I wish patients knew what the ER was for

[thegenius]

<rant>
I'm on shift, and this nice lady kept on asking me about bumps on her neck. I told her several times that I'm here just to make sure she didn't have a stroke (she came in dizzy). Finally her husband said "HONEY....he's not going to figure that out!"

"Ohhhh...honey you don't have to be mean about it. I was just asking."

Non stop today...people asking me about crap that I will never know the answer. It just gets so tiresome.

"If I had to know everything about everything in medicine, I would be in residency for 35 years."
</rant>

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[Angler]

Deep breath... repeat multiple times each shift...

 

[Rekt]

80% of the EM workforce would be immediately fired if only emergencies went to the ED.

With that said these patients make we want to taste cold steel daily.

 

[RustedFox]

80% of the EM workforce would be immediately fired if only emergencies went to the ED.

With that said these patients make we want to taste cold steel daily.

Americans are insufferable and getting worse.

 

[hoot504]

80% of the EM workforce would be immediately fired if only emergencies went to the ED.

With that said these patients make we want to taste cold steel daily.

The paradox of EM.

 

[JacobMcCandles]

It’s not necessarily the inappropriate use, it’s the patient expectations. I’ll run across patients that just need assurance and they’ll be happy and go on their merry way. If a patient has a non-emergent issue, nothing needs to be done, and the patient wants it fixed immediately then everyone is going to have a bad time.

 

[BoardingDoc]

Patients also seem to have the expectation that we are capable of doing literally anything in medicine and anytime we don't it's because we're simply disinclined to do so.

I had a woman bring in her elderly father for constipation a few days ago. Longstanding issue. GI appointment in 2 weeks. She kept asking for me to order a colonoscopy for him (e.g. to have one done that day).

I explained no less than 5 times that I can't do that. Each time she returned with some iteration of "ok, then just make sure the GI doctor knows about this so he can get it done tomorrow." Repeatedly explained that I couldn't do that even if I wanted to.

When he was discharged she asked the nurse to see me again because she couldn't find where the colonoscopy appointment (that I repeatedly told her I couldn't make) was listed on her DC papers.

FML

 

[Angler]

How much of these inappropriate ER visits are due to inadequate access to decent primary care? I bet that a lot of these patients would vanish if there was such access.

 

[gutonc]

How much of these inappropriate ER visits are due to inadequate access to decent primary care? I bet that a lot of these patients would vanish if there was such access.

I'm oncology, not EM or primary care, but I tend to be the first call for literally any issue for most of my patients. We answer the phones, call people back within minutes most times and always have same/next day appointments. And even still, I get my patients wandering into the ER for BS that could have been handled with a 30 second phone conversation every single day.

I'm not saying there isn't an issue with PCP access, I'm just saying that it's not the only, or maybe even the primary, issue here.

 

[VA Hopeful Dr]

I'm oncology, not EM or primary care, but I tend to be the first call for literally any issue for most of my patients. We answer the phones, call people back within minutes most times and always have same/next day appointments. And even still, I get my patients wandering into the ER for BS that could have been handled with a 30 second phone conversation every single day.

I'm not saying there isn't an issue with PCP access, I'm just saying that it's not the only, or maybe even the primary, issue here.

I am primary care and this exact scenario plays out daily (if not several times daily).

 

[TrailRun]

a lot of times "my doctor sent me to the ER" is actually 'the secretary at my doctor's office...'

but, referencing the poster above, I definitely feel bad especially when an oncology patient (immunosuppressed) comes to the ER for a non-urgent thing, then likely leaves having caught Covid/Flu from the waiting room

 

[sloh]

Patients also seem to have the expectation that we are capable of doing literally anything in medicine and anytime we don't it's because we're simply disinclined to do so.

I had a woman bring in her elderly father for constipation a few days ago. Longstanding issue. GI appointment in 2 weeks. She kept asking for me to order a colonoscopy for him (e.g. to have one done that day).

I explained no less than 5 times that I can't do that. Each time she returned with some iteration of "ok, then just make sure the GI doctor knows about this so he can get it done tomorrow." Repeatedly explained that I couldn't do that even if I wanted to.

