Frequent Flyers

[CueDoc]

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How do you deal with frequent fliers? There is a 50-ish Female that comes to our ED no less than 3x / week always with multiple vague non specific complaints like abdominal pain/dizziness/Leg pain, physical exam almost never helps you, diffuse pain on abdominal exam, CVA tenderness, etc. all of her multiple complaints have been worked up multiple times in the past in addition to being evaluated by psych in the ED on at least 2 occasions. Most of the time now when she comes in, the discharge papers are printed up before she is even through triage. One of these days I have no doubt that she is actually going to have some pathology and drop dead on our front steps. How do you guys deal with this?

 

[EMFreakz]

great question. boy/girl who cried wolf. you're definitely right, multiple visits doesn't r/o real pathology, but hard to discern when to do the w/u, and difficult when pts refuse to f/u.

 

[DrQuinn]

Just have to be objective, as well as to document well.

"Pt sitting in ED room eating bag of potato chips talking on cell phone" versus "writhin in pain in stretcher."

Also, "pt says pain is similar to previous exacerbations."

I do a lot of "po challenges" which aren't meals but are just juice and crackers.

I tend to be one of the nicer ED docs (working on being tougher).

That being said, I had a frequent flyer come in two days ago, ESRD patient with abdominal pain. comes in all the time (atleast once a week). This time was different. Put him in for a scan, vital signs were stable. Wants to leave and wants to eat, (but he told me his pain was very different this time). He ended up rupturing an 8 cm x 7 cm renal cyst into his belly and coded (ten minutes after I signed out to the doc). He actually wanted to leave AMA too about 15 minutes before he coded.

Q

 

[Katydid]

How do you all stand the frequent flyers?

And I'm not joking here, I'm serious. I can't imagine that your patience lasts that long as to put up with someone who comes in as much as three times a week, and takes up space for bullpucky complaints, that YOU know are crap, and THEY know are crap, but they take up valuable space in your ER?

But then, I read the Things I Learned From My Patients threads, and Medicine Sucks, and so forth. I think y'all are truly on a different wavelength from those of us who don't do this for a living!

 

[CueDoc]

How do you all stand the frequent flyers?

And I'm not joking here, I'm serious. I can't imagine that your patience lasts that long as to put up with someone who comes in as much as three times a week, and takes up space for bullpucky complaints, that YOU know are crap, and THEY know are crap, but they take up valuable space in your ER?

But then, I read the Things I Learned From My Patients threads, and Medicine Sucks, and so forth. I think y'all are truly on a different wavelength from those of us who don't do this for a living!

There has to be at least one down-side to our profession or it really wouldn't be fair would it?

 

[roja]

How do you all stand the frequent flyers?

And I'm not joking here, I'm serious. I can't imagine that your patience lasts that long as to put up with someone who comes in as much as three times a week, and takes up space for bullpucky complaints, that YOU know are crap, and THEY know are crap, but they take up valuable space in your ER?

But then, I read the Things I Learned From My Patients threads, and Medicine Sucks, and so forth. I think y'all are truly on a different wavelength from those of us who don't do this for a living!

No job is perfect. You must learn to deal with the frustrations in a constructive manner. Humor is one of them. 🙂

If you don't learn to laugh about it, you will go insane and be miserable.


Personally, I just pick my battles. This isn't one of them and I just don't give in. As quinn pointed out, you must have due diligence and make sure there isn't something serious going on, once I determine there isn't, I remove them from my mind and my ER.

Occasionally I get serious attitude, either at me, my nurses or my residents, I use a security consult liberally, after I have informed them that the behavior won't be tolerated.

 

[Katydid]

No job is perfect. You must learn to deal with the frustrations in a constructive manner. Humor is one of them. 🙂

If you don't learn to laugh about it, you will go insane and be miserable.


Personally, I just pick my battles. This isn't one of them and I just don't give in. As quinn pointed out, you must have due diligence and make sure there isn't something serious going on, once I determine there isn't, I remove them from my mind and my ER.

Occasionally I get serious attitude, either at me, my nurses or my residents, I use a security consult liberally, after I have informed them that the behavior won't be tolerated.

I see. That makes a difference, especially if you have security backup.

Of course, when my brother was doing medical transport for the county jail back home, he was the security backup if ER staff had a problem with one of his "wayward children". Of course, my brother is 6'3" and built like a barrel, so that makes a bit of a difference....there weren't too many problems with inmates when HE brought them in. That, and the inmates seem to respect him because he treats them like human beings worth respect as human beings, unless they prove otherwise.

Medicine, corrections and education - the most popular career choices among my family. And three career choices I greatly respect enough to know I'm not capable. I'm not tough enough for corrections or education, and not compassionate enough for medicine.

 

[kungfufishing]

I dont like calling the police gangtackle consult, but it sure can help at times.

 

[Jeff698]

I dont like calling the police gangtackle consult, but it sure can help at times.

Our hospital, instead of calling 'code X', calls 'Dr. X' over the PA system, ie. Dr. Blue, Room 452.

We have a 'Dr. Armstrong' code for someone needing a can opened up on 'em. The truly funny thing is in July, seeing the interns named Armstrong show up breathlessly and very confused in a room filled with security guards. 😉

Take care,
Jeff

 

[sparkleflower]

Dr. Armstrong must be standard code for security. I work on the crisis team in community mental health, and that's our building code for an armed and threatening client. 'Course since we don't have security, it's actually a signal for someone on my team to respond and attempt to defuse the situation. We like to think of it as our signal to leave the building, lol.