Negative workups

[startupquick]

How do you guys approach the negative workup? When you've done trops,ekg,x-ray for chest pain and it looks stone cold normal. Or belly workup etc... And they keep asking then why doc, is my chest (abd,back, leg) still hurting so bad? How do you explain this to patients?

looking for some tips or explanations that seem to work for you all.

Thanks

Suq

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[bravotwozero]

I tell them that nothing emergent is going on and all the conditions my work up has ruled out. And emphasize that I'm not always going to get to a diagnosis, and that's not what the ED is for, and if their symptoms persist, that they should pursue outpatient follow up. Makes for a lot of unhappy customers, but I don't care...


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[startupquick]

I tell them that nothing emergent is going on and all the conditions my work up has ruled out. And emphasize that I'm not always going to get to a diagnosis, and that's not what the ED is for, and if their symptoms persist, that they should pursue outpatient follow up. Makes for a lot of unhappy customers, but I don't care...


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That is essentially what I'm telling these guys too, that our job is to rule out things that are going to hurt you and or kill you and I don't see anything in that regards and that they can follow up with pcp and or specialist. People don't seem to take to it. Just checking to see if anyone had some magical explanation that made pts happy.

 

[alpinism]

There is none.

That being said the best offense is a good defense.

If it seems that the workup will likely turn up nothing its far easier to set their expectations early rather than later and wait till its time for discharge. For young healthy patients with chest pain I tell them up front that I'm going to rule out any life threatening emergencies and if its not any of those things they'll have to follow up with their own doctor.

 

[WilcoWorld]

I tell them that nothing emergent is going on and all the conditions my work up has ruled out. And emphasize that I'm not always going to get to a diagnosis, and that's not what the ED is for, and if their symptoms persist, that they should pursue outpatient follow up. Makes for a lot of unhappy customers, but I don't care...


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I do this as well - list all the things that my workup has looked for and not found. When possible, give an expected course and next actions (e.g.: "I expect that your pain should be better within week, if it isn't your primary care doctor may want to run some further tests that we don't have in the ED").

This works for most reasonable folks. If they still seem worried, I'll ask them if there's anything specific that they're worried about (though, more and more I am asking this during my H&P, as it is very useful knowledge). This can occasionally reveal some strange concern that you would've never thought about (e.g.: "My uncle died of mesothelioma, do you think I have that?").

If all of the above doesn't work, pretend that you just heard yourself overhead-paged to the resuscitation bay and back out of the room as you wait for the patient to inhale - when they do, say "Thank you!" then run away.

 

[WilcoWorld]

There is none.

That being said the best offense is a good defense.

If it seems that the workup will likely turn up nothing its far easier to set their expectations early rather than later and wait till its time for discharge. For young healthy patients with chest pain I tell them up front that I'm going to rule out any life threatening emergencies and if its not any of those things they'll have to follow up with their own doctor.

Great point - setting expectations during your H&P makes eventual discharge much easier.

 

[xaelia]

Point of caution – sometimes when I frame the encounter in terms of being unlikely to find something wrong, it sometimes comes across as I'm not taking their complaint seriously enough.

And that'll come back to bite you, too.

People are mysterious black boxes of meat and fat.

 

[Mighty Mouse]

When I can tell from the outset that their symptoms aren't likely to fit nicely into a diagnostic box, I reconstruct the expectations. I tell them that I am in the catastrophe business. My 2 goals are to get them feeling better, and that my job is to cross bad guys off the list. Sometimes I can't tell you what it is, but I can definitely tell you what its not. And I will help get you referred to a specialist as needed for further testing or management. I also validate they're symptoms. A lot of times, we're not good at communicating negative workups and patients interpret it as "nothing's wrong with me" or "they don't believe me" or "they think i'm lying/crazy." works for me pretty much 100% of the time.

patients want reassurance, to feel better, and a lifeline to grab on to to move forward. if we don't give them those things then we are failing them.

