I'm tired of these circus freaks.

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WorkNoteEmergency said:
My wife works in a public library and the stories are very similar except maybe slightly less nudity and less violence.
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I used to go to public libraries so much as a kid but the last few times I’ve been there’s always been a homeless person ruining the vibe. That along with kindles and no more tests = no more libraries for me.
 
EMdoc235 said:
I used to go to public libraries so much as a kid but the last few times I’ve been there’s always been a homeless person ruining the vibe. That along with kindles and no more tests = no more libraries for me.
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Like most institutions in the US, just gotta leave it to one "protected class" loser to ruin it for everyone.
 
Major said:
Urban, suburban, and rural it never ceases to amaze me how EDs attract people with personality disorders
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It’s the only place these freaks can show up and someone has to pay attention and listen to them. In their minds, they get to tell the triage nurse, then the bedside nurse and then the doc. 3 people who have to listen to them.
 
EctopicFetus said:
It’s the only place these freaks can show up and someone has to pay attention and listen to them. In their minds, they get to tell the triage nurse, then the bedside nurse and then the doc. 3 people who have to listen to them.
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Exactly.

I swear there is something about the giant lighted up red and white “EMERGENCY” sign that attracts ‘em. Rain or shine at 3 AM they are coming in.
 
EctopicFetus said:
It’s the only place these freaks can show up and someone has to pay attention and listen to them. In their minds, they get to tell the triage nurse, then the bedside nurse and then the doc. 3 people who have to listen to them.
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I am of the opinion that simply listening to a lot of these "freaks" is actually good therapy for them.
 
Saddleshoes said:
I am of the opinion that simply listening to a lot of these "freaks" is actually good therapy for them.
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I couldn’t be more disinterested. I didnt become a therapist. They want one they can find one.. thats not my job for them. For some patients maybe.. not these clowns.
 
Major said:
Exactly.

I swear there is something about the giant lighted up red and white “EMERGENCY” sign that attracts ‘em. Rain or shine at 3 AM they are coming in.
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My wife and I refer to them as "night people."

After working hundreds of overnight shifts, you begin to realize that everyone who comes to the ER at 3am belongs there. Either because they have a legit emergency, or they're one of the night people.

For the night people, the cacophony of demented old women screaming over the incessant beeping of some long ignored monitor, coupled with the aroma of always present but ever changing putrefaction provides a siren's call ... welcoming them to that place where they belong.
 
Pinner Doc said:
Also… has anyone else noticed that around 4:30 am you start to get all the old folks who got up to pee and then fell?
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Starts here around 1-2 am. Early to bed, early to fall.

They also always hit the dresser. Why do older people they have so many of them? I’m going to start a company that makes padded dressers.
 
Saddleshoes said:
I am of the opinion that simply listening to a lot of these "freaks" is actually good therapy for them.
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Sorry I missed this before. As a former psych patient I have had a Doctor in the ED do this for me (i.e take a few moments to sit with me during a panic attack, be reassuring, and offer some basic relaxation/grounding exercises that they thought might be helpful). I really appreciated what they did that night (I should state that it was one of the rare traversing of the sun around the earth kind of moments, where they actually had the time to do this), and tried to arrange a pizza delivery for the ED staff a week later, but was told that wouldn't be appropriate (but hey the thought was there).

Now this is where I'm gonna put a rather large (and probably obvious) caveat on this. In my layperson's opinion there is a huge difference between a patient, like myself that night, who comes in having experienced either a cluster of symptoms that is outside the norm for their diagnosis or is experiencing a sudden acute onset of symptoms that might be considered emergent outside of any psychiatric symptoms, and someone who is just there to suck all the energy out of the room with their entitlement and willful ignorance. Unless you are floridly psychotic, having a mental illness, or disorder, should not give someone the right to not take responsibility for their negative behaviour with excuses like, 'but mah anxiety disorder/adhd/autism/bipolar/tourettes/etc etc'.
 
