Attendings complaining of BS cases

[december07]

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Why do people hates BS cases so much in the ER setting? while managing 10 pts at the same time, isn't it a "good thing" to have 4-5 that are simple like sore throat and ear pain...blah blah? so you don't have to pay so much attention to them and focus on the high acute care?

cause if you managing 10 pts who are all high acute care, how can you really handle that all day everyday?

and without those simple cases, wouldn't your pay check be so much lower?

Thanks!

 

[docB]

Yeah we make money seeing the low acuity stuff and it does break up the critical care. But a lot of the bogus stuff that rolls in really just needs good primary care which we are not. It's frustrating trying to do something you're not good at and not trained for. Most of that stuff is also not very satisfying. Also a lot of the low acuity stuff really boils down to drug seeking and non-compliance.

 

[BADMD]

Why do people hates BS cases so much in the ER setting? while managing 10 pts at the same time, isn't it a "good thing" to have 4-5 that are simple like sore throat and ear pain...blah blah? so you don't have to pay so much attention to them and focus on the high acute care?

cause if you managing 10 pts who are all high acute care, how can you really handle that all day everyday?

and without those simple cases, wouldn't your pay check be so much lower?

Thanks!

10 of the 26 patients I saw yesterday were during a less than 2 hour stretch. I was glad a couple of them weren't very serious. I would have preferred that they see their own doctors leaving more time for the other 8. Also, for us, Fast Track nibbles off the sore throats, earaches and minor trauma, leaving an overall slightly higher acuity. I'd rather the simple ones see their PCPs. Besides, PCPs have to make a living too...

 

[Jeff698]

I don't mind the minor ACUTE care stuff. What really gets to me (because I'm not trained to manage it) is the chronic hypertension, diabetes type stuff.

It sucks up a lot of my time explaining how the SBP of 170 you have today only isn't going to kill you and that, yes, you really should be taking the lisinopril your PCP prescribed and, no, you're not having a stroke because of the toe pain you've had for three months.

That and the social dumps with no medical issues (they're old, mean and grandma can't take him anymore so she dumps him in the ED) drive me crazy.

I can usually see two chest pains for four sore throats in the time it takes me to deal with some of these other patients.

Take care,
Jeff

 

[roja]

I don't complain much because I figure this will make for a short career. It can be annoying at times when the nonACUTE stuff comes in, often complaining of waits, no room etc when you are juggling much sicker patients.

In horribly overcroweded ED's, which is most of them, the stuff that can be seen by a PMD, should be. It adds a large burden to the ED: MD's, nurses, ancillary staff and can interfere with care for sicker patients.

In a perfect world, I wouldn't care. One where I had plenty of nurses, doctors and time. But that's not the one we live in, so yes, at times, it is frustrating to have to deal with low acuity, non acute patients in the ED.

 

[Stitch]

For me it's the patient expectations that are hardest to manage. If all you want is reassurance that everything's fine, then I'm happy to bless you and send you on your way. It's quick, easy and we all feel good. Better than Cats.

It's the stuff that's been going on for a while and is relatively minor combined with the attitude of "I'm not leaving until I have an answer or treatment!" that really drains me. I'm not here to solve your chronic problems, go to your PCP, and rarely are patients satisfied with that. One of my friends says that if he doesn't get a nasty gram once a month from a patient, he assumes he's ordering too many tests.

 

[Apollyon]

One of my friends says that if he doesn't get a nasty gram once a month from a patient, he assumes he's ordering too many tests.

If your friend is in private practice, he'll be out of a job by the third nastygram, or he's working somewhere that NO ONE want to be.

 

[southerndoc]

I agree with Roja. If you start complaining about the patients that aren't supposed to be there, you'll just make your job more miserable. Either way, you have to see them.

 

[gman33]

What percentage of patients do you think really shouldn't be there?
If they weren't, what would that do to your income?
Is that a trade you would be willing to make?

 

[Pinner Doc]

Why do people hates BS cases so much in the ER setting? while managing 10 pts at the same time, isn't it a "good thing" to have 4-5 that are simple like sore throat and ear pain...blah blah? so you don't have to pay so much attention to them and focus on the high acute care?

cause if you managing 10 pts who are all high acute care, how can you really handle that all day everyday?

and without those simple cases, wouldn't your pay check be so much lower?

Thanks!

I'm not an attending, but.... I wouldn't call ear pain or sore throat "BS cases." I might call them potentially simple, but the cases I consider BS are the ones who, like others have said above, have chronic chief complaints.

On occasion I do get frustrated with the simple stuff, though-- I think it's usually on the high volume days when I just want to throw up my hands and say, "Did you really think this was an emergency??" because I'm spread so thin. Otherwise, I'd probably be psyched for a quick in-and-out case with a clear dispo.

 

[december07]

What percentage of patients do you think really shouldn't be there?
If they weren't, what would that do to your income?
Is that a trade you would be willing to make?

Good questions.

Are you willing to make the trade off if all you'll is see true emergency cases, but make less money? would you be more satisfying then?

thanks!

 

[docB]

What percentage of patients do you think really shouldn't be there?
If they weren't, what would that do to your income?
Is that a trade you would be willing to make?

Well over half. I'd be willing to take the pay cut. I hate seeing the people who are just here because primary care is inaccessable.

Looking over tonight's patient list I've seen 23 people so far.
-15 did not need an ER, they really just needed a primary doctor.
-2 were sent from nursing homes for complaints that could have been taken care of there but it was easier to dump them in the ER.
-2 were sent from primary care offices. Again, the issues could have been dealt with as out patients or at least with a direct admit but it was easier to dump them in the ER.
-1 was a psych patient sent to the ER by the psych hospital because he was psychotic. I know that sounds stupid but that's how we do it here in Vegas.
-3 were here exclusively for chronic pain issues.
-3 were young women with dysuria/belly pain and no PMD or GYN.
-2 were young men with urethral discharge.
and so on.

 

[Apollyon]

Good questions.

Are you willing to make the trade off if all you'll is see true emergency cases, but make less money? would you be more satisfying then?

thanks!

Or you could move to Hawai'i, where you'll (mostly) see truly emergent cases (as the population is majority Pacific Islander/Asian, where the idea is "maybe I'll be better tomorrow" - until you're NOT)), and make the same amount as you did (more or less) on the mainland, and see fewer patients, because 98% have insurance.

I'm not kidding. One hospital (second busiest ED on O'ahu) sees acuities of 4, and the pt load is - get this - 0.8/hr).