a dog I would probably take them in for something stupid because I really don’t know what kind of illnesses dogs get, what is sick for them, etc. I know many of our patients have low health literacy like that as well. And as an almost new mom I’m starting to understand the worry more over your kids and my fetus isn’t even here yet!

But yes we all have those frustrating days. I hope you can take some time to cool down and not let those frustrations linger and carry over to every patient interaction.

 

[DeadCactus]

To start with, I get the frustration and how these visits contribute to burn-out. Everyone in EM feels the same frustrations. The below is not a criticism but my approach to these patients.

First of all, this is a problem with the systems in place and not the patient. These patients could get a MSE and be turned away or sent a fast-track/urgent care. They aren't because the legal and billing incentives are to see them in the ED. Expecting patients to know when to come to the emergency department underappreciates the value of your 7+ years of formal education and N years of experience while over appreciating your knowledge of their access to care and ability to explain their symptoms and concerns. For me, there is no reason to have a response to these patients other than expressing that I understand their concern and I am relieved that everything looks reassuring. Educating patients on how they shouldn't have come at best is futile and at worst is is condescending. By all means, I educate them on return precautions so they don't come back unnecessarily.

 

[GonnaBeADoc2222]

Can you use an actual translator instead of Google translate?
Honestly, some people really don’t know.

I was just talking to my friend who owns a dog about how I know nothing about dogs. If I owned a dog I would probably take them in for something stupid because I really don’t know what kind of illnesses dogs get, what is sick for them, etc. I know many of our patients have low health literacy like that as well. And as an almost new mom I’m starting to understand the worry more over your kids and my fetus isn’t even here yet!

But yes we all have those frustrating days. I hope you can take some time to cool down and not let those frustrations linger and carry over to every patient interaction.

They know.

99% of what pediatricians do is anticipatory guidance. From the time the child is born through age 18, parents are told what to look out for and what to do in x, y, z situations.

Then, there are books you can read.

Then, there is (gasp!) Calling the pediatrician for guidance. They all say "the doctor told me to come to the ER" but this is a lie.

 

[Mbekweni]

The spanish speaking family bringing in the kid with a fever probably pays half of my bills. It's a little bit infuriating, but also a quick and easy dispo and usually patients are very pleasant and grateful. Put on a smile, explain that usually fever is caused by a benign virus, do a quick exam and exclaim how great the lungs sound etc. Pause and ask if there was anything in particular they were worried about or if they just wanted a general checkup. Some have been trained by a crazy pediatrician that they need some amoxicillin for fake strep throat and/or IM ceftriaxone at the first sign of fever. Most parents readily admit they just want a quick checkup (or perhaps some vague hope their child will stop crying in the middle of the night and they can get some sleep). Registration>triage>dispo from triage usually less than 10 min. Unfortunately the more efficient we get with that they more business we bring in since it's faster and easier than going to clinic, and free for them either way. Medicaid admin could likely benefit a lot by putting a $10 copay on visits to the ER, waived for a Level 5 and above visit and/or admission.

The part that kills me is when one of these easy dispo patients checks in, sits down and sees that the waiting room is busy, and then leaves since it won't be a quick convenient visit, sticking us with a LWBS that admit is all upset about.

 

[thegenius]

I don’t get frustrated at those who just want reassurance. I’ll generalize a bit but nearly all Spanish speaking patients I’ve had that come in with clearly benign etiology are typically very thankful. They’re also usually worried about something specific but for whatever reason never tell you that right off the bat.

The kid with the fever likely has parents that just don’t know any better. They just need reassurance and education. I can’t fault them for being worried and trying to do right by their child.

See this is bullshiit. If they want reassurance then they can pay money. They can see their primary care doctor. They can raise their educational level. You get this kind of behavior when there is free shiit in society. Every other aspect of human behavior improves when there is incentive to increase your knowledge about the topic. Buying homes, determining the best fruit to buy at a fruit stand, the list goes on and on.

You can fault them. Would you fault them if they had a fever for 5 minutes? Of course you would.

 

[thegenius]

Can you use an actual translator instead of Google translate?
Honestly, some people really don’t know.

I was just talking to my friend who owns a dog about how I know nothing about dogs. If I owned a dog I would probably take them in for something stupid because I really don’t know what kind of illnesses dogs get, what is sick for them, etc. I know many of our patients have low health literacy like that as well. And as an almost new mom I’m starting to understand the worry more over your kids and my fetus isn’t even here yet!

But yes we all have those frustrating days. I hope you can take some time to cool down and not let those frustrations linger and carry over to every patient interaction.

For serious conversations about real stuff I use a real translator. Like explaining a new diagnosis of cancer, for instance.