 

[WilcoWorld]

Point of caution – sometimes when I frame the encounter in terms of being unlikely to find something wrong, it sometimes comes across as I'm not taking their complaint seriously enough.

And that'll come back to bite you, too.

People are mysterious black boxes of meat and fat.

I never start out by saying I'm unlikely to find anything. I start out by saying that I want to check for X, Y and Z, adding that if no evidence of X, Y or Z are found, "then I'll probably be able to let you go home."

I agree that starting out by saying "nothing is wrong" is a set up for failure. You need to do some sort of testing to address patients' concerns. Often that "test" is a thorough physical exam or maybe it's a bedside ultrasound. You don't need to order blood or scans on everybody, but you have got to do something to make the patient feel like they've been taken seriously.

 

[WilcoWorld]

I'd like to add that my approach works best when it's genuine. If you're truly just going through the motions, your patients will pick up on it.

If you force yourself to take every patient seriously, it will come across to all but the most unsatisfiable of patients, and it'll occasionally save your butt.

 

[deleted109597]

"I'm not saying you don't have pain, I'm telling you that in the workup there's no evidence of a life threatening emergency."
"This doesn't mean that one can't be there though. If the pain isn't better in a week, or gets a lot worse, or you have other concerns, you should seek medical care at that time."

 

[Vandalia]

There is no one, set, answer. It depends on the patient. For example:

1) "I called my doc's office and said I had some indigestion and they said go straight to the ER. It is stupid. I am fine. But here I am."
2) A somewhat rational patient. First case of achalasia. Scared to death. Once it is explained they are fine.
3) Brother died of an MI last week at age 40. They thought they had some chest pain and are here scared to death (sometimes almost literally).
4) Person with a chronic illness who has seen every other doc in the state and thinks we might have an answer at 3 am.
5) Secondary gain.
6) Patient doesn't care/isn't aware but they are there because of their nursing home/kids/etc.
7) Cheapskates or people taking advantage of the system.
8) Mental illness of some form.

We could probably put together a list of at least 100. However, how you approach the "negative workup" depends on who you are dealing with. Are they on your side? (Or to put it differently, will they be happy or upset with the "negative workup" result (1/2 v 4/5)?) Are they going to be unhappy no matter what (4/5)? Is the "negative workup" more of a bureaucratic problem (6)?

What works well with one can be a disaster for the others.

 

[goodoldalky]

I tell them that nothing emergent is going on and all the conditions my work up has ruled out. And emphasize that I'm not always going to get to a diagnosis, and that's not what the ED is for, and if their symptoms persist, that they should pursue outpatient follow up. Makes for a lot of unhappy customers, but I don't care...


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This is a very common way of going about this. I see it everyday among both docs and midlevels, I used to do it this way. I didn't find it to be optimal though. Just last night I got called into a room of a midlevel patient who performed a million dollar workup that was negative that turned into a messy discharge because my NP gave the above spiel (happened to me a million times too). In the end turned out to be cannabis hyperemesis and we wasted a bunch of time and money, but her delivery at the end caused the problem. I used to do the same as above and always ran into this too, and found what I believe to be a better way.

Take abdominal pain for example, unless you have a fever, abnormal vitals, or something clinically pretty obvious going on, I rarely find anything of consequence even despite a workup. But these patients almost always get workups anyway.. CBC, CMP, Lipase, urine, CT. When it all comes back negative, I go in and say, "Wow! Have I got good news for you. Man, these labs were incredible. Your blood counts, perfect, infection markers, normal, platelets are great (they have no idea what platelets are, doesn't matter), sodium, potassium, kidney function, liver function, pancreas, urine, all perfect, you have the labs of a 21 year old. Not a drunk 21 year old, either, like a sober, non-drinking variety. And your CT scan, it looks like a textbook, squeaky clean. (usually smiling happy exchange here) I'm not totally sure why you had pain today, but it isn't XYZ, here's your clean bill of health, you'll probably be 100% better in a day or two, we are going to get you some meds to take at home and follow up with ___."

