Things I hate to hear patients say:

Started by RustedFox
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‘I’m here for my followup appointment’

‘I have fibromyalgia but this is different’ (but pain in the same spot with the same symptoms)

‘I haven’t slept at all in over a week’ (really? Not one minute?)

‘I don’t smoke’ (when did you quit?) ‘yesterday was my last cigarette’

‘I can’t go home in this condition’ (30 year old with flu)

‘We have been to neurology/rheum/pcp/cardiology/4 other ERs, we are here for answers’
 
I’ve been waiting foreeeeeeeever (time in department: 33 minutes to a board certified EP seeing you at 2230 on Saturday is not forever). This was my first patient last night.
 
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RustedFox said:
The one that will forever make me snarl is the patient's complete inability to even know, let alone pronounce, the medications that they take.

I have said some pretty hilariously rude things in response to this deficiency... to the right patient.
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"I don't keep track of that stuff. You'll have to ask my wife, brother, sister, son, ex-wife, cousin-in-law, etc."


Tenk said:
Eh, just don’t let this stuff get to you. In fact, you can literally just say “I can tell” to all these things and you sound good but in reality you’re being sarcastic af.

I have a high pain tolerance.
I can tell!
I know my own body.
I can tell!
This is not normal for me.

I CAN TELL!

Honestly, wtf does “I can tell” even mean?
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I always replied "Well, of course you do."

Now that I'm WAY out of the deep South. I wonder if I can get away with "Bless your heart"?
 
CajunMedic said:
"I don't keep track of that stuff. You'll have to ask my wife, brother, sister, son, ex-wife, cousin-in-law, etc."



I always replied "Well, of course you do."

Now that I'm WAY out of the deep South. I wonder if I can get away with "Bless your heart"?
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YES. I love it when you jump in.
THIS guy has stories to tell.
Still in Appalachia, amigo?
 
CajunMedic said:
"I don't keep track of that stuff. You'll have to ask my wife, brother, sister, son, ex-wife, cousin-in-law, etc."



I always replied "Well, of course you do."

Now that I'm WAY out of the deep South. I wonder if I can get away with "Bless your heart"?
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Man I’ll have to try bless your heart on the west coast. Will confuse the hell out of them.
 
Just yesterday:

"I read it on the internet" regarding unnecessary labs for a child. Parents don't love their kids, it's sick
"Can you help me find a dentist that accepts out of state Medicaid?"
 
bearstanley said:
"i know my body."
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Had a patient take this to a truly obnoxious end. ESRD fired from almost every dialysis joint in town due to being aggressive with staff. Frequents the ER for regular emergency dialysis. Comes in with vague malaise, insists she's hyperkalemic and demands insulin/dextrose/calcium. Normal CMP (besides BUN/Cr of course), normal EKG. Used the "I know my body" bit multiple times. I even showed her the normal K and EKG results and explained why insulin and calcium IV for funsies is a bad idea. Insisted we were wrong and not listening to her. She probably would've started throwing punches if her mom hadn't been there to reign her in.
 
Rekt said:
This is all immediately translated in my mind to "I'm very pathetic and I have no coping skills and my life force is essentially zero"
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The typical complaint message:

“I know my body” the doctor didn’t listen. “I have a high pain tolerance” and I’m hurting, “I have a fever at 99.0 because I’m usually 97” “I want the patient advocate”” that’s why my care was horrible and I don’t want to pay the bill.

And on that point. If you know about a patient advocate and what they do, you are in the hospital wayyy to often….
 
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NYEMMED said:
The typical complaint message:

“I know my body” the doctor didn’t listen. “I have a high pain tolerance” and I’m hurting, “I have a fever at 99.0 because I’m usually 97” “I want the patient advocate”” that’s why my care was horrible and I don’t want to pay the bill.

And on that point. If you know about a patient advocate and what they do, you are in the hospital wayyy to often….
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I would love it if someone came in and said "I have a crappy pain tolerance and I'm in a lot of pain. I can't take pain. I'm such a wuss."

I would give them a high five and some morphine. I be like "thank god you are honest. Seriously. here is some morphine and GTFU" and I would say it with a smile.
 
thegenius said:
It is funny.
Except the one time that I had a pt in residency and he said "I'm going to die"
And he did like 12 hours later.

But he came in with a BP of 70/20 and had an EF of like -6%.
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There is a big difference to me from the “body shutting down” patients and the sense of impending doom “I think I’m going to die” patients. The latter also look either subjectively like they’re going to die, or something objectively is terrible, like the BP and EF in your case. I’ve responded to the latter patient: “me too, that’s why I’m doing all of these things we’re doing. I’m doing my best to not let that happen”. The former usually looks completely fine, and objectively also almost always is fine.
 