When he was discharged she asked the nurse to see me again because she couldn't find where the colonoscopy appointment (that I repeatedly told her I couldn't make) was listed on her DC papers.

FML

Never overestimate the intelligence of gen pop.

 

[gro2001]

a lot of times "my doctor sent me to the ER" is actually 'the secretary at my doctor's office...'

I think this is an under appreciated aspect of the problem. The front of office and answering service employees seem to be like 95% idiots, nation wide. Our answering service for example can't tell the difference between neurologic specialties or physicians who work for our group vs outsiders. So neurocrit gets called for stroke or movement disorder calls all the time and vice versa. Private general neurologists ("she doesn't even go here!") get called for neurocrit transfers. Sometimes I get a call telling me the Dr GRO (ie me) is trying to reach me. Sometimes I get a call about me being the patient (I explain that I am the physician this doctor or patient may or may not be trying to reach). I shudder to think how many patients are sent to the ER (or, frankly, not sent to the ER when appropriate).

 

[GonnaBeADoc2222]

I am primary care and this exact scenario plays out daily (if not several times daily).

I've never bought the "increased access to primary care will decrease ER visits" argument. I can see this only happening in rural critical access areas.

The entitled nonsense presentations will come to the ED regardless of what outpatient resources are available to them.

 

[RustedFox]

I've never bought the "increased access to primary care will decrease ER visits" argument. I can see this only happening in rural critical access areas.

The entitled nonsense presentations will come to the ED regardless of what outpatient resources are available to them.

This is 90+ percent of EM visits in this day and age.
This is why people need to get out.
This is what the kids need to know when choosing a specialty.

 

[VA Hopeful Dr]

I've never bought the "increased access to primary care will decrease ER visits" argument. I can see this only happening in rural critical access areas.

The entitled nonsense presentations will come to the ED regardless of what outpatient resources are available to them.

It would probably help some, but I bet it wouldn't reduce daily ED visits by 10%.

You have to pay me at the time of service. You have to make an appointment and actually show up on time. I don't have IV opioids. Your insurance has to approve a CT scan and you might have to pay for it.

 

[rojamd]

Ive taken some time off from working clinically in the ER but I will tell you, figuring out what to be truly annoyed at is an important part of reducing burn out.

when I am at my lowest=
- job security. These things are part of what keeps us in business. every field has its negative. this is ours.
-easier chart. (okay, not on a dizzy patient but on simple stuff).

when I am not at my lowest=
-TV has made our field sexy as hell and confuses the vast majority of people. Aside form "are you a nurse" being the most common misidentified career choice for me the other one is "so, you do surgery."
-Not everyone does know. Or to get into their clinic will take weeks.

Things that help: I just admit I can't do lots of things and put it in context.
"I'd love to order you X but the insurance companies won't less us do that. If I did, they won't approve it and you will get stuck with a bill for thousands of dollars." Lots of patients don't really understand what we are up against with insurance companies.

"I'd really like to figure out what those aren't but that's what an x is for and really, I'm not the best one to do that.".

Ive worked, rural, urban, etc. Its constant everywhere. If you can't cope with this, EM is a tough field.

 

[Tenk]

You want to hear something scary? Most patients coming in with these things actually think they are having an emergency.

 

[Rekt]

You want to hear something scary? Most patients coming in with these things actually think they are having an emergency.

Patients can’t comprehend that sometimes you just hurt. Sometimes you just have chest pain. Sometimes you just have abdominal pain. Sometimes you just have joint pain. Etc. They just don’t understand there’s not an answer for everything.

Of course they aren’t happy with this and keep going to different physicians and then eventually some inept pretend level provider will draw an equivocal ANA and diagnose them with the flavor of the month auto immune disorder and throw on a diagnosis of alpha gal to top it off and the patient goes “See I knew something was wrong with me!” Then they go to TikTok and post their physician bashing journey.

 

[Tenk]

Patients can’t comprehend that sometimes you just hurt. Sometimes you just have chest pain. Sometimes you just have abdominal pain. Sometimes you just have joint pain. Etc. They just don’t understand there’s not an answer for everything.