Just remember, your average lay public watched TV shows like ER, and whatever garbage is on these days, where the "ER doctor" does all sorts of neurosurgery at the bedside in the trauma bay after getting a portable 3D MRI with a cell phone. Patients appreciate the "show" and they think of that kind of stuff when they come to see you. So make a big deal about all the low yield testing you did that came back normal, and they'll respond a lot better.

Since I've started doing it this way, I've found myself in way fewer arguments, saved hours of time, less complaints, etc. The main reason I do it this way though (selfishly), is because it saves me a bunch of time and makes my job easier. Nothing more soul crushing than a tug of war discharge.

 

[HooliganSnail]

This is a very common way of going about this. I see it everyday among both docs and midlevels, I used to do it this way. I didn't find it to be optimal though. Just last night I got called into a room of a midlevel patient who performed a million dollar workup that was negative that turned into a messy discharge because my NP gave the above spiel (happened to me a million times too). In the end turned out to be cannabis hyperemesis and we wasted a bunch of time and money, but her delivery at the end caused the problem. I used to do the same as above and always ran into this too, and found what I believe to be a better way.

Take abdominal pain for example, unless you have a fever, abnormal vitals, or something clinically pretty obvious going on, I rarely find anything of consequence even despite a workup. But these patients almost always get workups anyway.. CBC, CMP, Lipase, urine, CT. When it all comes back negative, I go in and say, "Wow! Have I got good news for you. Man, these labs were incredible. Your blood counts, perfect, infection markers, normal, platelets are great (they have no idea what platelets are, doesn't matter), sodium, potassium, kidney function, liver function, pancreas, urine, all perfect, you have the labs of a 21 year old. Not a drunk 21 year old, either, like a sober, non-drinking variety. And your CT scan, it looks like a textbook, squeaky clean. (usually smiling happy exchange here) I'm not totally sure why you had pain today, but it isn't XYZ, here's your clean bill of health, you'll probably be 100% better in a day or two, we are going to get you some meds to take at home and follow up with ___."

Just remember, your average lay public watched TV shows like ER, and whatever garbage is on these days, where the "ER doctor" does all sorts of neurosurgery at the bedside in the trauma bay after getting a portable 3D MRI with a cell phone. Patients appreciate the "show" and they think of that kind of stuff when they come to see you. So make a big deal about all the low yield testing you did that came back normal, and they'll respond a lot better.

Since I've started doing it this way, I've found myself in way fewer arguments, saved hours of time, less complaints, etc. The main reason I do it this way though (selfishly), is because it saves me a bunch of time and makes my job easier. Nothing more soul crushing than a tug of war discharge.

A fine approach, I agree entirely with everything you said

I have also moved away from the "nothing emergent discussion" in the generic sense. Patients have no real understand of emergent or not, and that is Ok.

I do my approach very similarly...especially the "I have great news!!!", then profile all the things that are normal. I always sit down next to the bed when I do it, and I never say "follow up with PCP", that is a generic statement that means nothing to real patients. I always ask who their doctor is in the H/P part, and even if I don't know that person, I make it seem like I do. (although I know most of the PCP's in my area) I do spend a little bit of time emphasizing the things that I WANT THEM TO RETURN TO THE ED for. It works very well. I say something like "I feel comfortably sending you home, but I think it is very important to make an appointment with Dr. xxxx this week", I want you to come back if ......." The whole process takes like 3-10 minutes depending on how many questions they have, time well spent really.

When it's done, they (hopefully) think "that doctor cared, he took my complaints seriously", and they leave with definite understanding of what was done, that I want them to see Dr. xxxx, and this it is vitally important to return to the ED if the symptoms get worse.

So much depends on why the patient is actually there. If the person is truly there because they are concerned, then they really do feel better knowing I checked them out for all that stuff. These people always respond very well to the above approach

If patients do not responds well to the above approach, then there may be another reason why they are there, maybe they just want a work note, maybe they have some malingering stuff going on. If that is the case, then it doesn't matter what we do at all, because they are never going to be happy.

