Does anyone just like....hate this?

[zurned]

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Why get the patient a turkey sandwich? I don't get a tip, and don't get extra money. My time is better spent seeing another patient and racking up more RVUs. If the hospital allows me to accept cash tips, or pays me to do other people's jobs too then I have no problem.

Cuz it takes 5 minutes off your 12 hours doing an unimportant and mindless easy task that you are getting paid for time-wise. I guess I could be intubating Someone for 5 minutes for the same amount of money.

 

[RustedFox]

Cuz it takes 5 minutes off your 12 hours doing an unimportant and mindless easy task that you are getting paid for time-wise. I guess I could be intubating Someone for 5 minutes for the same amount of money.

You're either a resident, or you aren't paid for productivity.

 

[Dr Mantis Toboggan]

He would do...I mean make the intern do, anything for the Press Ganies.

What a weak pathetic man.

 

[lucid_leprechaun]

Bizarre move by the attending. My response would have been ama paperwork. I would also have probably put in his quotes verbatim in the chart

Agreed I document the behavior and tell to person to leave my ER until they can act like an adult.

 

[dadaddadaBATMAN]

I think I agree with most of your points. Maybe it’s just splitting hairs. I guess I practice that you do everything you can to keep a patient from leaving AMA and rarely utilize it. If allowing them to have a coffee (and it’s easily available) will keep them from leaving so that you can complete a workup, then just let them have it. If they are rude and disruptive, but I think they still need further evaluation to determine that there isn’t anything emergent occurring, then I have a terse conversation with them outlining what kind of speech and behavior is tolerated (still ridiculous that its necessary to interact with adults who act like children). I don’t assume that they are declining a workup without confronting them. These aren’t pleasant conversations, but I’m sometimes surprised by jerks who completely change their demeanor and the whole encounter through deescalation over something minor like a coffee. I don’t like talking to patients as much as the next person, but I find myself stewing more so over the difficult patient that storms out of the ED than if I find a different workable solution.

I don’t send these people without talking to them. If I hear them saying something like that or the nurse tells me I walk in and tell them that I recommend they not eat/drink if they should be npo, but if it’s that or no workup they can have it but might delay blah blah blah. If they aren’t reasonable or are demanding we use our staff to perform non clinical duties i point out the door. I don’t lose sleep over this. If the whole thing is documented, I have trouble believing they’ll find a sympathetic jury, but I’m in a pretty good malpractice environment.

I don’t document ama for legal purposes, though I think it doesn’t hurt anything there. I do it for communication with other docs regarding why a standard workup didn’t happen, I do it for the ombudsman, and I do it for the Monday morning qbs (the qa comittee and abrasive specialists). I find that it does seem to prevent these things from escalating.

edit: if they leave without my having a chance to talk to them I just write that down and don’t lose sleep over it. I make a reasonable attempt to contact them (phone call x2) to have ama conversation, document that, then go about my business. I always discuss my differential during my initial pass, and so I note the life threats/disabling conditions pt was aware of and that they left before we could rule these out and knew it.

 

[zurned]

You're either a resident, or you aren't paid for productivity

Yep, hourly only. Truly a cog’s job.

 

[GeneralVeers]

I don’t send these people without talking to them. If I hear them saying something like that or the nurse tells me I walk in and tell them that I recommend they not eat/drink if they should be npo, but if it’s that or no workup they can have it but might delay blah blah blah. If they aren’t reasonable or are demanding we use our staff to perform non clinical duties i point out the door. I don’t lose sleep over this. If the whole thing is documented, I have trouble believing they’ll find a sympathetic jury, but I’m in a pretty good malpractice environment.

I don’t document ama for legal purposes, though I think it doesn’t hurt anything there. I do it for communication with other docs regarding why a standard workup didn’t happen, I do it for the ombudsman, and I do it for the Monday morning qbs (the qa comittee and abrasive specialists). I find that it does seem to prevent these things from escalating.

edit: if they leave without my having a chance to talk to them I just write that down and don’t lose sleep over it. I make a reasonable attempt to contact them (phone call x2) to have ama conversation, document that, then go about my business. I always discuss my differential during my initial pass, and so I note the life threats/disabling conditions pt was aware of and that they left before we could rule these out and knew it.

I don't waste my time with these people. They need to leave and I don't care how. If you are screaming and yelling, and making threats, and can walk out of the department you likely don't have an emergent condition.

 

[GeneralVeers]

You’ll be right the vast majority of the time. The problem is the rare time you aren’t. These ridiculous people can occasionally have something going on. A bad outcome plus an angry patient is what leads to litigation. It’s rare you’ll be in that situation, but this is how you get there. I can’t say I won’t be in the same boat, but I think it’s important to be cognizant of this fallacy.

Just document you discussed it with them, whether or not you did. Who's going to take Crazy McCrazyFace at his word?

 

[GeneralVeers]

You are potentially right. I don’t like being drug into the muck of dishonesty though just because that is commonplace of many of the patients we interact with in the ED. We shouldn’t have to manipulate truth because our medicolegal risk is more important than the patient in front of us. Sadly that frequently seems to be the case. This is a window into a much bigger philosophical discussion regarding if it is okay to to be dishonest or ‘harm’ (theoretically, or in some seemingly insignificant manner) someone who is ‘evil’ for the benefit of the rest of the ‘good’ you provide to everyone else.

If you aren't manipulating the truth, then you aren't charting correctly. See our discussions on documentation of chest pain patient.s