Apologies of the EM Staff

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If there was one thing you would love to tell your patients in a one-on-one setting, somthing you'd like them to understand about you and the ED, what would it be?
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Wear a helmet when you ride a motorcycle?
 
I would tell people not to use the ED for their minor or chronic problems. When people come into the ED for primary care issues it bogs us down, increases wait times and inappropriately uses a scarce resource.

I know that there are various stressors that cause people to come to the ED despite knowing that they should go elsewhere. Let's look at a few of those:

"I don't have insurance." - I've been getting this more and more lately. Even from legit people with jobs. Any Urgent Care will be happy to see you. Most for well under $100. And, by going that route you will not get the $2000 bill from the ED in a month.

"I don't have any money." - That doesn't mean I'll be able to do your primary care. We are really only set up to deal with serious emergencies. Even if I can prescribe you something that will get you by for awhile you won’t be able to fill it. Many community EDs don’t have in house pharmacies that will give out free meds.

“My primary doctor sent me here.” – If he sent you here because he thinks you have an emergent medical condition then fine. If he sent you because he can’t see you and is using the ED as an overflow clinic that just means he care less about you getting a huge bill and having to wait for a long time than he does about his on convenience and clinic schedule.

“I don’t have a primary doctor.” – See above about Urgent Care. See also the Yellow Pages.

“I need a work note.” – The Ed is, without a doubt, the most expensive place to get a work note.

“I want a second opinion.” – I’m an Emergency Physician. Unless you want an opinion about something another Emergency Physician said I’m not your guy. If you’re here because you want an opinion from a specialist I’d either have to admit you and get a consult which I’m not going to do if it isn’t indicated or I’d have to call the specialist to the ED which I’m not going to do if it isn’t indicated. The ED is, without a doubt, the most expensive place to get referred to someone who can give you a second opinion.


I am well aware that seeing these minor/chronic patients is where a lot of money comes from. But playing a poorly trained primary care doc (Do you know what the best third line antihypertensive in a 40 yo AA male with a family history of heart disease is? I sure as Hell don’t.) is just not what I like doing.
 
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The fact that you are morbidly obese

-makes it harder for us to diagnose you
-makes it harder for us to treat you
-causes 90-95% of the symptoms you experience every day
-will kill you


Close second:

Your demented, bedbound, pressure ulcer ridden 89 year old grandmother

-probably does not know you are here
-is actually not "a fighter" anymore
-is suffering through her every waking day
-should be allowed to sucumb to her next major illness
 
ccfccp said:
Wear a helmet when you ride a motorcycle?
Click to expand...

I'm in a "no helmet law" state. The other day I parked next to a beat up old pick up truck that had a window decal with the emblem of some motorcycle society that said "Thank us for no helmets" underneath it.

I literally wanted to punch that guy in the face.
 
To the parents of 99% of pediatric patients:

"Would your parents have brought you to the ER for this crap when you were a kid? If not, then don't bring your own kid."
 
PeepshowJohnny said:
I'm in a "no helmet law" state. The other day I parked next to a beat up old pick up truck that had a window decal with the emblem of some motorcycle society that said "Thank us for no helmets" underneath it.

I literally wanted to punch that guy in the face.
Click to expand...

A appropriate thing to spray paint underneath it would be, "thank you for the livers, corneas, and natural selection."
 
DO NOT complain if you're getting free care. And if you have to wait 3 hours for a free CT scan, then please do so patiently. Otherwise go to Northwestern and wait 10 minutes for the $3000 scan and another 2 months working your ass off to pay for it.

*****.
 
PeepshowJohnny said:
I'm in a "no helmet law" state. The other day I parked next to a beat up old pick up truck that had a window decal with the emblem of some motorcycle society that said "Thank us for no helmets" underneath it.

I literally wanted to punch that guy in the face.
Click to expand...

You should slap some sort of organ donation sticker right next to it.
 
If you've been to the ED five times now for the same problem and haven't followed our recommendations and referrals, don't get pissed when we keep doing the same thing over and over.

We have a limited bag of tricks. Once we've exhausted it, you're pretty much looking at rerun city with a high price tag.

If you're problem has been going on for 5 years and you've already seen 20 different sub-specialists, don't expect a diagnosis when you come to the ED.

Take care,
Jeff
 
I would love for more of my patient population take ownership and responsibility for their own bodies and health. I'm not asking for complete diet and fitness rehab for my type 2 DM'ers, but hey, knowing your med list with dosages would be a great start. Bonus points for knowing which meds are treating which chronic diseases, your average daily blood glucose, and dates of surgery/caths etc. Is it really that hard to keep a little card in the wallet with this info???
 
"Lady, I get vague abdominal pains occasionally and I sometimes get really bad diarrhea but I have never gone to the Emergency Department for it...or called an ambulance."
 
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"This is the sixth time in one year you've attempted suicide. What's the matter? Don't you have the internet at your house?"
 
To my 25-year-old patient in for his tenth suicide attempt in two years who said he wanted to end it all because he was a complete failure at everything he tried to do:

"Yeah, no kidding."
 