Ceke2002 said:
Sorry I missed this before. As a former psych patient I have had a Doctor in the ED do this for me (i.e take a few moments to sit with me during a panic attack, be reassuring, and offer some basic relaxation/grounding exercises that they thought might be helpful). I really appreciated what they did that night (I should state that it was one of the rare traversing of the sun around the earth kind of moments, where they actually had the time to do this), and tried to arrange a pizza delivery for the ED staff a week later, but was told that wouldn't be appropriate (but hey the thought was there).

Now this is where I'm gonna put a rather large (and probably obvious) caveat on this. In my layperson's opinion there is a huge difference between a patient, like myself that night, who comes in having experienced either a cluster of symptoms that is outside the norm for their diagnosis or is experiencing a sudden acute onset of symptoms that might be considered emergent outside of any psychiatric symptoms, and someone who is just there to suck all the energy out of the room with their entitlement and willful ignorance. Unless you are floridly psychotic, having a mental illness, or disorder, should not give someone the right to not take responsibility for their negative behaviour with excuses like, 'but mah anxiety disorder/adhd/autism/bipolar/tourettes/etc etc'.
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This reads more as a defense of one's own experience as a patient in the ED than an expansion of the thread. To be clear, the issue at hand isn't the random patient who shows up at 3am with a panic attack. That's fine. **** happens. That said....

If it's your 12th visit this week, you're inconsolable, screaming and refuse to listen to calm reasoning and explanations that your symptoms are psychiatric in nature and not an indicator of actual impending doom and I need to strap you down and give you 5 and 5 of drop and versed.... you're not having a panic attack. You're one of the night people.
 
BoardingDoc said:
This reads more as a defense of one's own experience as a patient in the ED than an expansion of the thread. To be clear, the issue at hand isn't the random patient who shows up at 3am with a panic attack. That's fine. **** happens. That said....

If it's your 12th visit this week, you're inconsolable, screaming and refuse to listen to calm reasoning and explanations that your symptoms are psychiatric in nature and not an indicator of actual impending doom and I need to strap you down and give you 5 and 5 of drop and versed.... you're not having a panic attack. You're one of the night people.
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I was responding specifically to the post about listening to these sorts of patients as a form of good therapy from them. I guess I was kind of stating the obvious, but my intent was to point out that, whilst commendable, it's perhaps not always a feasible idea if the patient is one of the night people. Apologies if that didn't come across properly in my previous post. Also no defensive intended; I've had my own experience with the night hordes (as a patient and a carer), they are more than a little frustrating.

This article from the Cleveland Clinic Journal of Medicine might be of interest to folks as well, I hope.

Patients with challenging behaviors: Communication strategies
 
Ceke2002 said:
I was responding specifically to the post about listening to these sorts of patients as a form of good therapy from them. I guess I was kind of stating the obvious, but my intent was to point out that, whilst commendable, it's perhaps not always a feasible idea if the patient is one of the night people. Apologies if that didn't come across properly in my previous post. Also no defensive intended; I've had my own experience with the night hordes (as a patient and a carer), they are more than a little frustrating.

This article from the Cleveland Clinic Journal of Medicine might be of interest to folks as well, I hope.

Patients with challenging behaviors: Communication strategies
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Most of the challenging patients the article describes are more appropriate in an outpatient setting.

As far as aggressive and hostile patients, they get a medical screening exam and discharged whether they walk out on their own or security escorts them out. No other business/public space puts up with that behavior so don’t let anyone convince you that you have to put up with it either.
 
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BoardingDoc said:
This reads more as a defense of one's own experience as a patient in the ED than an expansion of the thread. To be clear, the issue at hand isn't the random patient who shows up at 3am with a panic attack. That's fine. **** happens. That said....

If it's your 12th visit this week, you're inconsolable, screaming and refuse to listen to calm reasoning and explanations that your symptoms are psychiatric in nature and not an indicator of actual impending doom and I need to strap you down and give you 5 and 5 of drop and versed.... you're not having a panic attack. You're one of the night people.
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You forgot the meth.....
 
