"My Doctor said they'd come see me here in the ER"

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RustedFox

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Attention all non-ER physicians.

If your patient tells me this, and you don't have privileges at this hospital - then shame on you and I'm telling your patients of your lies.

If your patient tells me this, and you DO have privileges at this hospital - then I'm calling you and telling you to come see them. Yes, even if that means that you're in the OR. Don't be surprised and act all pissy when you set expectations that you can't meet.

Also, stop.

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Attention all non-ER physicians.

If your patient tells me this, and you don't have privileges at this hospital - then shame on you and I'm telling your patients of your lies.

If your patient tells me this, and you DO have privileges at this hospital - then I'm calling you and telling you to come see them. Yes, even if that means that you're in the OR. Don't be surprised and act all pissy when you set expectations that you can't meet.

Also, stop.



Awesome.

I had one patient say “my doctors office told me he is in house today and he will come see me here”

I called their doctor who said why do I have to see them In Your ED?

Well your staff told them to come here to see you, take it up with your staff...
 
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I’d first work on the assumption that all patients lie.
 
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I’d first work on the assumption that all patients lie.

Agree. Patients - especially patients who end up in the ED - are not always the best at accurately reporting conversations.

It is always possible that the staff said "Dr. X said you need to be seen in the ER (sic)", and they heard, "Dr. X will see you in the ER."
 
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Probably not the best for PG scores, but when I hear this I openly chuckle and say "That's not that way this works."
 
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I just think that the patients report the conversation incorrectly. Their poor listening skills, combined with no knowledge of how our system works is the problem.
 
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When I actually look into this, it is very rare that the physician spoke to the patient and actually told them this information.

I just tell the patient that their doc doesn't work in the ER and I will evaluate them and get them involved if they are needed.
 
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“My GI doctor told me to come here and they would see me.” I then tell them to call their GI doctor or whoever else told them they would see them and let them know they are in the ED. They never do that. It’s because their specialist didn’t actually tell them that. If someone is going to see their own patient in the ED they call us ahead of time.
 
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Attention all non-ER physicians.

If your patient tells me this, and you don't have privileges at this hospital - then shame on you and I'm telling your patients of your lies.

If your patient tells me this, and you DO have privileges at this hospital - then I'm calling you and telling you to come see them. Yes, even if that means that you're in the OR. Don't be surprised and act all pissy when you set expectations that you can't meet.

Also, stop.

While I have also been frustrated with this mismanagement of expectations, there are a few more innocent possibilities than outright lies by those MDs:
  1. Misunderstanding by the patient. Maybe he said something along the lines of them "being seen in the ED" and the patient assumed that this specific doc was going to be seeing them. Maybe they meant the ED doc would do the "seeing", or maybe they meant someone on their team, like the GI fellow. Maybe they assumed the patient would get admitted, and he will see them, but on rounds the next day. Or maybe the MD said nothing of the kind and the patient just assumed that's how it works.
  2. Changing circumstances. Maybe the doc was fully intending to see them, but then something happened and he is now tied up.
I always call the doc and let them know the patient is under the impression that they will be seen. However, if they can't, I am not going to give them a hard time about it. I would also definitely not tell the patient that their doc is "lying" to them. This is how the conversation goes:

Pt: "Dr SoAndSo said they would come and see me in the ER."
Me: "Oh yeah? I know Dr SoAndSo. I'll be sure to given them a call and let them know."

To the MD:
Me, after discussing the case with Dr SoAndSo: "By the way, they are under the impression that you will be coming by to see them in the ER, is that the case?"
Dr SoAndSo: "Hmm, kinda busy over here..."
Me: "No worries, I'll let them know we talked and you said hi"

To the Patient:
"So, I spoke with your doc (he says hi and appologizes that he won't be able to come see you in the ER) but we discussed the case, and this is what we agree we should do...."

