Article: "7 Secrets of the Emergency Room"

[Moonglow]

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From the New York Times:

What's the worst thing you can say to the nurse in an emergency room?

This and other questions are answered in an informal survey of doctors, nurses and paramedics, who offer their own insights into the inner workings of hospital emergency rooms.

Every year, the nation's emergency rooms treat 117 million patients, and the average patient spends nearly three hours in the E.R.

But what really goes on behind the scenes? The magazine Reader's Digest quizzed emergency health workers about the quirks and peeves of the E.R. Here is some of what they had to say.

Continues with links to other Readers' Digest and Well Magazine related articles:

http://well.blogs.nytimes.com/2010/02/18/7-secrets-of-the-emergency-room/

 

[doctorFred]

"Standing in the doorway and staring at us while we work won’t help your loved one get treated more quickly."

so very, very true. not just in the ER, either. i worked with an orthpod during an outpatient surgery week and if a patient stood in the doorway outside their room waiting for "service", he'd intentionally bump that person down on the queue, so to speak. not that that's the most mature way to handle the situation, but it drives me crazy when people assume you haven't seen them yet because you somehow forgot about them.

 

[Venko]

The set of "secrets" articles on that site, are disgusting. The tone in which the statements are given gives the impression that we make our patients prove to us they are sick and deserve our time, when in fact, we assume they are sick until they show us otherwise. The reactions to those articles by outraged people in our communities is justified based on these "secrets"...why would these doctors, nurses, and paramedics be so heartless in such a public forum?

 

[deleted109597]

People are "outraged"?
I guess those people shouldn't watch the movie "Waiting".

 

[GeneralVeers]

The set of "secrets" articles on that site, are disgusting. The tone in which the statements are given gives the impression that we make our patients prove to us they are sick and deserve our time, when in fact, we assume they are sick until they show us otherwise. The reactions to those articles by outraged people in our communities is justified based on these "secrets"...why would these doctors, nurses, and paramedics be so heartless in such a public forum?

What kind of resident are you? Certainly not Emergency with that attitude.

Every patient needs to prove they are sick ever day, or they get discharged. The well-appearing 28-year old female with sore throat normal vitals and no obvious findings is going to get 1 minutes of my time and discharge. In contrast the 50 year old with chest pain and cardiogenic shock can have all of my time that he needs.

 

[Flopotomist]

I have to say I sorta agree with Thymeless. It is one thing to come into a forum such as this surrounded by peers and "gripe" about frustrations, but it is another thing to do so in a public forum under the guise of revealing "secrets" from the ED.

Giving the appearance that we are arrogant jerks dismissive of patients complaints is not the way to gender support from the public.

Further, this was a huge opportunity lost. We as a group had the ear of the public in this very well-circulated article and didn't bring up things that truly are more important that we should like the public to know.

 

[Venko]

What kind of resident are you? Certainly not Emergency with that attitude.

Every patient needs to prove they are sick ever day, or they get discharged. The well-appearing 28-year old female with sore throat normal vitals and no obvious findings is going to get 1 minutes of my time and discharge. In contrast the 50 year old with chest pain and cardiogenic shock can have all of my time that he needs.

I assure you I am an Emergency Medicine Resident. I think you are misunderstanding. The article talks a lot about those who "abuse" the system; the drug seekers, malingerers etc. I dont assume someone is gaming the system ("not sick") in my book, I assume they have a true illness until they prove otherwise.

As for triage, of course, those with abnormal vitals always get more of my time than those with normal ones. With that said, I approach every patient assuming they have something that will kill them. For example, the twenty eight year old patient you mentioned eariier has Lemmiere's disease until my exam rules it out. People are assumed to be ill until I prove them otherwise.

This is my view of Emergency medicine, and maybe its a different view from others, but it is most certainly the view of an Emergency Physician.

 

[DarkFark]

A couple thoughts:

- I wouldn't be surprised if these quotes were selected from whatever number was collected, in order to make the ED sound like what the writer wanted to portray.

- I really disliked this one:
14. "We don't have time to read the background on every patient. So if you're having stomach pain, and you've had your appendix or gallbladder removed, tell us so we don't go on a wild-goose chase." —Dana Hawkins, RN

Isn't it the responsibility of the clinician to take a good history? I mean, how long does it take to ask a patient, "have you ever had any surgery?". Who doesn't ask that question, especially for abdominal pain? I hope this is not representative of ED nursing as a whole. In my experience, it isn't.

Now if you ask the patient and they don't tell you, that's a whole different story.

 

[deleted109597]

Nurses don't always ask the history, because it isn't as important to them. Just like I don't ask where they usually stick IVs (unless the nurses make me put one in).
I guarantee you there was bias in what was published. Remember, the media asks Jenny McCarthy what she thinks about medicine too.