Boatswain2PA said:
You forgot the meth.....
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Man, I'm thankful that my substance abuse patients were 70% EtOH, 20% opioids, 5% shrooms/LSD or too much weed and 5% other, with only maybe 1% of the "other" being meth. Thank god.
 
BoardingDoc said:
Man, I'm thankful that my substance abuse patients were 70% EtOH, 20% opioids, 5% shrooms/LSD or too much weed and 5% other, with only maybe 1% of the "other" being meth. Thank god.
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Most of our meth come thru as psych patients. Last shift.. guy tried to stab himself in the belly cause baby mama was gonna leave him. Up 3 days on meth blah blah blah. stab wound was barely an abrasion, a little talc and then dc.
 
Mount Asclepius said:
Starts here around 1-2 am. Early to bed, early to fall.

They also always hit the dresser. Why do older people they have so many of them? I’m going to start a company that makes padded dressers.
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They make corner and edge padding. We had it on low sharp objects when we had toddlers.

Repackaging it for older people could be an actual idea.
 
Recent pet peeve of mine is patients coming in for AMS when they're drunk. Most often by their families who are unaware of the extent of their drinking, but occasionally on their own accord. Sometimes they even convince triage to activate a stroke alert.

Do I have a right to be mildly irritated with these people?
 
turkeyjerky said:
Recent pet peeve of mine is patients coming in for AMS when they're drunk. Most often by their families who are unaware of the extent of their drinking, but occasionally on their own accord. Sometimes they even convince triage to activate a stroke alert.

Do I have a right to be mildly irritated with these people?
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You have the right to hate these people.
 
turkeyjerky said:
Recent pet peeve of mine is patients coming in for AMS when they're drunk. Most often by their families who are unaware of the extent of their drinking, but occasionally on their own accord. Sometimes they even convince triage to activate a stroke alert.

Do I have a right to be mildly irritated with these people?
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or "not feeling right" after eating an edible, delta-9, etc.

I grin at them and think to myself "thanks for the RVUs, you're gonna be surprised in a few weeks."
 
HemorrhagicShock said:
I love reading these posts.

Not because I love seeing other physicians suffer, but because it makes me so grateful that I'm done with patient-facing roles. Yes, it's noble work, but my god do I never want to do deal with patients ever again. It's the worst part of medicine.

I got so tired of explaining simple concepts, common sense actions, and various things that IMHO 100% of humans should know by the age of 30+. Hell, you LITERALLY LIVE IN A HUMAN BODY and you don't know that your heart pumps blood, your lungs deliver oxygen, and your brain controls movement.

I could go on and on and on in excruciating detail.

And this isn't just EM. I feel bad for anybody who has to spend time with patients or families for any part of their day.
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I come here as a Radiologist for the fun stories and to remind myself why I never want to see patients or work in a hospital.
 
southerndoc said:
or "not feeling right" after eating an edible, delta-9, etc.

I grin at them and think to myself "thanks for the RVUs, you're gonna be surprised in a few weeks."
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I had a high school kid recently who ate an entire bag of frosty maxx gummies which contain thc-p and is apparently much more potent than delta 9. I called tox and they were like "yeah, you're gonna need to admit him." I think he was in the hospital for 2 days until the high wore off. I searched some reddit threads for the stuff and it was just people talking about how awful it is haha.
 
southerndoc said:
I grin at them and think to myself "thanks for the RVUs, you're gonna be surprised in a few weeks."
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Gold Humanism Award right there.

Wild the disconnect between "sacrificing oneself for the betterment of society" drilled into the poor medical student and the crispy edge of reality where our time is being wasted by *****s and sometimes the compensation is the only positive to be found.
 
xaelia said:
Gold Humanism Award right there.