If you owned a dog you would educate yourself on how to be a good owner of a dog. You would do research on the cost of ownership. And if you wanted reassurance from a professional, you are going to pay $$. You will become a more educated dog owner.

 

[thegenius]

Discomfort is often the only suitable motivator for behavioral changes.

$$$ also is a motivator for behavioral changes.

Exhibit A: $350 for a speeding ticket going 10-15 over limit.

 

[southerndoc]

I love it when a certain patient population is dizzy...

Dehydrated? Dizzy
Stroke? Dizzy
Chest pain? Dizzy
Sprain your ankle? Dizzy

Seriously, it means "unwell" to them when translated and doesn't mean at all what we generally consider it.

 

[GonnaBeADoc2222]

I actually have no issue reassuring pedi fever parents so long as they are receptive and grateful. These interactions are some.of my favorites.

I do take issue when they want ridiculous things like labs or IV fluids for their 2 yo.

 

[JacobMcCandles]

See this is bullshiit. If they want reassurance then they can pay money. They can see their primary care doctor. They can raise their educational level. You get this kind of behavior when there is free shiit in society. Every other aspect of human behavior improves when there is incentive to increase your knowledge about the topic. Buying homes, determining the best fruit to buy at a fruit stand, the list goes on and on.

You can fault them. Would you fault them if they had a fever for 5 minutes? Of course you would.

I bet we’d agree on most thing politically but, you too, need a day off.

 

[JacobMcCandles]

I actually have no issue reassuring pedi fever parents so long as they are receptive and grateful. These interactions are some.of my favorites.

I do take issue when they want ridiculous things like labs or IV fluids for their 2 yo.

Bingo. Telling a new parent that they’re doing everything right, giving them education, and them being reasonable and receptive is a very satisfying interaction.

 

[VA Hopeful Dr]

They know.

99% of what pediatricians do is anticipatory guidance. From the time the child is born through age 18, parents are told what to look out for and what to do in x, y, z situations.

Then, there are books you can read.

Then, there is (gasp!) Calling the pediatrician for guidance. They all say "the doctor told me to come to the ER" but this is a lie.

You've never called the pediatricians after hours line have you?

 

[DeadCactus]

Some of you seem really detached from the reality that most of our patients live in.

 

[sloh]

Too much feel good nonsense up in this thread.

#1 is for sure one of the most annoying cases in all of emergency medicine. I don't blame you at all. It's an exorbitant amount of time spent unecessarily and a severe waste of resources. It doesnt matter their SES, culture, language, etc it's as simple as not being a dumb ****ty parent that can at least rub two brain cells together.

Lots of times, can’t fix dumb

 

[RuralEDDoc]

See this is bullshiit. If they want reassurance then they can pay money. They can see their primary care doctor. They can raise their educational level. You get this kind of behavior when there is free shiit in society. Every other aspect of human behavior improves when there is incentive to increase your knowledge about the topic. Buying homes, determining the best fruit to buy at a fruit stand, the list goes on and on.

You can fault them. Would you fault them if they had a fever for 5 minutes? Of course you would.

The current practice of emergency medicine is the worst I’ve seen in a roughly 15 year career and I feel for you, me, and all others trying to stay sane while practicing.
For these patients, don’t hate the player, hate the game. I think you practice in the Bay Area like me. If so, the FQHCs are crap, the state makes it free for Medicaid patients to go to the ER, and your hospital makes sure you go see low acuity patients quickly. It’s rational to overuse the free ER for quick questions. I’m curious why that mother was there. Perhaps the child needs a negative COVID test to go to daycare or needs to be on antibiotics for 24 hours to go back to daycare (daycares are crazy). Or the mom had an unvaccinated cousin in the old country who died from meningitis within one day of a fever. Or the patients cousin has febrile seizures and so the family thinks fevers are emergencies. Or something else. Either way it’s free and relatively quick and that’s the result of public policy, not irrational patients.

 

[RustedFox]

I love it when a certain patient population is dizzy...

Dehydrated? Dizzy
Stroke? Dizzy
Chest pain? Dizzy
Sprain your ankle? Dizzy

Seriously, it means "unwell" to them when translated and doesn't mean at all what we generally consider it.

There's a variant of that here where it's "dizzy all over".

 

[DeadCactus]

It's one thing to vent to each other, it's another when an immigrant mom worried about her kid becomes the villain in your autobiography. This thread is nothing but willful ignorance about the reality of trying to get medical care in the US when you don't have some friend in specialty X, about the mixed messaging parents get about fevers, about navigating a system in a different language, and the logistic challenges of getting healthcare when you a single job doesn't pay enough for rent and food.