PianoMedic said:
There is a big difference to me from the “body shutting down” patients and the sense of impending doom “I think I’m going to die” patients. The latter also look either subjectively like they’re going to die, or something objectively is terrible, like the BP and EF in your case. I’ve responded to the latter patient: “me too, that’s why I’m doing all of these things we’re doing. I’m doing my best to not let that happen”. The former usually looks completely fine, and objectively also almost always is fine.
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I know dude I'm pulling your leg. All I was getting at is about 1/100 when someone says "there is something really wrong", or "i'm going to die", there is. But it's usually obvious. They are not putting down the paper when they tell you that.
 
turkeyjerky said:
Sometimes when I'm feeling a little chippy I tell them "well, luckily, that's not actually a thing".
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If they are 20 and obviously fine, I say ok, I mean you’ll die some day, but not THIS day, go back to my desk and order the covid/flu swab 🤣
 
FM doc who stumbled onto your board while feeling sorry for myself during an ER shift tonight. This was a very cathartic thread. I moonlight in a nearby rural ER on top of my normal FM clinic...originally because of loans but now due to lifestyle.🙄
You guys have the toughest job in medicine and I honestly don't know how you do it for a full career.
Have heard and been annoyed by almost all the comments on this thread but had to add an additional one that drives me crazy.
The anxious mom insisting that her sick, snotty nose, feverish, but otherwise fine kid "is usually really happy" or "usually never acts like this" when I try to explain they have a viral URI. When I see them in clinic it's not as annoying because I have a prior relationship with mom but when it's a stranger at 2 AM in the ER it takes everything I have to not scream "BECAUSE THEY USUALLY AREN'T SICK!"
Anyway, thanks for the free therapy. And I agree totally about the BP comments above. One of the most annoying CCs is BP high and asymptomatic (since I get paid hourly I don't care how easy the patient is). Often seems to happen at 2AM. Why the freak are you checking your BP at 2am? Often accompanied by daughter, granddaughter, niece, person off the street who is a nurse (but often turns out to be an LPN who is the family's medical sage) who has gotten the whole family worked up and they all come in as a frantic herd.
Working so much ER has made me VERY stingy on who I send to the ER.
 
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5150man said:
FM doc who stumbled onto your board while feeling sorry for myself during an ER shift tonight. This was a very cathartic thread. I moonlight in a nearby rural ER on top of my normal FM clinic...originally because of loans but now due to lifestyle.🙄
You guys have the toughest job in medicine and I honestly don't know how you do it for a full career.
Have heard and been annoyed by almost all the comments on this thread but had to add an additional one that drives me crazy.
The anxious mom insisting that her sick, snotty nose, feverish, but otherwise fine kid "is usually really happy" or "usually never acts like this" when I try to explain they have a viral URI. When I see them in clinic it's not as annoying because I have a prior relationship with mom but when it's a stranger at 2 AM in the ER it takes everything I have to not scream "BECAUSE THEY USUALLY AREN'T SICK!"
Anyway, thanks for the free therapy. And I agree totally about the BP comments above. One of the most annoying CCs is BP high and asymptomatic (since I get paid hourly I don't care how easy the patient is). Often seems to happen at 2AM. Why the freak are you checking your BP at 2am? Often accompanied by daughter, granddaughter, niece, person off the street who is a nurse (but often turns out to be an LPN who is the family's medical sage) who has gotten the whole family worked up and they all come in as a frantic herd.
Working so much ER has made me VERY stingy on who I send to the ER.
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It reminds me of a observation I heard once, ER docs do family medicine a 2 am and trauma surgeons to general surgery at 2 am. 🙁 FML.

I also hate the asymptomatic hypertension. Patient feels funny -> checks BP -> hmm, it isn't normally 121/81 -> proceeds to check their BP on an accelerating schedule until they can't cycle their wrist cuff any faster. OMG, I'm going to die at 3 am with my head blowing up!!!!
 
MechEDoc said:
It reminds me of a observation I heard once, ER docs do family medicine a 2 am and trauma surgeons to general surgery at 2 am. 🙁 FML.

I also hate the asymptomatic hypertension. Patient feels funny -> checks BP -> hmm, it isn't normally 121/81 -> proceeds to check their BP on an accelerating schedule until they can't cycle their wrist cuff any faster. OMG, I'm going to die at 3 am with my head blowing up!!!!
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So I have a nearly unrelated question on this post. Kind of taking a survey. What time duration would you consider a 'full career' in EM? I suspect the standard deviation will be large 🙂. Thanks....
 
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3rdJob said:
So I have a nearly unrelated question on this post. Kind of taking a survey. What time duration would you consider a 'full career' in EM? I suspect the standard deviation will be large 🙂. Thanks....
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20 years as an attending. Longer than that is for people who made poor financial decisions (in general). Shorter is for people who prioritized getting out above all else (in general). 20 seems like a good average number where you are still able to retire at that point, but lived a fairly luxurious lifestyle while getting there.
 