Wild the disconnect between "sacrificing oneself for the betterment of society" drilled into the poor medical student and the crispy edge of reality where our time is being wasted by *****s and sometimes the compensation is the only positive to be found.
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I generally order whatever tests people want within reason if they're well insured, excluding MRIs. If they're Medicaid/uninsured, I dismiss most of their BS testing requests. Call me unethical or whatever but if I have to deal with spending another minute in the same vicinity with a patient, it better be worth my time.
 
EMdoc235 said:
I generally order whatever tests people want within reason if they're well insured, excluding MRIs. If they're Medicaid/uninsured, I dismiss most of their BS testing requests. Call me unethical or whatever but if I have to deal with spending another minute in the same vicinity with a patient, it better be worth my time.
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I had an attending in residency that did something similar, but also extended it to medmal liability.

He mentioned that the likelihood of a medicaid/uninsured patient successfully suing for anything was astronomically low. Access to justice/lawyers, money to pay for initiating a lawsuit, language barriers, cultural barriers, and a lot of systemic factors suggested he was right.

As such he would put minimal to no effort after doing a brief chart biopsy on their insurance. He played this well with the woke/DEI type medical students too, since he knew there was zero risk, he would allow the medical students to do all sorts of time-wasting social work and social determinants of health BS, while spending 30-45 minutes at the bedside. Those medical students loved him because they had no idea of the context for WHY he let them spend all that time "managing" stuff that didn't matter in the ED as far as reimbursement and risk was concerned.

On the other hand if you were a middle aged well-insured white woman, or mom, you were getting every second of his attention, a full on 20 minutes in the room if desired.

I hate to admit this, but he was right when he showed me the risk and reimbursement data. Morally though? Reprehensible.

EM sucks for so many reasons.
 
xaelia said:
Gold Humanism Award right there.

Wild the disconnect between "sacrificing oneself for the betterment of society" drilled into the poor medical student and the crispy edge of reality where our time is being wasted by *****s and sometimes the compensation is the only positive to be found.
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You should come work at some of the IHS sites.

There is one in particular that is absolutely notorious for micromanaging everything and will demand the most useless tests.

Case in point the tribal PD will make the rounds and pick up the town drunks off the street and dump them in the ED every night.

They had a few bad outcomes back in the day so now instead of just the usual observation till sobriety its do all of the labs and scans.

To be clear I mean all of the labs and scans. Like full Sepsis Workup, Lactate, Blood Cultures, Urine Cultures, etc... with a Pan Scan.

For the town drunks with literally no complaints that come in multiple times a week to sleep it off in the emergency department.

Oh and the best part is that they're not allowed to be discharged until the ETOH is under 100 even in severe alcoholics.

So of course many will go into withdrawal and they don't have any ICU beds and they'll all get flown to the regional hospital.

In the end a condition that needs $0 of medical care will receive $200K of medical care and a lifeflight helicopter ride.

Not surprisingly most docs hate working there and they have to pay locums docs 300/hr to see all of the drunks.
 
turkeyjerky said:
Recent pet peeve of mine is patients coming in for AMS when they're drunk. Most often by their families who are unaware of the extent of their drinking, but occasionally on their own accord. Sometimes they even convince triage to activate a stroke alert.

Do I have a right to be mildly irritated with these people?
Click to expand...
southerndoc said:
or "not feeling right" after eating an edible, delta-9, etc.

I grin at them and think to myself "thanks for the RVUs, you're gonna be surprised in a few weeks."
Click to expand...


A few years ago, as edibles became more legal/accessible locally, I had a run of late-middle-aged Dads who were GIVEN edibles by their 20-something children, with all parties consenting and understanding these were THC gummies and would get you HIGH... then Dad acts goofy and they'd EMS him to the ED with ?STROKE?

Like GUYS... Question stroke? Answer BLAZED ON SOUR BALLZ GUMMIES!

Nothing stroke-like about them, just slightly slow speech and being goofy and laughing.

This was the subset that irritated me. You know dad had a gummy. Now he's laughing. Just turn on the TV and let him ride!

