Another EM Rant

[tonem]

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Okay maybe its not really a rant but......what a week I've been having.

I know that practicing under a microscope is part and parcel to emergency medicine but what's life if you can't complain? After all patients do it so why can't we?


So the other day I show up to work all happy and chipper and bump into our clinical director....he says...oh, I haven't pulled the chart yet but we got a complaint letter about you....and i say oh, what kinda complaint. Apparently some kid I saw in the ED saw the primary care the next day who told the parents that we completely misdiagnosed poor innocent junior and that we shouldn't be seeing kids (uuummmm, then why did he refer them to us in the first place?) anyway i looked at the chart and thought oh yeah i remember this guy....kid shows up at 2am crying and tuggin at his ear....with red but mobile TM and otherwise completly normal.....so i explain that we'll get him some topical pain medicine but that he doesn't need antibiotics...when they ask why not i tried to explain....but i could tell all they were hearing was yada yada yada...so i said...okay tell you what i'll write a prescription and if he's not getting better fill it....so they see their pediatrician the next day who told them basically the same thing...no ear infection why on earth would they give you antibiotics??? So they wrote a letter to thenrecommended that i receive more training in pediatrics....

then...i see an employee that tripped in the parking garage and walked into the ED....i examined her and told her that she didn't look like she had a fracture....she said I need an xray to tell that....so i patiently explained the Ottawa ankle rules to her and told her that we'd be happy to provide her with crutches and a splint...her reply...no i need an xray....so since it was busy and i was already spending too much time with her i said....okay...we'll get you an xray....an hour and 30 minutes later the xray was negative and i asked the nurse to discharge the patient cuz i was going into see a new stroke patient.....

then i spent 15 minutes explaining to someone that his 23 year old daughter didnt need a plastic surgeon to close her facial lac....again okay we'll call plastics for you....3 hours later plastics shows up and says yeah we're not closing that...we're too busy...so 20 minutes later the patient is discharged with a perfectly closed laceration....

I get home and 2 hours later my pager goes off....hhmmmm....who could that be....turns out its patient services....they're asking me to call the lady with the sprained ankle and apologize for her inordinate wait for xrays...

you just can't win sometimes.....thats it i'm done...i feel better already🙂

 

[TysonCook]

I guess that it goes to that basic stupid quote that it is more important that we treat the patient and not the disease.

I would refuse to call the pt who waited for the x-ray, that is their job, not yours. Waiting for a unnecessary test is part of the deal when you order one.

Sometimes I'll state up front before the exam what I'll do in case of X, and in case of Y, that way there really isn't bargaining involved and they know up front, if they can walk on it, then it isn't getting an x-ray (etc).

Some days just suck like that.

 

[USCDiver]

My take on the ankle rules is that everyone has maleolar tenderness if you push hard enough. Also if they tripped on Hospital property you had damn well better make sure they don't have a fracture.

 

[basementbeast]

it is all a show! there was a great EM:RAP where Greg Henry talks about putting on a show....

 

[Dr.Evil1]

it is all a show! there was a great EM:RAP where Greg Henry talks about putting on a show....

Trust me, if you saw Greg Henry speak in person that point would have been driven home all the more.

It is tough, though, to put on the show if you are the resident. First of all most of the residents don't have enough gray hair to do it. Second it is pointless if then 2 min later the attending will walk in and just give them whatever they want.

 

[basementbeast]

Trust me, if you saw Greg Henry speak in person that point would have been driven home all the more.

It is tough, though, to put on the show if you are the resident. First of all most of the residents don't have enough gray hair to do it. Second it is pointless if then 2 min later the attending will walk in and just give them whatever they want.

True Dat!

 

[DrQuinn]

Yup. I've been an attending for 15 months now, and have really realized that it really is just putting on an "act" and a "show." Some are good at it, some aren't. This is the main point that I will drive to my residnets that rotate with me, and I think its rubbing off on them. You need to see the big picture and see "why the patient is there." You get good at reading 80-90% of the people and can make them happy as a clam.

You have just some really crappy examples that could have happend to the best "showmen/showwomen" out there, but regardless, here are some things I have done to help with the "show."

Print out copies of the labs and show it to them and tell them "give this to your doctor next time you see them, it'll save you a lot of time."

Print out copies of the XR (I can print it on regular paper, quality isn't good but you can see most things if its abnormal). Give it to them. "I don't see a broken ankle, look. Here is where you hurt."

Make sure you talk to all family members, and ask them if they have any questions or concerns.

If there's a long wait for XR or CT or results, I always ask "is there anything I can do for you while you're waiting?" 90% of the time they don't say anything. If they do, its for water or food, which most of hte time I don't care about.

Offer to let hte patient use my phone. At work I have a 'spectrelink' phone which is basically a ghetto 1990s cell phone that works only in hospital, but can dial locally.

So far, I have only had one patient complaint, and that was on a 23 year old postal worker who wanted a week off from work for his allergic rhinitis. I refused to give it to him, so he wrote a letter. (My med director only mentioned it to me because it was my first complaint, and I specifically told him to let me know about any complaints, no matter how cooky).

Hope this helps.

Somedays, it feels, you just can't win with the patients.

Q