 

[engineeredout]

Take abdominal pain for example, unless you have a fever, abnormal vitals, or something clinically pretty obvious going on, I rarely find anything of consequence even despite a workup. But these patients almost always get workups anyway.. CBC, CMP, Lipase, urine, CT. When it all comes back negative, I go in and say, "Wow! Have I got good news for you. Man, these labs were incredible. Your blood counts, perfect, infection markers, normal, platelets are great (they have no idea what platelets are, doesn't matter), sodium, potassium, kidney function, liver function, pancreas, urine, all perfect, you have the labs of a 21 year old. Not a drunk 21 year old, either, like a sober, non-drinking variety. And your CT scan, it looks like a textbook, squeaky clean. (usually smiling happy exchange here) I'm not totally sure why you had pain today, but it isn't XYZ, here's your clean bill of health, you'll probably be 100% better in a day or two, we are going to get you some meds to take at home and follow up with ___."

Love this and this is what I usually use as well. Especially the GREAT NEWS YOU DONT HAVE APPENDICITIS!! For the six months of vauge abdominal Discomfort. I also cap it off when they seem disappointed with "Hey I'm glad I didn't find anything bad. If I did it means having to get surgery or finding cancer or those sorts of things. I know we didn't figure out exactly what is wrong, but I'm so glad you don't have something terrible". Most semi-rational people are satisfied with that. The ones that aren't are usually irrational and nothing will make them happy anyway.

 

[Venko]

I think the themes are there the same but with slight twists. Here is my approach...

At the beginning of the encounter:
1. Patients need validation they did the right thing by coming to the ED even when we may have preferred they do it differently.
2. You need to carefully place the seed that it's a good thing if we don't find a cause. Done right this is invaluable to the discharge step, done poorly it can make patients believe you don't truly believe in their concerns
3. Understand what their specific concerns are

Example:
- I'm glad you're here Mrs. Jones, it can be difficult to tell if this pain is something serious and I'm glad you've given us the chance to do it. Certainly, we hope that we don't find anything dangerous but it's important we make sure you don't have a terrible infection, dangerous bleeding, blockages or tears. As strange as it may seem, the best outcome would be that we don't find anything dangerous and we can't explain what's happening today just yet but that we can give you peace of mind that it's safe to let your family doctor look into this thoughtfully and with a different set of skills than ours. Mrs Jones, based on talking with you and examining you, I think it's important that we make sure you gallbladder and pancreas are okay by getting some blood tests and an ultrasound. There are some other less consistent things I will check for as well. Do you have anything specific that you're worried about that I can spend time thinking about while you're here? (Pt answers) I'm glad you told me about that. Let me consider that today too. Certainly your evaluation is unique to you, but in general evaluations of abdominal pain can average about 4 hours before we have all the results back. We will work to keep you as comfortable as we can safely while we are here. Do you have any questions or is there anything else I can do for you right now? (Pt answers) great! Let's get started.

At the end of the encounter:
1. It's important to again validate their coming to the ED
2. Reiterate the dangerous considerations you had at the beginning and remind them about unique factors to them that make these stronger considerations.
3. Let them know you have great news for them and go over the big picture ones and the ones they asked for in the beginning.
4. Empathize that you don't have an answer and remind them that this is just one step in the process.
5. Go over a plan to keep them as comfortable as you can safely while the condition runs its course or is further evaluated.