Of course they aren’t happy with this and keep going to different physicians and then eventually some inept pretend level provider will draw an equivocal ANA and diagnose them with the flavor of the month auto immune disorder and throw on a diagnosis of alpha gal to top it off and the patient goes “See I knew something was wrong with me!” Then they go to TikTok and post their physician bashing journey.

Yes, always be wary of any diagnosis that has nonspecific tests, loose diagnostic criteria, and no specific treatment (or treatment with an antidepressant).

 

[AW125]

Patients can’t comprehend that sometimes you just hurt. Sometimes you just have chest pain. Sometimes you just have abdominal pain. Sometimes you just have joint pain. Etc. They just don’t understand there’s not an answer for everything.

Of course they aren’t happy with this and keep going to different physicians and then eventually some inept pretend level provider will draw an equivocal ANA and diagnose them with the flavor of the month auto immune disorder and throw on a diagnosis of alpha gal to top it off and the patient goes “See I knew something was wrong with me!” Then they go to TikTok and post their physician bashing journey.

I don't know if I am not reading this correctly as I am not a med student yet but are you saying that patients should be judicious in their assessment of chest pain and abdominal pain before going to the ED?

 

[HemeOncHopeful19]

I don't know if I am not reading this correctly as I am not a med student yet but are you saying that patients should be judicious in their assessment of chest pain and abdominal pain before going to the ED?

I see where you’re going with this and I do understand why you’re asking so I’ll try to explain what I think @Rekt meant here

Have you ever had a mild tummy ache that resolved after letting loose a large fart?

Did you go to the ER for it?

 

[AW125]

I see where you’re going with this and I do understand why you’re asking so I’ll try to explain what I think @Rekt meant here

Have you ever had a mild tummy ache that resolved after letting loose a large fart?

Did you go to the ER for it?

Most people won't interpret it as such.

But if patients are ending up in the ER for what you feel are unwarranted visits, I'd argue that is due to inefficient primary care where physicians should be able to explain to patients what an emergency is and is not.

If the primary care relationship is not good to begin with, I actually would not blame the patient for going to the ED for random abdominal pain.

 

[hoot504]

Most people won't interpret it as such.

But if patients are ending up in the ER for what you feel are unwarranted visits, I'd argue that is due to inefficient primary care where physicians should be able to explain to patients what an emergency is and is not.

If the primary care relationship is not good to begin with, I actually would not blame the patient for going to the ED for random abdominal pain.

Reeks of someone who has no idea what they're talking about.

 

[dozitgetchahi]

80% of the EM workforce would be immediately fired if only emergencies went to the ED.

With that said these patients make we want to taste cold steel daily.

If it helps you feel any better, this issue is certainly a thing in some outpatient specialties too (rheumatology)…but at least I can intercept a lot of this nonsense before it gets to the clinic by blocking the consult, and what does sneak through the filters is usually fairly easy to dismiss from clinic.

I cannot imagine dealing with a unbridled, unfiltered stream of undifferentiated patients, 80% of which are basically nonsense and/or are not appropriate for the specialty…with a smattering of high risk, acutely ill patients randomly mixed in. I feel for you guys.

 

[dozitgetchahi]

Americans are insufferable and getting worse.

Yeah. My experience in outpatient rheumatology since the pandemic started has basically led me to the same conclusion.

After dealing with the whiny/bratty/bossy/nasty/rude vibes of the typical patient that seems to walk through the door these days…my feelings about the “average American” are probably better left unsaid. It used to be that maybe three quarters of patients that came in most days were pretty cool people, with maybe the other quarter being as described above…after the pandemic, some days it feels like that’s been inverted.

 

[Fox800]

Chest pain for 5 seconds, 8 hours ago.

Go to the ED 8 hours later.

#winning

 

[Apollyon]

Reminds of something from about 7 years ago, or so. Pt and spouse complained because I told them it wasn't an emergency. And there wasn't anything that a prudent layperson might construe as a possible emergency (like chest pain or abd pain). My boss said that I couldn't say that.

 

[AW125]

Reeks of someone who has no idea what they're talking about.

You'd be surprised

My advice to you all is to treat all those abdominal pains and other things that YOU don't think are serious as serious because sometimes those cases are life and death situations. Believe me I know.