Almost 100% of the time both patients and MDs are very happy with this. I don't think that most of the time the patients care that much that their doc sees them. They do think that their doc has a better understanding of what is going on, and don't want that to be ignored by this ER doc they just met. This approach puts their mind at ease that we are all on the same page. It feels like a smooth transition of care between the outpatient doc, the ER, and then back to the outpatient doc (as it should be) instead of the completely new adventure each time that it can often feel like.

Also, I have to work with those docs for a long time, and I want them to know that I am usually reasonable so that when I do actually need them to come in, they are much more likely to do so. I don't want to squander whatever social capital I have on teaching them a lesson. Aint nobody got time for that.
 
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Attention all non-ER physicians.

If your patient tells me this, and you don't have privileges at this hospital - then shame on you and I'm telling your patients of your lies.

If your patient tells me this, and you DO have privileges at this hospital - then I'm calling you and telling you to come see them. Yes, even if that means that you're in the OR. Don't be surprised and act all pissy when you set expectations that you can't meet.

Also, stop.
This is how I handled this once. I called the doc. Answered his call at the patient bedside. When he admitted he told the patient this, I said, "Hold on," handed the phone to the patient and walked away. I don't remember how it worked out, but it sure made me feel better.
 
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I just think that the patients report the conversation incorrectly. Their poor listening skills, combined with no knowledge of how our system works is the problem.

I go with this. Patients call outpatient offices with a cough for 18 seconds, want to be seen immediately, the MAs on the phone say something like "well we can't see you right now, but if things are really that bad you can go to the ED", and the patient hears "My Doctor said I have to go to the ER right now!!"
 
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This is how I handled this once. I called the doc. Answered his call at the patient bedside. When he admitted he told the patient this, I said, "Hold on," handed the phone to the patient and walked away. I don't remember how it worked out, but it sure made me feel better.
Yeah if the other guy admits to saying that, he deserved it.

In 5 years of practice I have never said that. Did once in residency because it was a patient I knew well and was doing an ED rotation at the time and so did see them...
 
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One of the best things I've seen in a while is when a patient came in stating that Dr. X said he would be waiting on her. She was irate when I explained the process. She insisted I call him and notify him she's finally in the ER or she was calling the health system CEO, who she routinely threw the name out quite a few times. She said she would have me fired for not calling him because "an important neurosurgeon and not just an ER doc" and he doesn't have time to wait on me to call him.

So I called said neurosurgeon. He told me to put her on speakerphone. Took a while to figure out the Ascom speakerphone button, but finally made it happen. He started the conversation with her by saying he wanted to make sure there were no distractions and she could hear him very clearly. He basically told her he never said he would see her in the ER, said she needed to go to the ER to have a CT scan (post-op patient), we were perfectly trained to deal with it and to quit disrespecting what we do, etc. He told her he knows she's not friends with the CEO and if she actually was, he encouraged the patient to call her. If she did, he was firing her from his practice immediately. Then he told her to quit lying to the ER staff, "shut the h#!@ up" and let us do our "God d!@# jobs". He berated her, and in a way I felt sorry for her but in another way I felt good to hear him call her out on it and defend what we do. He literally was yelling at her.
 
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One of the best things I've seen in a while is when a patient came in stating that Dr. X said he would be waiting on her. She was irate when I explained the process. She insisted I call him and notify him she's finally in the ER or she was calling the health system CEO, who she routinely threw the name out quite a few times. She said she would have me fired for not calling him because "an important neurosurgeon and not just an ER doc" and he doesn't have time to wait on me to call him.

So I called said neurosurgeon. He told me to put her on speakerphone. Took a while to figure out the Ascom speakerphone button, but finally made it happen. He started the conversation with her by saying he wanted to make sure there were no distractions and she could hear him very clearly. He basically told her he never said he would see her in the ER, said she needed to go to the ER to have a CT scan (post-op patient), we were perfectly trained to deal with it and to quit disrespecting what we do, etc. He told her he knows she's not friends with the CEO and if she actually was, he encouraged the patient to call her. If she did, he was firing her from his practice immediately. Then he told her to quit lying to the ER staff, "shut the h#!@ up" and let us do our "God d!@# jobs". He berated her, and in a way I felt sorry for her but in another way I felt good to hear him call her out on it and defend what we do. He literally was yelling at her.