"Your fake-ass, totally bogus complaint which is nothing more than a transparent attempt to get some drugs out of me is keeping me in the department an hour past the end of my shift and it is hard, oh so very hard, for me not to hate you."
 
Lack of planning on your part does not constitute an emergency.
No, I will not sign off on your football/cheerleading/upward basketball clearance. I don't know if your asthma is well controlled or not.
Seriously, if you just spent 4 days in another hospital, don't come directly to mine expecting me to find something they didn't.

If you are ever in an accident, knock out all your teeth, get a tattoo, and start cussing the staff. It is the only way to live.
 
Dr.McNinja said:
If you are ever in an accident, knock out all your teeth, get a tattoo, and start cussing the staff. It is the only way to live.
Click to expand...

Well the more positive your tattoo to tooth ratio, the more protected you are, right? :horns:
 
.
 
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While you should have access to medical care, recognize that if you're not paying for it then someone else is paying for you through taxes, premiums, etc.

Don't waste resources--ie our money--by doing things like calling for an ambulance because you can't remove your lip ring and you're too lazy to get a ride or to take a train.
 
before you call the ambulance, ask yourself this: is my problem worth at least $2000? if the answer is no, then chill your ass out and go to your primary care. if you don't have a primary care, go to a free clinic or urgent care center. chances are you'll be seen a hell of a lot faster by people who won't roll their eyes at your complaints.
 
1) I can save you from alot of things, but I can't save you from yourself.

2) If you can afford cigarettes and a cell phone, you can buy your own f*cking tylenol.
 
What, you can't afford the motrin?
I'm sorry, do you smoke?
Ahhh, well it looks like you will have to skip the next pack of cigarettes...here are your discharge papers...don't let the door hit you on the way out. :mad:
 
"What, the first two pregnancy tests you took at home were positive...what do you think this one will be?"
 
"Our records show you were at the ER up the street earlier today for back pain as well, what did they give you for pain there?" Here are your discharge papers...don't let the door hit you on the way out.
 
No we don't have a list of the medications you are on...you last came here in 1987, and no you're doctor didn't call to let us know you were coming, and no you can't have anything to eat until I'm done examining you.
 
If you have a toothache, get scripts for Percs and PCN, and don't fill the PCN, telling us that probably isn't a good idea. Nor is telling us you took 20 Percs in 2 days. That makes us order blood work on you and refuse to give you new narcotics prescriptions.
 
If you are more concerned with how long till you get discharged than what brought you to the ED in the first place then you are do not have an emergency and shouldn't have come here in the first place.
 
"I'd be more impressed with your 15 out of 10 abdominal pain if you weren't hoovering a sandwich when I walk in the room."
 
"You came here by ambulance, in excruciating pain, holding your belly like you were going to die. We took care of your pain, controlled your nausea, and have spent five thousand bucks on your work-up. You have received everything that American medicine has to offer from intricate lab work to a state-of-the-art abdominal ultrasound and have not been asked to pay (nor would you) a thin dime for any of it."

"So your impatience is unfathomable. You have got more medical care poured onto and into you in two hours than most people will use in their whole lives. If you had gone to your own doctor the entire process of obtaining studies and consults would have taken months and yet there you are standing at the door bitching that we aren't doing anything and demanding to be sent home."

"What's up with that? And why can't you go two hours without eating? I am a stocky guy but I can miss a meal or two and not get agitated. No, you can't eat yet...you were so sick you were going to die not one hour ago."
 
C'mon Panda- if you've got time to post, you've got time to blog.

On topic of the post... things I would like to tell my patients...

exaggerating your symptoms to be taken seriously/be seen faster/or whatever your motivation (drugs) makes me distrust you on a basic level and will make me more likely to miss something important on your 15th visit. You can just tell me you hurt, you don't have to grimace and moan every time I glance in your direction.

I don't care what your "normal" body temperature is. 98.6 is NOT a damn fever.

Please don't make me code your mom. She needs to go.

This ain't Burger King.

Your vague, wandering parasthesias and weakness make me want to curl up in the fetal position abd suck my thumb.

If you are not dying, call a cab. You don't need an ALS crew for your chronic back pain. You still get to go to triage.

Yes ma'am, I feel your fibromyalgia pain...if you want to learn more about your disease, you should visit pandamd.com
 
(While Doing an Ultrasound for Pregnancy)

"What's that you say? Your friend told you if you were on top it would be a boy and if the babydaddy was on top it would be girl? I've never heard that...hello...why...it looks like you're going to have puppy."
 
LOL Panda I'm offering you a job when you're done
 
There are very few problems that cannot be solved with 5 of haldol and 2 of ativan.
 
"You are 65, have had a CABG and two stents place, and called the ambulance for chest pain, now you're surprised that I want to admit you and want to sign out AMA?"
 
"If you're worried about the angle of the head of your bed enough to interrupt me while I'm running by to see a patient with an ACTUAL medical problem, then your vague BS chronic complaint is better and you need to go home."
 
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