 

[hoot504]

You'd be surprised

My advice to you all is to treat all those abdominal pains and other things that YOU don't think are serious as serious because sometimes those cases are life and death situations. Believe me I know.

Dude. Log off. You aren't in the right place.

 

[AW125]

Dude. Log off. You aren't in the right place.

Gotta lose that arrogance man. You'll probably be one of those docs that ends up killing a patient.

 

[hoot504]

Gotta lose that arrogance man. You'll probably be one of those docs that ends up killing a patient.

Not arrogant. You're just clearly a lay person who has no place in this thread.

 

[AW125]

Not arrogant. You're just clearly a lay person who has no place in this thread.

Your argument is a dangerous one and I'm calling you out on it. A lay person won't have the awareness.

 

[Apollyon]

Your argument is a dangerous one and I'm calling you out on it. A lay person won't have the awareness.

This site isn't for patients.

And anyone EM trained has not had multiple patients die because they were blown off by the doctor. Actually, statistically, we are actually rather good at finding the wheat among the chaff. Really bad and really not look really alike.

 

[hoot504]

Your argument is a dangerous one and I'm calling you out on it. A lay person won't have the awareness.

I haven't even put forth an argument, other than that you have no idea what you're talking about.

 

[AW125]

I haven't even put forth an argument, other than that you have no idea what you're talking about.

You are agreeing to an argument that is flawed and I am trying to help you to think outside of that so you don't kill a patient and then wonder why you are getting sued for negligence.

I'm not even attacking you. It's the thought that you still have ER docs out there who don't know how to communicate with a patient that irks me and I suspect that might be you and a few others here and that will only lead to disastrous outcomes.

 

[AW125]

This site isn't for patients.

And anyone EM trained has not had multiple patients die because they were blown off by the doctor. Actually, statistically, we are actually rather good at finding the wheat among the chaff. Really bad and really not look really alike.

But you treat patients.

And I don't think all EM docs know what is going on in the next ED and if you did, I'm saying you might be surprised.

 

[Apollyon]

But you treat patients.

And I don't think all EM docs know what is going on in the next ED and if you did, I'm saying you might be surprised.

None of this is new or unknown. We have all lived this, whether ourselves, or working with "Dr Death". Especially when it's EM and non EM working next to each other, we see that.

 

[AW125]

None of this is new or unknown. We have all lived this, whether ourselves, or working with "Dr Death". Especially when it's EM and non EM working next to each other, we see that.

The point I was going for was that in medicine, communication is critical and everybody is not well versed on that idea and the diagnosis is many times in that communication alone.

I'm talking specifically about EM though. When you have a patient that comes in with abdominal pain, I mean you have to really look at that from all angles to come to the correct diagnosis because that could be anything. To be fair, I don't think you have the time or the energy to go through all those differentials but if you put the blame on the patient or expect them to diagnose themselves, you're just asking for trouble. Again, been there done that.

Can we at least agree that there are people in EM that should not be in EM and perhaps in medicine altogether and would help fix some of the issues that you encounter in your specialty?

 

[hoot504]

The point I was going for was that in medicine, communication is critical and everybody is not well versed on that idea and the diagnosis is many times in that communication alone.

I'm talking specifically about EM though. When you have a patient that comes in with abdominal pain, I mean you have to really look at that from all angles to come to the correct diagnosis because that could be anything. To be fair, I don't think you have the time or the energy to go through all those differentials but if you put the blame on the patient or expect them to diagnose themselves, you're just asking for trouble. Again, been there done that.

Can we at least agree that there are people in EM that should not be in EM and perhaps in medicine altogether and would help fix some of the issues that you encounter in your specialty?

I'll agree if you log off and forget this forum exists.

 

[AW125]

I'll agree if you log off and forget this forum exists.

You sound like a child.

 

[hoot504]

You sound like a child.

I wouldn't argue with that. I still know oceans more about this subject than you do.

 

[RustedFox]

You sound like a child.

Tell me you're not a physician without telling me you're not a physician.

 

[AW125]

Tell me you're not a physician without telling me you're not a physician.

I don't think what I was saying has anything to do with if I am a physician or not. I think I pointed out that I wasn't.

