"But Doctor....how do I know if I have an emergency or not?"

[thegenius]

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that was in response to my statement that I only work up emergency and deadly causes of her symptoms.

Doh

After I told her I've been doing this for a long time, and said I doubt I will find an emergency cause for her nausea, throat pain, joint pain, dizziness, and about 4 other symptoms for several weeks, but I'll be happy to run some blood work to make sure her major organs are working OK...

she eloped

As someone wrote earlier on this forum, just as good that she eloped because it prevents running needless tests and frees up bed space.

 

[Zebra Hunter]

Meh, don't give these patients much thought. I tell the triage nurse to keep these patients in the waiting room if we are busy, and I discharge them from there, or they elope before that.

Hilariously, I just had some anxious, self-important septuagenarian claim today that I wasn't taking her complaints seriously because of her age, as if somehow if she was young, her complaints would be more valid. "Ma'am, I'm not taking your complaints seriously because they have been going on for 8 months, not because you are old as ****." God, sometimes I wish I could say the stuff that is on the tip of my tongue.

 

[deleted836128]

Pretty smart of you to lay out your expectations up front so the patient will know what your work up will entail ...and whether or not they are going to want to stay. Sometimes I am grateful when the chronic left sided nasal congestion, right cheek numbness, vertigo, chest pain, diarrhea, and right leg pain patient decides to GTFO after I tell them “Hmm, sounds like a lot of this has been going on for a long time... probably isn’t anything emergent going on.”

I don’t mind chronic as much as I mind chronic AND obscure, intermingled with real acute symptoms. Like it’s a totally positive review of systems...and then you have to ask for EVERY symptom - “Is this a new issue or old issue?” “Yeah, how long has that been going on?” and it takes you 20 minutes to sort through what’s new and acute, and guess what’s important and what really isn’t, and then you do a huge work up and go back in the room and then they’re like, “Well, why is my right leg swollen?! I feel like no one listened to me about what I came in here for!” FML.

 

[alpinism]

Completely agree.

Always set expectations up front as it saves everyone a lot of hassle when it comes time for discharge.

The problem is that were fighting a losing battle with not just patients but also everyone else in medicine who wants the ER to function as their own personal 24/7 convenience care clinic for any medical problem. Its nearly impossible to tell patients the ER is for emergencies when you have billboards advertising wait times and 30 minute guarantees. Add on that the the fact that specialists tell patients to go straight to the ER for any concerns since you'll get seen right away and they have fancy CTs and MRIs to diagnose your problem.

Honestly its not a problem of not being able to tell what is and what is not an emergency. Patients aren't stupid. They know they're not dying and don't require immediate treatment to save their lives. They abuse the ER because its the fastest and cheapest option and because everyone else says its okay to go to the ER to be checked out and to make sure everything is fine. I'll often ask my patients if they think they're dying or if they think they'll survive to see their children tomorrow. Almost every time they get this confused look on their face like I'm speaking another language.

What!? Are you serious!? Doctor I better not be dying I'm leaving for my vacation in the Bahamas next week!!

 

[deleted109597]

I always give expectations. Whether it be ER pts or urgent care.
I don't mind the chronic patients, except when they wake me up on a 24 at 3am to find out why they've been hurting since 1997

 

[Tenk]

I usually ask these types what they are afraid of the most or what do they think it is. Sometimes they will be afraid of something ridiculous and all they need is assurance. Sometimes... not. Worth a shot though since it's just a simple question and you can hone in on why they are there.