The worst part if how angry some of you get about "wasted resources". Like these visits don't prop up our specialty and like "saving resources" does anything but put more money into the pockets of people exploiting emergency physicians while making healthcare less convenient and accessible to patients. Donate to ACEP if you have such a cuckhold fetish.

 

[GonnaBeADoc2222]

It's one thing to vent to each other, it's another when an immigrant mom worried about her kid becomes the villain in your autobiography. This thread is nothing but willful ignorance about the reality of trying to get medical care in the US when you don't have some friend in specialty X, about the mixed messaging parents get about fevers, about navigating a system in a different language, and the logistic challenges of getting healthcare when you a single job doesn't pay enough for rent and food.

The worst part if how angry some of you get about "wasted resources". Like these visits don't prop up our specialty and like "saving resources" does anything but put more money into the pockets of people exploiting emergency physicians while making healthcare less convenient and accessible to patients. Donate to ACEP if you have such a cuckhold fetish.

The "resource" is my "professional time" and i should be able to use it how i see fit.

 

[DeadCactus]

The "resource" is my "professional time" and i should be able to use it how i see fit.

Yea, and you chose to use to be on shift. Sounds like you should open a private practice where you sit around smiling your way into poverty as no one shows up.

Edit: Just make sure you hire a CEO and get a few shareholders. You won't have any income for them to siphon off but maybe they can slap you or eat part of the lunch you brought from home.

 

[JacobMcCandles]

As medical students typically don't have a realistic viewpoint of medicine, it seems like a lot of people here also don't have a realistic viewpoint. It seems that some people think they're going to change the entire system with one patient encounter. I highly recommend spending as little as time as possible dealing with chronic ED abusers but having a hostile interaction with someone that has difficulty navigating the healthcare system only gets the patient, family, and yourself upset. Then, you'll find yourself on SDN posting with the burnout just oozing out of your posts like many of the other malcontents.

 

[RustedFox]

Yea, and you chose to use to be on shift. Sounds like you should open a private practice where you sit around smiling your way into poverty as no one shows up.

Edit: Just make sure you hire a CEO and get a few shareholders. You won't have any income for them to siphon off but maybe they can slap you or eat part of the lunch you brought from home.

Le sigh.
You're SPECIAL special.

 

[johhnybgood]

I don’t fault the op for having a meltdown. EM is tough. We all feel it and hit that point.

I agree that while these are frustrating patients they are easy encounters. And I empathize with this type of patient trying to navigate the system. Where I get more concerned is that the mother or family may be reluctant to seek care for themselves or family members moving forward because of treatment in previous encounters.

 

[Franzd'Epinay]

I'm not against the concept of a $10/$25/$50/$whatever copay, but I'm having a hard time envisioning how this would work logistically in the way some of you hope.

If the idea is that this would deter people "gaming" the system, I don't see this playing out successfully:

Someone on Medicaid comes in to the ED, gets a $50 copay, doesn't pay and then what? Are they going to be kicked out of Medicaid (which, by definition, is supposed to be for people in a poor financial situation)? Unlikely.

But say they do get kicked out of Medicaid. They are now uninsured. The next time they want to "game" the system they can just come in to the ED and be guaranteed an evaluation under EMTALA. I know people here like to throw out "just do an MSE and nothing more" as a solution, but the optics of this is such that it is usually only done in extreme cases (obviously secondary-gain patient discharged < 24-48 hrs prior). Is ED lobby supposed to have a poster behind the counter that says "provide an MSE and nothing else to these people who are uninsured due to not paying their Medicaid ED copays"? I can't see a hospital risk management department signing off on that.

Open to hear others' thoughts on how this would/could work.

 

[Rekt]

"Difficulty navigating healthcare".

Please, 90% of these people are medicaid abuse. They pay nothing to get their free dose of Tylenol and Motrin. Charge them a dollar and they don't show up.

 

[DeadCactus]

Le sigh.
You're SPECIAL special.

If you have some point you disagree with, feel free to address it. I've been clear that I get the frustration with these patients and the need to vent. I'm not going to sit here and pretend that a bunch of misers who hate their career life lording over some woman worried about her kid is anything but lashing out at victim of crappy healthcare system because they can.

 

[DeadCactus]

"Difficulty navigating healthcare".

Please, 90% of these people are medicaid abuse. They pay nothing to get their free dose of Tylenol and Motrin. Charge them a dollar and they don't show up.