The point being is that the attitudes you are demonstrating are contributing factors to the problems in medicine today.

On one end you have poor primary care which sends the cases that you complain about your way and on the other end whether it is the result of apathy or lack of resources, you send those patients back without actually fixing those problems or worse you kill them through negligence.

So when I see an EM physician saying that patients should know when you visit the ED and when not to visit the ED, I think you should be a little more aware.

 

[RustedFox]

I don't think what I was saying has anything to do with if I am a physician or not. I think I pointed out that I wasn't.

The point being is that the attitudes you are demonstrating are contributing factors to the problems in medicine today.

On one end you have poor primary care which sends the cases that you complain about your way and on the other end whether it is the result of apathy or lack of resources, you send those patients back without actually fixing those problems or worse you kill them through negligence.

So when I see an EM physician saying that patients should know when you visit the ED and when not to visit the ED, I think you should be a little more aware.

Check back with us during your second year of residency.
Actually. Bookmark this post and come back to it.
You'll see just how and why you were oh-so-very naive.

 

[AW125]

Check back with us during your second year of residency.
Actually. Bookmark this post and come back to it.
You'll see just how and why you were oh-so-very naive.

Oh I don't doubt that my view is in the minority but at the same time, where does change begin?

 

[RustedFox]

Oh I don't doubt that my view is in the minority but at the same time, where does change begin?

Honest answer: with the patient and self-responsibility/appropriate use of resources.
You're so young and new, bro.
I remember when I was like you.
You're committing the "John Everyman" fallacy.
See; we're taught to think in an egalitarian fashion by our parents, teachers, and mentors.
"All men are created equal" and the like.
It makes us feel good to think that about ourselves. Look how just we are!
You probably consider that the average patient is not so different than yourself, and that they would behave similarly and responsibly.
The truth is: the average ER patient is so amazingly reckless, irresponsible, and just plain dumb... that we all wonder who reminds them to breathe.
It's unpleasant to think about, isn't it?
They call us "elitist", "racist", "classist", and other names.
But we're not wrong.

Think on that one for a bit. There's an entire forum of dozens of physicians with hundreds of years of experience telling you...

The number one cause of burnout is... the patient.

 

[hoot504]

Honest answer: with the patient and self-responsibility/appropriate use of resources.
You're so young and new, bro.
I remember when I was like you.
You're committing the "John Everyman" fallacy.
See; we're taught to think in an egalitarian fashion by our parents, teachers, and mentors.
"All men are created equal" and the like.
It makes us feel good to think that about ourselves. Look how just we are!
You probably consider that the average patient is not so different than yourself, and that they would behave similarly and responsibly.
The truth is: the average ER patient is so amazingly reckless, irresponsible, and just plain dumb... that we all wonder who reminds them to breathe.
It's unpleasant to think about, isn't it?
They call us "elitist", "racist", "classist", and other names.
But we're not wrong.

Think on that one for a bit. There's an entire forum of dozens of physicians with hundreds of years of experience telling you...

The number one cause of burnout is... the patient.

I don't even think this guy's a pre-med. I think he's just a disgruntled patient who stumbled onto this forum.

 

[AW125]

Honest answer: with the patient and self-responsibility/appropriate use of resources.
You're so young and new, bro.
I remember when I was like you.
You're committing the "John Everyman" fallacy.
See; we're taught to think in an egalitarian fashion by our parents, teachers, and mentors.
"All men are created equal" and the like.
It makes us feel good to think that about ourselves. Look how just we are!
You probably consider that the average patient is not so different than yourself, and that they would behave similarly and responsibly.
The truth is: the average ER patient is so amazingly reckless, irresponsible, and just plain dumb... that we all wonder who reminds them to breathe.
It's unpleasant to think about, isn't it?
They call us "elitist", "racist", "classist", and other names.
But we're not wrong.

Think on that one for a bit. There's an entire forum of dozens of physicians with hundreds of years of experience telling you...

The number one cause of burnout is... the patient.

I'll send you a private message...

 

[RustedFox]

I don't even think this guy's a pre-med. I think he's just a disgruntled patient who stumbled onto this forum.

Let him cook.