I never minded the "its the first time I had THC and I'm panicky/anxious" presentation. I get it. Its fine. Let's turn out the lights and here is an Ativan, you're ok! you're going to be fine. We'll put this monitor on you to make sure. OK chill we'll be back in a couple hours.

I also had one lady who (seriously) accidently ate a mega-dose of THC as she didn't know her husband was into those things. He came home and she was (literally) drooling in the recliner. EMS brought her as a code stroke, all hyped up. I met her, and said "wow she seems more intoxicated / globally slowed than classic stroke" but she was in her 60s and thus we did the things. Husband eventually shows up sheepish with the empty wrapper of what she ate, clinching the diagnosis. It was one of those wrappers that looks 99% like a normal big-brand food item, a mimic shall we say.

I put her into ED OBSV as it was getting late. And signed her out. And she got signed out again. And then I came back 24hr later and took her back in signout. Then half way though my shift she suddenly wakes up and is walking out of the room all "wait, why am I here??". I think it was 32hr of THC Coma...
 
Gummies are usually ridic cases

My only bad overdose was a 2 year old that ate dad's 100 mg gummy and basically slipped into a coma. Tubed and shipped to children's hospital. I was amazed at how rapidly that kid declined. I had heard for years you can't OD on weed but he basically stopped breathing, so....

another reason I'm glad I'm out. I see **** like this and I think about what if this was my own kid, etc
 
AlmostAnMD said:
Gummies are usually ridic cases

My only bad overdose was a 2 year old that ate dad's 100 mg gummy and basically slipped into a coma. Tubed and shipped to children's hospital. I was amazed at how rapidly that kid declined. I had heard for years you can't OD on weed but he basically stopped breathing, so....

another reason I'm glad I'm out. I see **** like this and I think about what if this was my own kid, etc
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agree, THC is generally safe when compared with fentanyl or similar, but I've seen a couple toddlers who needed at least 12-30hr of very close observation before returning to normal. Thankfully I haven't personally intubated one for it, yet.
 
The THC cases are nonsense. No only do they feed into the "just in case" culture of modern EM, but they are LOS and resource killers. They should be going home to be babysat by their families, not taking up a bed with their scromitting.
 
AlmostAnMD said:
My only bad overdose was a 2 year old that ate dad's 100 mg gummy and basically slipped into a coma. Tubed and shipped to children's hospital. I was amazed at how rapidly that kid declined. I had heard for years you can't OD on weed but he basically stopped breathing, so..
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Had exactly the same thing.

Except parents weren't smart enough to know how much she ate, just that she ate ALL of them.
 
qwerty89 said:
I come here as a Radiologist for the fun stories and to remind myself why I never want to see patients or work in a hospital.
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I come here as a psychiatrist who almost went EM to read the funny patient stories told from the EM perspective and laugh as I recall many similar stories from my time premed working in an ER and rotations through med school and residency. Then I’m reminded why I didn’t go into EM and am extremely happy with my choice. But also the EM forum is the most down to earth, least woke place on here.

I am seeing a steady increase of the patients who have the fibro/EDS/dysautomomia/adhd/autism/somehow given a bipolar diagnosis because they were in a “manic episode” one day last week for 20 minutes then were really sad and can’t regulate their emotions for sh$t combo/ tik tok diagnoses with severe anxiety, smokes weed all day every day because it’s “the only thing that works”, asking for disability because they can’t handle being around people or just functioning quasi normally in society. The number of patients coming in telling me they saw a video or a friends sister’s cousin studied psychology for a year in undergrad and told them they should get evaluated for adhd and autism because they “can’t focus at all” or “hyperfocus and sometimes don’t get social cues” despite making straight A’s through every level of schooling including a masters degree, holding down a good job for years and never having any other sign of adhd or autism…. It’s wearing me down.
 
DOswag said:
I come here as a psychiatrist who almost went EM to read the funny patient stories told from the EM perspective and laugh as I recall many similar stories from my time premed working in an ER and rotations through med school and residency. Then I’m reminded why I didn’t go into EM and am extremely happy with my choice. But also the EM forum is the most down to earth, least woke place on here.