That is amazing. What did this delightful patient say?
 
One of the best things I've seen in a while is when a patient came in stating that Dr. X said he would be waiting on her. She was irate when I explained the process. She insisted I call him and notify him she's finally in the ER or she was calling the health system CEO, who she routinely threw the name out quite a few times. She said she would have me fired for not calling him because "an important neurosurgeon and not just an ER doc" and he doesn't have time to wait on me to call him.

So I called said neurosurgeon. He told me to put her on speakerphone. Took a while to figure out the Ascom speakerphone button, but finally made it happen. He started the conversation with her by saying he wanted to make sure there were no distractions and she could hear him very clearly. He basically told her he never said he would see her in the ER, said she needed to go to the ER to have a CT scan (post-op patient), we were perfectly trained to deal with it and to quit disrespecting what we do, etc. He told her he knows she's not friends with the CEO and if she actually was, he encouraged the patient to call her. If she did, he was firing her from his practice immediately. Then he told her to quit lying to the ER staff, "shut the h#!@ up" and let us do our "God d!@# jobs". He berated her, and in a way I felt sorry for her but in another way I felt good to hear him call her out on it and defend what we do. He literally was yelling at her.

Seems way over the top to me. We have a responsibility to be professional no matter how unreasonable patients are. No excuse to say “shut the **** up!” to a patient.
 
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Seems way over the top to me. We have a responsibility to be professional no matter how unreasonable patients are. No excuse to say “shut the **** up!” to a patient.

I don't care. That would have been awesome to hear in person. I don't know any doctors who say things like that to patients who don't fully deserve it. This was clearly NOT the first time this had happened.
 
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I think this had been a difficult patient for a variety of reasons, and this particular neurosurgeon had been on-call the entire weekend.

I agree, unprofessional, but I could hardly contain my laughter.

Her CT was negative and she was discharged.
 
Seems way over the top to me. We have a responsibility to be professional no matter how unreasonable patients are. No excuse to say “shut the **** up!” to a patient.

I'm not sure this is "way over the top." Patients who disrespect physicians do so because they presume we can't or won't defend ourselves. Respect is a two-way street. What would it take for you to defend yourself?
 
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I'm not sure this is "way over the top." Patients who disrespect physicians do so because they presume we can't or won't defend ourselves. Respect is a two-way street. What would it take for you to defend yourself?

Unfortionately, in the modern era, with patients who want you to write a prescription for Tylenol but carry iPhone 10s, were only a couple clicks away from becoming viral for the wrong reasons.

https://nypost.com/2017/10/11/doctor-recorded-screaming-at-patient-in-waiting-room/
 
Seems way over the top to me. We have a responsibility to be professional no matter how unreasonable patients are. No excuse to say “shut the **** up!” to a patient.

I don't care. That would have been awesome to hear in person. I don't know any doctors who say things like that to patients who don't fully deserve it. This was clearly NOT the first time this had happened.

I agree that this isn't the approach I take to your standard "difficult" patient.

But when you try to be polite (which it appears SD did) and the patient responds by dropping names and promising to get you fired, they warrant "special" treatment.
 
Seems way over the top to me. We have a responsibility to be professional no matter how unreasonable patients are. No excuse to say “shut the **** up!” to a patient.

Professional, yes. But I can't bring myself to be a pushover all the time.
 
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Professional, yes. But I can't bring myself to be a pushover all the time.

I don’t believe in being a pushover at all. However, I believe in having inner strength and being a steady rock at all times, especially at work. This means not being triggered into states of emotionality and infantility.
 
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I don’t believe in being a pushover at all. However, I believe in having inner strength and being a steady rock at all times, especially at work. This means not being triggered into states of emotionality and infantility.

So, no angry bird face at work?
 
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