Example:
- Mrs Jones, thank you again for coming to the ED, you did the absolute right thing, because it's not easy to know if your abdominal pains are from something very serious...in fact it took us many hours with all our testing to sort through it. I'm glad you didn't stay at home worrying. Overall, the news is good and I want to go through the key points with you. After talking with you, the way the pain came on quickly and because it was really bad when I pushed in this right upper part of your belly, it was very important we made sure your gallbladder is okay. Thankfully the blood tests show it is working well and the ultrasound could see that it is not inflamed or obstructed either. Overall it looks quite good. We also talked about how your sisters history of diabetes is on your mind and so we made sure that your blood sugar is okat and we looked st your pancreas (the organ central to the disease of diabetes) with blood tests and the ultrasound and it seems to be doing great today. We also looked at your bloo counts and kidney function and a few other things that can cause major problems and they are okay too. This is great news but many times we all will still feel disheartened that we don't have a specific answer as to why you are suffering. Don't worry, sometimes more time and a different set of eyes can uncover different answers that although not immediately dangerous, certainly can make us feel really bad. Your family doctor is trained in many things that I'm not and may have a completely different idea; thankfully because you came here we can give you peace of mind that it's safe to let them work through this more carefully in the coming days. Let's talk about how you can be as comfortable as safely possible while they look into it...

This is what I do and it goes really really well and quickly. I hope it helps!


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[gman33]

As above, validate that you are glad they came in to get checked out.

Up front, set expectations about what you are looking for and a plan if the workup is negative.

Something like, if we don't find a cause for your belly pain we will start some medication to help your symptoms are refer you to gi for further testing.

As long as you are very clear in the initial encounter, and patients think you care, most don't have a problem with going home after a negative workup.

If they don't get told anything, wait around for 4+ hours and go home with no plan or answers, that's when the complaints roll in.

 

[Tiger26]

Satisfaction = Results divided by expectations

 

[Frazier]

I think the themes are there the same but with slight twists. Here is my approach...

At the beginning of the encounter:
1. Patients need validation they did the right thing by coming to the ED even when we may have preferred they do it differently.
2. You need to carefully place the seed that it's a good thing if we don't find a cause. Done right this is invaluable to the discharge step, done poorly it can make patients believe you don't truly believe in their concerns
3. Understand what their specific concerns are

Example:
- I'm glad you're here Mrs. Jones, it can be difficult to tell if this pain is something serious and I'm glad you've given us the chance to do it. Certainly, we hope that we don't find anything dangerous but it's important we make sure you don't have a terrible infection, dangerous bleeding, blockages or tears. As strange as it may seem, the best outcome would be that we don't find anything dangerous and we can't explain what's happening today just yet but that we can give you peace of mind that it's safe to let your family doctor look into this thoughtfully and with a different set of skills than ours. Mrs Jones, based on talking with you and examining you, I think it's important that we make sure you gallbladder and pancreas are okay by getting some blood tests and an ultrasound. There are some other less consistent things I will check for as well. Do you have anything specific that you're worried about that I can spend time thinking about while you're here? (Pt answers) I'm glad you told me about that. Let me consider that today too. Certainly your evaluation is unique to you, but in general evaluations of abdominal pain can average about 4 hours before we have all the results back. We will work to keep you as comfortable as we can safely while we are here. Do you have any questions or is there anything else I can do for you right now? (Pt answers) great! Let's get started.

At the end of the encounter:
1. It's important to again validate their coming to the ED
2. Reiterate the dangerous considerations you had at the beginning and remind them about unique factors to them that make these stronger considerations.
3. Let them know you have great news for them (when the results are integrating).
4. Empathize that you don't have an answer and remind them that this is just one step in the process.
5. Go over a plan to keep them as comfortable as you can safely while the condition runs its course or is further evaluated.

Example:
- Mrs Jones, thank you again for coming to the ED, you did the absolute right thing, because it's not easy to know if your abdominal pains are from something very serious...in fact it took us many hours with all our testing to sort through it. I'm glad you didn't stay at home worrying. Overall, the news is good and I want to go through the key points with you. After talking with you, the way the pain came on quickly and because it was really bad when I pushed in this right upper part of your belly, it was very important we made sure your gallbladder is okay. Thankfully the blood tests show it is working well and the ultrasound could see that it is not inflamed or obstructed either. Overall it looks quite good. We also talked about how your sisters history of diabetes is on your mind and so we made sure that your blood sugar is okat and we looked st your pancreas (the organ central to the disease of diabetes) with blood tests and the ultrasound and it seems to be doing great today. We also looked at your bloo counts and kidney function and a few other things that can cause major problems and they are okay too. This is great news but many times we all will still feel disheartened that we don't have a specific answer as to why you are suffering. Don't worry, sometimes more time and a different set of eyes can uncover different answers that although not immediately dangerous, certainly can make us feel really bad. Your family doctor is trained in many things that I'm not and may have a completely different idea; thankfully because you came here we can give you peace of mind that it's safe to let them work through this more carefully in the coming days. Let's talk about how you can be as comfortable as safely possible while they look into it...

