Is EM just "dealing with drunks?"

[tdavie]

Hello. I'm a third year medical student at an allopathic U.S. school, considering EM as a career choice. Just wanted to hear some opinions about something I heard recently from a resident I was working with. They said that they didn't like the ED, and when asked why, they said:

"In the emergency room, you're just dealing with a lot of lying drunks. I got very little satisfaction treating them, and the patients who did have a real problem didn't have insurance to go see a regular doctor."

In my experience (a very short rotation), this is inaccurate. During the time that I've spent in the emergency department, I felt like there was quite a variety of patients, including a majority with legitimate and various problems, and legitimate insurance.

Any thoughts? Thanks!

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[EM4life]

The ED has the special task of dealing with societal drunkards who somehow manage to end up in our hands. You can view them as a pain in the ass, which arguably they certainly are, but you can also see them as having potential for interesting pathology. There's plenty of trauma, subdurals, metabolic abnormalities, torsades, wernickes, wet beri beri ( to name a few) to go around.

You will see a lot of drunks in your EM training, you also see a lot of other cool stuff.

 

[Dotsero]

As a former ER nurse I can say that there is some truth to this statement. You end up taking care of a lot of drunks, particularly on the weekends. A large number of trauma involves alcohol. And that can be very frustrating day in and day out.

The other group that will drive you nuts are the people who abuse the system and use the ED for non-emergent issues. There are ALOT of these types. I've seen people with over 150 visits to the ED. Most average about 30. I can count on one hand (actually one finger) the number of times I went to the ED to be treated. Hell if I didn't work there I wouldn;t want to be there at all. But these people are drawn to the place.

Anyways, the ED is a mixed bag. You can really help somebody and save their life one moment and the next you are dealing with an abusive drunk who is trying to spit on you while you are starting his IV.

But it gets in your blood and you keep going back.

 

[ccfccp]

I probably see about 1-2 drunks per night shift (significantly less during the day... but not zero.) They're easy to see (as long as you're careful) and a quick note. I usually also see a couple of chronic pain/drug seeker patients in shift. Is it a part of the environment, certainly. My personal pet peeve is the entitled attitude I get from certain subsets of my population for care that I am basically providing them for free.

I also see septic patients, trauma patients, orthopedic injuries, run-of-the mill cold/flu, peds, ob/gyn, and whatever else rolls through the door. I see diseases that "never present like that" because patients who don't have insurance and don't get things taken care of early can end up with unusual, bad pathology. I like it, and I can almost always have something interesting to talk about when I get home.

On the whole, the sagest advice I've ever gotten from another physician was this: "It's important to like the good parts of your job, but it's even more important to be able to put up with the bad parts." Every job has things that are annoying and frustrating at times. If you can't deal with those things, you'll be miserable no matter how much you enjoy the "fun stuff."

 

[EctopicFetus]

Truly who you see matters on where you work.

I work at 3 hospitals and in one of them I probably see a drunk patient every 4th shift. (I work all nights) at one of them on a friday/sat/sun I probably see 3-6? It just depends but yes you see some of them. The flip side is we see high acuity.. insured and otherwise.

If you work at a trauma center many traumas are drunk, those centers also end up being the types of places that see lots of drunks.

 

[WilcoWorld]

I'd estimate that our ED census averages 30% of patients either drunk or there for alcohol related illness. On one 8am sign-out I got during the holidays 12 of 14 patients were there for alcohol related illness.

I need a beer.

 

[dotcb]

one word - no.

 

[WilcoWorld]

To add a little info: I think the situation I described above represents an extreme end of the spectrum. The ED I worked in previously was much less inundated with EtOH abusers and it was more like 1 or fewer "drunks" per shift.

In either case, I do a heck of a lot more than "dealing with drunks", but EM deals with more drunks than anyone else in medicine except maybe addictions specialists. And man oh man - drunks can have some crazy pathology.

 

[deleted109597]

Yes.

Or are we talking about just the patients?

 

[DrMom]

I work in 3 suburban EDs, one of which is considered a rural critical access hospital. I definitely do not see a drunk every shift. I'd guess I average one every 5-7 shifts. Even on my New Years Eve overnight shift I only had 2 in 12 hrs.

It really depends on where you work.