3rdJob said:
So I have a nearly unrelated question on this post. Kind of taking a survey. What time duration would you consider a 'full career' in EM? I suspect the standard deviation will be large 🙂. Thanks....
Click to expand...
I’d say 15 years, at least that’s what I’m hoping how long it takes for me to GTFO.
 
BoardingDoc said:
20 years as an attending. Longer than that is for people who made poor financial decisions (in general). Shorter is for people who prioritized getting out above all else (in general). 20 seems like a good average number where you are still able to retire at that point, but lived a fairly luxurious lifestyle while getting there.
Click to expand...

ProTip: Don't start with 300K+ in debt like me, or you're on the 25 year track.
 
Mount Asclepius said:
Agree with @BoardingDoc.

10-15 for FIRE. 15-20 full time average. 20-25 for those with spending issues or those that want a few part time years at the end. 25+ for the true believers in academics.

I started off with exactly $300K in education debt. Paid it all off in 1.5 years while on a preparternship track while even making less money from that job by also working extra moonlighting at another ED on top of my regular job, living frugally like a resident, and putting every extra dime I had towards my loans.

I know some favor the strategy of refinancing and trying to invest money with a higher return instead. That’s okay, but wasn’t for me. I didn’t want non-forgivable debt hanging over my head.

After paying off, it allowed me to accelerate my net worth with simple saving and investing over the next several years because I’d developed good habits. FIRE in 10 years totally achievable even with $300K in initial debt. I think though now I might be doing 15-20 years by choice. Doubt I’ll go bast 20. By no means do I need to do 25+ though because of my initial debt. That’s a spending problem, not a debt or earning problem.

For what it’s worth I eventually gave up the moonlighting, cut back the hours and started enjoying a nice thing or two in life more often.

I know I’m not telling you @RustedFox anything novel. More so just sharing my two cents with everyone else. I agree that education debt does set you back initially. I don’t think it should to such a degree, but does unfortunately. In my opinion we don’t value education enough in this country as a society. Some education debt at our income levels is by no means insurmountable though.
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Yeah, you're right. I figure I'll do 20-25 and then transition to something else entirely.
I didn't save/spent early in my attendinghood because of a few life items, and an attitude of "I've seen people younger and healthier than me get sick and die FAST. This is what I worked for. I'm gonna have a bit of fun now because I have so many years left to work." Little did I know how poisonous EM would become; and I hit it at just the wrong time.

EDIT: My situation is a bit different in multiple aspects. I'm pretty sure that if I quit working (at least in some reasonably regularly capacity) that I will most certainly die quickly. I took a year off from EM and felt pretty "dead" away from clinical medicine.
 
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Let’s make a tale of 3 EPs.

I too graduated with over 300k debt. Paid it off in just over 2 years time, working for a CMG circa post 2015 boom time in Texas making jumbo payments of 15k a month. Bought a house with 60% down payment 2 years later, and can pay off the balance now at 37k, but planning on just paying it off in less than 12 months for cash flow and investing reasons.

If the market can give me an average return of 8%, can likely FIRE in less than a decade. I think my timing of entry into the EM job market was good, which was enormously helpful. I've also now cut down my shifts from an average of 15-18 to 12-13 per month, and enjoy a lot more free time.

Can a new grad at this time pull it off? Not sure.
 
bravotwozero said:
Let’s make a tale of 3 EPs.

I too graduated with over 300k debt. Paid it off in just over 2 years time, working for a CMG circa post 2015 boom time in Texas making jumbo payments of 15k a month. Bought a house with 60% down payment 2 years later, and can pay off the balance now at 37k, but planning on just paying it off in less than 12 months for cash flow and investing reasons.

If the market can give me an average return of 8%, can likely FIRE in less than a decade. I think my timing of entry into the EM job market was good, which was enormously helpful. I've also now cut down my shifts from an average of 15-18 to 12-13 per month, and enjoy a lot more free time.

Can a new grad at this time pull it off? Not sure.
Click to expand...

Oooh! Like a Dickens novel. Cool.
 