This is what I do and it goes really really well and quickly. I hope it helps!


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Gold.

 

[Tenk]

"Well at least you don't need surgery today!"

"Well hey at least we didn't find anything life threatening!"

"But now you can go home and sleep in your bed instead of this crummy one!"

"At least you can eat now!"

People eat that crap up like candy. Remind them that they are the lucky ones.

 

[Apollyon]

People eat that crap up like candy.

This just made me laugh.

 

[Venko]

"Well at least you don't need surgery today!"

"Well hey at least we didn't find anything life threatening!"

"But now you can go home and sleep in your bed instead of this crummy one!"

"At least you can eat now!"

People eat that crap up like candy. Remind them that they are the lucky ones.

it's probably just me, but I would not find these very funny if I'm feeling pretty bad. When I had my kidney stone I'm glad no one told me these, I would have lost my temper pretty quickly.

If someone is scared, hurting, exhausted, etc, I don't see it as the time to remind them they aren't as important as someone else and they should be grateful. I personally prefer to alleviate the fear, empathize with the pain, recognize the exhaustion.

Again, it's probably a style or generational thing.

I remember after having open heart surgery and experiencing some chest pain. Even though I cognitively knew it wasn't likely anything dangerous, I still worried. If a provider treated me this way I would find them to be dismissive and diminutive of my concern.




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[RustedFox]

I'll add.

I agree with the "setting expectations early" and "validating their visit" items enumerated earlier.

The approach with "negative workup, go the hell home" that I generally take is:

*Enter room*

"Hey! Your nurse tells me that you've been doing slowly better since you got here. That's good! I'm glad you came tonight."
(Notice how this is a semi-closed statement. I didn't ask them anything, and I don't expect an argument unless there's an obvious need to be addressed.)

"I have all of your results now. Thanks for waiting while they trickled in bit by bit. Jumping to conclusions is never a good thing."
(Again; the subtext is "shut up and listen; don't overreact. I did my job; it takes time. Be patient.)

"I bring you good news, and I bring you mixed news. I bring you no bad news."
(There's no bad news! Now pay attention!)

"Your bloodwork, urine tests, and [x/y] are very normal. The [imaging study] is also very normal and reassuring. This correlates what I sense (use that verb; 'sense') on exam.
(I am reassured that you will be fine tonight. I am interpreting multiple diagnostic modalities that correlate and agree.)

"The good news is; I find no evidence of anything terrible that I need to keep you here tonight for. The mixed news is; I also don't have any smoking-gun evidence as to what exactly the problem here is just yet. The bad news is that... wait.... (actually say this) there is no bad news ."
(We haven't caught your problem red-handed yet, but we're hot on the trail. Whatever it is; it ain't gonna kill ya tonight.)

"Even though I can't confirm it just yet.... here's what I think the problem is [explain benign disease process here]. I have a plan. Here are the next steps [explain need for outpatient workup here]."
(See! I'm not abandoning you and saying "my work here is done.... adios MF'er"! Here's what I recommend next.)

"Do you have any questions for me? I'm here now, so ask away."

 

[EMDOC17]

I use a mix of the above. Seems like this is mostly abdominal pain. "I have your lab results, urine tests, +/- CT results back. These all look really great. This is good news is I did not find anything really concerning. This is actually really good news since usually when I do find something you will need surgery or have something really bad going on. It is really good that you do not have that. The bad news is I don't have a specific reason for your pain or discomfort. It is not that something isn't wrong it is just that it is not life threatening. The next test we can do is the test of time. I imagine you will get better but if you do not you should follow up with your PCP or return to the ED." I have almost always seemed that patients respond well to this.