I am seeing a steady increase of the patients who have the fibro/EDS/dysautomomia/adhd/autism/somehow given a bipolar diagnosis because they were in a “manic episode” one day last week for 20 minutes then were really sad and can’t regulate their emotions for sh$t combo/ tik tok diagnoses with severe anxiety, smokes weed all day every day because it’s “the only thing that works”, asking for disability because they can’t handle being around people or just functioning quasi normally in society. The number of patients coming in telling me they saw a video or a friends sister’s cousin studied psychology for a year in undergrad and told them they should get evaluated for adhd and autism because they “can’t focus at all” or “hyperfocus and sometimes don’t get social cues” despite making straight A’s through every level of schooling including a masters degree, holding down a good job for years and never having any other sign of adhd or autism…. It’s wearing me down.
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I wonder how many of these bipolar / ADHD fake diagnoses are applied by NPs. I'm betting the vast majority.

Oh you can't focus? Here's a stimulant.

Oh now you can sleep? Here's some Xanax

Oh now you're depressed? Here's some wellbutrin.

And on and on.
 
WhatJobDoIPick said:
I wonder how many of these bipolar / ADHD fake diagnoses are applied by NPs. I'm betting the vast majority.

Oh you can't focus? Here's a stimulant.

Oh now you can sleep? Here's some Xanax

Oh now you're depressed? Here's some wellbutrin.

And on and on.
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I think you vastly underestimate the number of ****ty psychiatrists out there.

There's a guy in town who does exactly this (MD psychiatrist), he's at least 80 and we are all screwed when he dies/retires and his patients all go into withdrawals.
 
DOswag said:
I come here as a psychiatrist who almost went EM to read the funny patient stories told from the EM perspective and laugh as I recall many similar stories from my time premed working in an ER and rotations through med school and residency. Then I’m reminded why I didn’t go into EM and am extremely happy with my choice. But also the EM forum is the most down to earth, least woke place on here.

I am seeing a steady increase of the patients who have the fibro/EDS/dysautomomia/adhd/autism/somehow given a bipolar diagnosis because they were in a “manic episode” one day last week for 20 minutes then were really sad and can’t regulate their emotions for sh$t combo/ tik tok diagnoses with severe anxiety, smokes weed all day every day because it’s “the only thing that works”, asking for disability because they can’t handle being around people or just functioning quasi normally in society. The number of patients coming in telling me they saw a video or a friends sister’s cousin studied psychology for a year in undergrad and told them they should get evaluated for adhd and autism because they “can’t focus at all” or “hyperfocus and sometimes don’t get social cues” despite making straight A’s through every level of schooling including a masters degree, holding down a good job for years and never having any other sign of adhd or autism…. It’s wearing me down.
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I've had a sharp increase in people with ADHD wanting me to write that because of their ADHD they should be allowed to work from home.

I hate them.
 
VA Hopeful Dr said:
I think you vastly underestimate the number of ****ty psychiatrists out there.

There's a guy in town who does exactly this (MD psychiatrist), he's at least 80 and we are all screwed when he dies/retires and his patients all go into withdrawals.
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Same. I weathered this storm about 10 years ago. This one used to be pretty strict but really fell off as he got older. Seems to be a common trait.

The edibles/thc vape intoxication cases are going to only worsen as time goes on. People put a LOT of trust that what they say is in there is the ONLY thing in there and we all know how that went with the tobacco companies. I wouldn’t assume any purity standards when the packaging looks like a Grateful Dead album cover. God bless the never ending quest for the ‘real good s***.’

Is there a reliable test for Kratom yet? One of mine kept having new onset (in her 40s) witnessed seizures. Asked her any idea what could have caused it (ETOH/UDS always normal). Her response to me, “I guess it was too much Kratom.” Good to know they sell bricks of this ish in head shops, herb shops and gas stations.

Who would ever think modern American life would become a blend of Idiocracy, the matrix and terminator 2.
 
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