 

[Cerberus]

I don't see "that many" drunks. Sure, there are usually are few per shift in the ED, but most of them are frequent flyers that we basically just house until they sober up. I don't particularly like dealing with drunks, but they are a very small percentage of my pt population.

 

[DrFrankenstein]

But it gets in your blood and you keep going back.

And that my friends, is the reason we practice Universal precautions.

 

[45408]

I'm a surgery resident at a program that serves as a big referral center, but the ED functions more like a smaller community ED (the referrals bypass the ED and come to medicine or surgery directly). I did a month-long rotation in the ED, and I can safely say that less than 5% of them had recently consumed any alcohol (or at least enough for me to notice), and I don't think I had anyone who was completely trashed. Most of the "I had a few drinks" crowd were coming in because they fell or did something stupid with a sharp object.

Now, when we get trauma patients (which also bypass the ED and go to the trauma surgery team), they are more frequently intoxicated...

My point being: if you're in an inner-city or major metropolitan ED, there will be plenty of drunk people. If you work at a community ED, you probably won't see nearly as many.

 

[tkim]

My point being: if you're in an inner-city or major metropolitan ED, there will be plenty of drunk people. If you work at a community ED, you probably won't see nearly as many.

Uh, no.

 

[45408]

Uh, no.

Uh, yes.

Care to elaborate? After having worked in EMS for several years, we had lots of "found down, drunk" patients that we brought into a wide variety of inner-city/metro area hospitals, but we never bothered to drive out into the suburbs to do so. After having worked in some more suburban/rural areas, I've encountered far fewer drunk patients. My sample size is small, so feel free to counter with actual evidence.

 

[gro2001]

My point being: if you're in an inner-city or major metropolitan ED, there will be plenty of drunk people. If you work at a community ED, you probably won't see nearly as many.

we had lots of "found down, drunk" patients that we brought into a wide variety of inner-city/metro area hospitals, but we never bothered to drive out into the suburbs to do so. After having worked in some more suburban/rural areas, I've encountered far fewer drunk patients. My sample size is small, so feel free to counter with actual evidence.

I think the confusion is that you use the term 'community hospital' in contrast to 'inner city/metro area hospital'. Although the association may be true in a large number of cases, 'community hospital' is a also used to differentiate a regular hospital from an 'academic medical center' (usually a teaching site of a medical school). As such, a community hospital may be inner city, metropolitan, level 1 trauma center, and even have residency programs. Such a place would probably see a lot of drunks.

 

[SFO-IST]

Yes.

Or are we talking about just the patients?

zingggggggggggggggg

 

[45408]

I think the confusion is that you use the term 'community hospital' in contrast to 'inner city/metro area hospital'. Although the association may be true in a large number of cases, 'community hospital' is a also used to differentiate a regular hospital from an 'academic medical center' (usually a teaching site of a medical school). As such, a community hospital may be inner city, metropolitan, level 1 trauma center, and even have residency programs. Such a place would probably see a lot of drunks.

I did mean "community hospital in a suburban/rural area" rather than any community hospital, thanks.

 

[tkim]

Uh, yes.

Care to elaborate? After having worked in EMS for several years, we had lots of "found down, drunk" patients that we brought into a wide variety of inner-city/metro area hospitals, but we never bothered to drive out into the suburbs to do so. After having worked in some more suburban/rural areas, I've encountered far fewer drunk patients. My sample size is small, so feel free to counter with actual evidence.

So testy.

Well, if we're gonna pull out the EMS stick ...

How about fourteen years on the bus.

Worked inner-city, urban, suburban. Boston to Ipswich. Plenty of drunks to go around. Took them to the inner-city, urban and suburban hospitals. Community hospitals with nice houses all around, and waterfalls in the lobby. Puky, mean, pissed their pants wet, swinging drunks.

My residency in Buffalo. County - sure we got a ton of drunks. But the inner-city academic hospital got only a couple. Go figure. My suburban ED rotation, got tons of drunks. My rural ED rotation in east bumblefck. Lots of drunks.

Where I work now, quaint Western New England village, surrounded by colleges. Start of the school year and some weekends we get the amateur drunks. But every day we get the professionals too. There hasn't been a day that I haven't seen at least 2-3 drunks during my shift. And this is in my quaint, New England hospital in the woods. Hard vodka drinking, cut yourself with glass and smear blood over your own face drunks, who like to take a swing at the nurses, get tackled and darted with Haldol and Ativan drunks. Yep.