 

[Tenk]

it's probably just me, but I would not find these very funny if I'm feeling pretty bad. When I had my kidney stone I'm glad no one told me these, I would have lost my temper pretty quickly.

If someone is scared, hurting, exhausted, etc, I don't see it as the time to remind them they aren't as important as someone else and they should be grateful. I personally prefer to alleviate the fear, empathize with the pain, recognize the exhaustion.

Again, it's probably a style or generational thing.

I remember after having open heart surgery and experiencing some chest pain. Even though I cognitively knew it wasn't likely anything dangerous, I still worried. If a provider treated me this way I would find them to be dismissive and diminutive of my concern.




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Your workup wasn't negative for the kidney stone or the surgery therefore everything you said doesn't apply to what the OP was asking. You're right. That would be inappropriate. These are for the 20 year old abdominal pains who have a negative ct, are texting on their cell phone while eating 2 hr old McDonald's they brought with them while still complaining about 11/10 pain.

 

[Venko]

Your workup wasn't negative for the kidney stone or the surgery therefore everything you said doesn't apply to what the OP was asking. You're right. That would be inappropriate. These are for the 20 year old abdominal pains who have a negative ct, are texting on their cell phone while eating 2 hr old McDonald's they brought with them while still complaining about 11/10 pain.

I would recommend treating them all (as hard as I know it is) as a person who perceives an emergency may be taking place. If they really aren't concerned you won't hurt anything. If they are concerned and are texting their loved ones about how they feel, well then you'll be glad that you err'd on the side of assuming they are scared, worried, hurting or other. It's the right thing to do.


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[Tenk]

I would recommend treating them all (as hard as I know it is) as a person who perceives an emergency may be taking place. If they really aren't concerned you won't hurt anything. If they are concerned and are texting their loved ones about how they feel, well then you'll be glad that you err'd on the side of assuming they are scared, worried, hurting or other. It's the right thing to do.


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And I would recommend doing what I said because it usually results in an easy discharge and a smile once people realize hey I guess being OK is better than needing life saving surgery or having cancer or having some other terrible diagnosis that I have to give on a daily basis. You are clearly taking this the wrong way. I don't do this like an ass, I do this with a smile and reassurance.

 

[Venko]

And I would recommend doing what I said because it usually results in an easy discharge and a smile once people realize hey I guess being OK is better than needing life saving surgery or having cancer or having some other terrible diagnosis that I have to give on a daily basis. You are clearly taking this the wrong way. I don't do this like an ass, I do this with a smile and reassurance.

Okay. I do tend to take things differently sometimes. Maybe it's just me, maybe it's a generational thing. Keep doing what you feel is right, it's clearly working for you.


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[HunterGatherer]

Remember your ABC folks:

Always Be Closing!

 

[gamerEMdoc]

I use the cancer trick.

I subtly throw in he words no cancer.

"Good news. Your Ecg and heart blood work are normal. Your xray doesnt show any signs of any heart or lung problems, pneumonia, or any cancer. I dont see any serious bad cause of your pain that we need to act on right now, but you may need further testing as an outpatient to find some of the more benign things."

I've had this work over and over. People come to the ED scared for many reasons. Sometimes, something as simple as telling them they dont have cancer causing their pain is enough to reframe their state of mind.

 

[bbbcccppp]

I use the cancer trick.

I subtly throw in he words no cancer.

"Good news. Your Ecg and heart blood work are normal. Your xray doesnt show any signs of any heart or lung problems, pneumonia, or any cancer. I dont see any serious bad cause of your pain that we need to act on right now, but you may need further testing as an outpatient to find some of the more benign things."

I've had this work over and over. People come to the ED scared for many reasons. Sometimes, something as simple as telling them they dont have cancer causing their pain is enough to reframe their state of mind.

Winner winner chicken dinner. Perfection


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