5150man said:
FM doc who stumbled onto your board while feeling sorry for myself during an ER shift tonight. This was a very cathartic thread. I moonlight in a nearby rural ER on top of my normal FM clinic...originally because of loans but now due to lifestyle.🙄
You guys have the toughest job in medicine and I honestly don't know how you do it for a full career.
Have heard and been annoyed by almost all the comments on this thread but had to add an additional one that drives me crazy.
The anxious mom insisting that her sick, snotty nose, feverish, but otherwise fine kid "is usually really happy" or "usually never acts like this" when I try to explain they have a viral URI. When I see them in clinic it's not as annoying because I have a prior relationship with mom but when it's a stranger at 2 AM in the ER it takes everything I have to not scream "BECAUSE THEY USUALLY AREN'T SICK!"
Anyway, thanks for the free therapy. And I agree totally about the BP comments above. One of the most annoying CCs is BP high and asymptomatic (since I get paid hourly I don't care how easy the patient is). Often seems to happen at 2AM. Why the freak are you checking your BP at 2am? Often accompanied by daughter, granddaughter, niece, person off the street who is a nurse (but often turns out to be an LPN who is the family's medical sage) who has gotten the whole family worked up and they all come in as a frantic herd.
Working so much ER has made me VERY stingy on who I send to the ER.
Click to expand...
Bless you, kind soul.
 
The theme of the evening is: I have covid and don't feel well and I have the IQ of a piece of celery.

23F with a sore throat and home COVID+ test. Throat just hurts. Hasn't taken anything for it. I literally said "I need you to help me understand precisely why you came to the emergency department instead of taking 2 tylenol." She didn't like me.

65F here with covid-like symptoms. Husband has a cough and his home test was positive yesterday. She expresses shock at the idea that she could have gotten it from him. Husband at bedside shrugs.
66M checks in an hour later. Husband of the 65F. Wants a covid test. For the covid that he knows he has ... that I told him moments earlier that he gave to his wife ... who just had a confirmed positive test here.

22F with flu-like symptoms for a week. Felt better for first 3 days, but then stopped taking tylenol. Now she has muscle aches and doesn't understand what she can do about it. I suggest Tylenol. She doesn't like me.

Family of 4 check in with covid symptoms for several days. Angrily LWBS after waiting an hour. Highlight of the evening.
 
thegenius said:
Hey boarding doc, I agree that it is ok to make people feel a wee bit bad about select decisions they make. No compunction at all.
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I really wish I had the testicular fortitude to do this sometimes, but I work at a center for Press-Ganey excellence. Usually I try to subtly get the patient to realize that they’re idiots without being slightly rude.

Patient checking in for a known flu/COVID diagnosis:

“Yeah, there’s not anything I can do for you here in the ER to cure you, it’s just going to take a few days to clear up on its own. I can get you some Motrin and Tylenol though. Have you tried either?”

“No. So you’re telling me you can’t do anything for me!?”

“What I’m telling you is that I can do something, but the extent of it is essentially what you can do for yourself at home.”
 
Had a patient sign out AMA because when the nurse went to perform his Covid test, he wanted to read the label. Found out it was made in China. He then wanted to leave AMA without further workup despite his 5,000 d-dimer. I went to talk to him. He and his wife go on and on about how China invented Covid-19 and then started manufacturing testing equipment and treatments so they could get rich. I couldn't reason with him so he left AMA. Sad that society actually believes this kind of stuff.
 
southerndoc said:
Had a patient sign out AMA because when the nurse went to perform his Covid test, he wanted to read the label. Found out it was made in China. He then wanted to leave AMA without further workup despite his 5,000 d-dimer. I went to talk to him. He and his wife go on and on about how China invented Covid-19 and then started manufacturing testing equipment and treatments so they could get rich. I couldn't reason with him so he left AMA. Sad that society actually believes this kind of stuff.
Click to expand...

The number one cause of burnout is....
 
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Mount Asclepius said:
Fair. We've all seen young healthy people die young, which certainly puts life into perspective. I'll admit this contributed partially to changing my 10 year FIRE plan to more of a 15-20 year plan unless the whole system burns down. I still feel it's important to gain independence so that you have more control.
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This is sorta my plan - I started out working tons of OT- and trying to save a lot - but ended up just spending more - but now I am going to sorta glide FIRE, slowly cutting back hours (I just dropped to 0.75 FTE) with the goal of 0.5 FTE by 50 or so. Figure still bringing in a little money to live off of and let my investments grow vs going from 120 to 0 instantly,
 
Dred Pirate said:
and then they gas light you saying you can do things to change it...

Just received that email this week
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I get at least 2 of those emails every week. I'm thinking about setting up a filter to auto-delete any email with "burnout" or "resilience/resiliency" anywhere in it.
 
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RustedFox said:
Remind me to reply to this later on tomorrow.
Send me a PM, or a reply, or whatever.

I have something useful to say, but I need a nap.
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was just gonna post your reminder.

Actual conversation the other day
Mgmt - where hear you talk about burn out in the department - there are five things you can do to help reduce it (take vacation, meditation, et)

Me -(trying to be professional) I appreciate your efforts to address burnout- the items you list are all things I can do, none of them address the underlying reason why burnout occurs. What are you doing as mgmt to address the root cause?

Mgmt - I sounds like you are frustrated, we think you benefit by taking advantage of the ideas in the email.

Me - I suggest you look up the meaning of gaslighting and then we can continue this conversation
 
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