 

[Hamhock]

- I really disliked this one:
14. “We don’t have time to read the background on every patient. So if you’re having stomach pain, and you’ve had your appendix or gallbladder removed, tell us so we don’t go on a wild-goose chase.” —Dana Hawkins, RN

Isn't it the responsibility of the clinician to take a good history? I mean, how long does it take to ask a patient, "have you ever had any surgery?".

I wonder if this is a reaction to this typical exchange:
Doc: Have you had any abdominal surgery?
PT: Its ALL in my RECORD. Just CHECK my RECORDS.

HH

 

[Arcan57]

Pts' understanding of what consititutes a past medical history is fundamentally different from clinicians'. I wish their was some universal question that would led patients to understand that I need to know:

1) That you have HIV (cancer, diabetes, multiple cardiac stents), etc. I hate trying to piece together your medical history based on your med list (if you even remember what meds you're on)

2) That you've already had a positive home pregnancy test

3) you have a specific disease you are worried about having (especially if you will keep creating new complaints until you're told you don't have X)

I would also like to know (but don't expect to be told) that you are in the ED solely for test X, a work excuse for date Y, or because doctor Z stopped refilling your pain medication

 

[DarkFark]

I wonder if this is a reaction to this typical exchange:
Doc: Have you had any abdominal surgery?
PT: Its ALL in my RECORD. Just CHECK my RECORDS.

HH

Ah, right, gotcha.

 

[docB]

I wonder if this is a reaction to this typical exchange:
Doc: Have you had any abdominal surgery?
PT: Its ALL in my RECORD. Just CHECK my RECORDS.

HH

I've given up fighting with them over this. I just document "Patient refuses to answer questions." and proceed based on my educated guesses.

Similar to when they push my hands away when I try to examine them. "Patient refuses physical exam."

 

[DrMom]

I've given up fighting with them over this. I just document "Patient refuses to answer questions." and proceed based on my educated guesses.

Similar to when they push my hands away when I try to examine them. "Patient refuses physical exam."

I may have to start doing this myself. I'm getting tired of showing them the blank sheet of paper I have as their record. I also waste too much time explaining to some of these folks that it makes no sense for them to come to the ED for a physician's evaluation and then not let me examine them to evaluate their chief complaint. Your method is much more time effective.

 

[docB]

I may have to start doing this myself. I'm getting tired of showing them the blank sheet of paper I have as their record. I also waste too much time explaining to some of these folks that it makes no sense for them to come to the ED for a physician's evaluation and then not let me examine them to evaluate their chief complaint. Your method is much more time effective.

Yeah, I don't have 20 minutes to hold their hand and cajole them into letting me do a physical exam. If I wanted to do that I'd have done peds.

 

[GeneralVeers]

Yeah, I don't have 20 minutes to hold their hand and cajole them into letting me do a physical exam. If I wanted to do that I'd have done peds.

Had a young girl yesterday who was having an "anxiety attack" she was hyperventilating and crying and screaming. Oh and BTW "She's vomiting blood at home" said her Mom who accompanied her. I couldn't even examine her, but some Vitamin A definitely calmed things down.

Some days I wish HIPAA didn't exist, and I could show all the hysterical people in the waiting room the dying people on vents in the main ED.

 

[Homunculus]

Yeah, I don't have 20 minutes to hold their hand and cajole them into letting me do a physical exam. If I wanted to do that I'd have done peds.

easy on the pediatricians 😛 could also be geriatrics 😀

i don't cajole. i don't mind the screaming. plus, if they fight you off, it normally means they aren't that sick i've become relatively immune to the crying.

i will document "declines physical exam even after explaining benfits/risks of not performing" because i i always will explain (or ask) why the h3ll they are there if they won't let me do my job. same things when parents refuse labs.

overall it's really rare in peds though. i guess they aren't as belligerent yet, and can usually be overpowered.

the media can spin anything (ie, Jenny McCarthy is obviously an autism expert . . ) , and i wouldn't get upset at this. seriously, what are their options? "i hate ED docs, so i'm going to go to the . . . . ummmm . . . damn, there's no alternative the ED!"

-your friendly "are you sure there are no monkeys in your ear?" caveman

 

[Jeff698]

I...that it makes no sense for them to come to the ED for a physician's evaluation and then not let me examine them to evaluate their chief complaint.

Ah, I now see the flaw in your reasoning. You're under the assumption they came in for your assessment and medical opinion.

Silly girl, they came for the CT scan, antibiotics and vicodin.

Take care,
Jeff

 

[GeneralVeers]

Ah, I now see the flaw in your reasoning. You're under the assumption they came in for your assessment and medical opinion.

Silly girl, they came for the CT scan, antibiotics and vicodin.

Take care,
Jeff

Don't forget Xanax......for hand-twitching seizures.

 

[DrMom]

Ah, I now see the flaw in your reasoning. You're under the assumption they came in for your assessment and medical opinion.

Silly girl, they came for the CT scan, antibiotics and vicodin.

Take care,
Jeff

You're right. Somehow I've managed to hang on to a small shred of naivete through these past 8 years. Damn.