What bull****. It's Medicaid abuse to use their benefits but if everyone here trying to maximize every barely related 1099 tax write-off isn't tax abuse? And there is just some epidemic of people who want nothing more out of life than to sit in some ****ty ED waiting room and catch an attitude from half-a-dozen bitter staff for a few dollars worth of over-the-counter medicine? You don't want to be there for hundreds of dollars an hour but they want to for some Tylenol just for the rush of gaming the system. What a racket! Some of you are so desperate to be angry at people for being poor.

 

[Franzd'Epinay]

What bull****. It's Medicaid abuse to use their benefits but if everyone here trying to maximize every barely related 1099 tax write-off isn't tax abuse? And there is just some epidemic of people who want nothing more out of life than to sit in some ****ty ED waiting room and catch an attitude from half-a-dozen bitter staff for a few dollars worth of over-the-counter medicine? You don't want to be there for hundreds of dollars an hour but they want to for some Tylenol just for the rush of gaming the system. What a racket! Some of you are so desperate to be angry at people for being poor.

I don't disagree with your wider point, but these aren't resonable comparisons. One is working 8-12+ hrs 4+ times per week with a disrupted sleep schedule vs. a 1-3 hr visit occasionally. Also, the other benefit of the ED visit isn't just the treatment, but the convenience--scheduling an appointment with a pediatrician (if one already has established care) takes 0.5-2 days (if one has not established care, then tough ****).

 

[TrailRun]

At least that kid had an actual fever

 

[VA Hopeful Dr]

I don't disagree with your wider point, but these aren't resonable comparisons. One is working 8-12+ hrs 4+ times per week with a disrupted sleep schedule vs. a 1-3 hr visit occasionally. Also, the other benefit of the ED visit isn't just the treatment, but the convenience--scheduling an appointment with a pediatrician (if one already has established care) takes 0.5-2 days (if one has not established care, then tough ****).

Urgent Care is a thing...

 

[ER BlueBlood]

<vent>

I had two small meltdowns in front of patients the other day:

1) mom brought in her 2 yo daughter because of fever for 2 hours. That's it. She felt hot at home. Temp was 100.9 in ED. Everything is normal. After I looked at the daughter for 5 seconds, listened to lungs for 5 seconds, pushed twice on the belly, I spent the next 7-8 minutes using the Google Translate app from English to Spanish explaining how this isn't the right use of the ER, nobody in their right mind is going to workup a fever for 2 hours, she is fine, and loads of other stuff. I remember saying "no child in the history of mankind has died after having a fever for 2 hours". then i said "Seriously! Maybe once like 200 years ago. 1 child died right after having a fever for 2 hours." Then I said "There is no doctor that is going to workup a fever for 2 hours." "There is nothing to do." Then I said "I will only consider trying to figure this out if she has a fever for 5 days." then I quipped "Do you understand what I'm saying?"

She said "yes".

I left the room. I think Mom was upset with me.

2) 45 yo woman comes in with epigastric pain for 45 minutes. It resolved prior to coming to the ER. Every vital sign was normal, and her exam was normal. The description was such that it was either hepatobiliary or gastric, not cardiac. Nonetheless the EKG was normal. I wouldn't have even ordered labs but they were ordered by triage. Normal. I again spoke to her (and her son translated from English to Spanish) that she must have made an immediate decision to go to the ER the moment she had this pain because it takes time to drive and come to the ER. Did she bother taking any meds? Did she bother to say "maybe I should just wait and see what happens?" 98% of all doctors are out in the world, not in the hospital, and you need to see them. They are there for a reason. The hospital and ER are only here if you are dying. Literally dying like you are in a car accident and there are bones sticking out of your body. Or if you are unconscious. If you are unconscious then I hope you get yourself to an ER and get treated for that. There are 100 things that can cause her transient upper abdominal pain and I'm not going to do anything about it because it went away. I can't test for all of these 100 things. Honestly next time this happens take some tylenol and motrin and lay down in bed. Just wait a little bit. then I said "I'm not trying to be dismissive here...but no doctor is going to do anything about having pain for 45 minutes that just goes away."

</vent>

Don’t worry, you still provided healthcare and more medical consideration than they have probably received their entire lives in their former country. Sad but true.

I understand some folks saying this isn’t the best way to deal with it but just wait, these types will be infiltrating your school system, healthcare system (already seeing this) and inundating all social services (DMV etc). Then I’d like to see how some folks react. Lol. It def won’t be the same reaction.

 

[ER BlueBlood]

What bull****. It's Medicaid abuse to use their benefits but if everyone here trying to maximize every barely related 1099 tax write-off isn't tax abuse? And there is just some epidemic of people who want nothing more out of life than to sit in some ****ty ED waiting room and catch an attitude from half-a-dozen bitter staff for a few dollars worth of over-the-counter medicine? You don't want to be there for hundreds of dollars an hour but they want to for some Tylenol just for the rush of gaming the system. What a racket! Some of you are so desperate to be angry at people for being poor.

Calm down

 

[ER BlueBlood]

Some of you seem really detached from the reality that most of our patients live in.

True I am detached from receiving anything for free and a gov that’s now designed to serve myself and my predicament. I even get to pay for peoples poor educational choices now. Awesome.

 

[DeadCactus]

True I am detached from receiving anything for free and a gov that’s now designed to serve myself and my predicament. I even get to pay for peoples poor educational choices now. Awesome.

You're in a profession where your degree is propped up by taxes, your medical education is propped up by taxes, your customer base is propped up by taxes, regulations force customers to see you for access to the goods and services they want, you can still game the system for tens to hundreds of thousands of dollars in tax benefits, foreign competition is kept out by regulations, internal competition is limited by regulations, and you're paid hundreds of thousands of dollars a year by government payors but the Mom getting $5 in over-the-counter medications is the one getting free stuff from the government. Detached from reality. Some of you work really hard to keep your victim fantasy going and find a way to villainize poverty.

 

[sylvanthus]

You're in a profession where your degree is propped up by taxes, your medical education is propped up by taxes, your customer base is propped up by taxes, regulations force customers to see you for access to the goods and services they want, you can still game the system for tens to hundreds of thousands of dollars in tax benefits, foreign competition is kept out by regulations, internal competition is limited by regulations, and you're paid hundreds of thousands of dollars a year by government payors but the Mom getting $5 in over-the-counter medications is the one getting free stuff from the government. Detached from reality. Some of you work really hard to keep your victim fantasy going and find a way to villainize poverty.

Im not even involved in this conversation and this pissed me off. Staying out of it though. Enjoy the holier than thou posts dudes. You all suck, are horrible human beings are selfish tax evaders, and hate immigrants. Back to the regularly scheduled bashing.

 

[sylvanthus]

<vent>

I had two small meltdowns in front of patients the other day:

1) mom brought in her 2 yo daughter because of fever for 2 hours. That's it. She felt hot at home. Temp was 100.9 in ED. Everything is normal. After I looked at the daughter for 5 seconds, listened to lungs for 5 seconds, pushed twice on the belly, I spent the next 7-8 minutes using the Google Translate app from English to Spanish explaining how this isn't the right use of the ER, nobody in their right mind is going to workup a fever for 2 hours, she is fine, and loads of other stuff. I remember saying "no child in the history of mankind has died after having a fever for 2 hours". then i said "Seriously! Maybe once like 200 years ago. 1 child died right after having a fever for 2 hours." Then I said "There is no doctor that is going to workup a fever for 2 hours." "There is nothing to do." Then I said "I will only consider trying to figure this out if she has a fever for 5 days." then I quipped "Do you understand what I'm saying?"

She said "yes".

I left the room. I think Mom was upset with me.

2) 45 yo woman comes in with epigastric pain for 45 minutes. It resolved prior to coming to the ER. Every vital sign was normal, and her exam was normal. The description was such that it was either hepatobiliary or gastric, not cardiac. Nonetheless the EKG was normal. I wouldn't have even ordered labs but they were ordered by triage. Normal. I again spoke to her (and her son translated from English to Spanish) that she must have made an immediate decision to go to the ER the moment she had this pain because it takes time to drive and come to the ER. Did she bother taking any meds? Did she bother to say "maybe I should just wait and see what happens?" 98% of all doctors are out in the world, not in the hospital, and you need to see them. They are there for a reason. The hospital and ER are only here if you are dying. Literally dying like you are in a car accident and there are bones sticking out of your body. Or if you are unconscious. If you are unconscious then I hope you get yourself to an ER and get treated for that. There are 100 things that can cause her transient upper abdominal pain and I'm not going to do anything about it because it went away. I can't test for all of these 100 things. Honestly next time this happens take some tylenol and motrin and lay down in bed. Just wait a little bit. then I said "I'm not trying to be dismissive here...but no doctor is going to do anything about having pain for 45 minutes that just goes away."

</vent>

I feel ya, I had a rough week that ended up resulting in me being “taken off the schedule.”. So essentially **** canned at a teamhealth site. Had a lady come in, sent in by her naturopath for LFTs bloodwork after starting oral antifungal medication for “systemic hives”. I Iost it, told her the blood test is unnecessary in the ED and her pcp can do it if he deems it necessary. Told her she should stop taking oral antifungal medication given to her by a naturopath. Of course this naturopath turned out to be the sister of one of the other staff docs. “shes the smartest person I know”. **** show ensues.