Things I Wish My Patients Knew

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WilcoWorld

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If you tell me that you have been vomiting blood:
You will get stuck with a needle to have your blood drawn multiple times over a period of several hours.
A tube will be placed through your nose, down the back of your throat and into your stomach.
Up to a liter of water will be pumped into said tube and sucked back out of your stomach, to see if you're still bleeding.
You'll get a finger up your butt.

And you'll get the same doses of pain/nausea medications that you would have if you'd just said you had a belly ache.

Keep 'em coming folks...
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That a fever does not warrant a trip to the ER.

Neither does a cough.

That it is normal for a fever to come back after the Tylenol wears off.

99 is not a fever...even if your kid's "normal" temperature is 97.

If you tell me you're "numb" somewhere and you insist that you mean that you can't feel, not that you feel pins and needles, I will poke you with something (my thumbnail, a broken off tongue depressor, an 18g needle) where you say you are numb.
 
If you are over 30 and tell me you have "chest pain" that does not mean you will get narcotics. It does mean you'll get hours of testing, nitro that will give you a raging headache, followed by an admission to the hospital with stress testing.

Also....

If you call an ambulance for your chronic BS condition it does not mean you will get a bed and be seen immediately. It does mean that you will be escorted out to the waiting room on the ambulance gurney, and put in line behind everyone else. You are also going to have to pay/find your own ride home when I discharge you for your chronic BS condition.
 
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I wish my patients knew about this concept that the ED revolves around, called "triage." It's a concept where whoever is SICKEST gets seen soonest, not whoever is the most impatient. That way, they'd stop asking me, their PCP, to "call ahead and tell the ER that I want be seen first." :rolleyes:
 
I really wish people could understand that we're not here to definitively diagnose all of their problems. We're here to try to identify serious, acute illness. Once we're pretty sure you don't have one it's on your way with some symptom relief. That's not because we're mean. It's because it's the way it has to be.
 
That I don't care what some bleeding-heart usually gives your for your MSK pain. The fact that at one point you got IV dilaudid for your chronic back pain in no ways obligates me to do the same. And it's not that I don't believe that's what you usually get when you see other doctors, I just don't care.
 
docB said:
I really wish people could understand that we're not here to definitively diagnose all of their problems. We're here to try to identify serious, acute illness. Once we're pretty sure you don't have one it's on your way with some symptom relief. That's not because we're mean. It's because it's the way it has to be.
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Of course, when I explain this to them, they come up with, "Well, I was actually hoping I could be admitted for this condition so that the inpatient team could work it out!"
 
1) I am not here for a second (or third) opinion. If the back specialist you see tells you something, I'm not going to dispute/refute it or come up with another diagnosis.
2) There's this neat concept called prescription drug monitoring. You should look into it before the DEA looks into your house.
3) While I feel for you not being able to afford your definitive care, I really can't fix your kidney stones/busted ass teeth/symptomatic cholelithiasis/peptic ulcer disease. Those doctors have a business to run, they are going to want to be paid. We would too if the government would let us. Continuing to come to us is going to cause us to label you.
4) Hang up your phone when I enter the room. If you can afford cellphones/cigarettes/multiple tattoos/bluetooth, you can afford your lisinopril.
 
The chance that you broke every single bone in your spine when you were rear-ended at a stop sign is vanishingly small, but if you scream in pain when I touch anywhere on your back then you're going to get radiated. Also, a big ol' stack of negative xrays is not going to win you your "golden ticket" lawsuit.
 
Pinner Doc said:
Of course, when I explain this to them, they come up with, "Well, I was actually hoping I could be admitted for this condition so that the inpatient team could work it out!"
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I prophylax against this by saying, at the end of my H&P, that we're going to be looking for life-threatening things that could cause you need to be admitted to the hospital or go to surgery. That way they (mostly) feel relieved when everything comes back normal, or I've already had the discussion about how I'm not going to admit them for work-up of their chronic complaint. This saves about 20 minutes on the back-end and they usually swallow it easier up-front then after they're pissed about the wait.

Also, if you come in complaining of lower abdominal pain giving me a urine speciman ASAP is going to shave hours off of your LOS. Although I wish the nurses internalized this also.
 
When you say "worst headache of your life", that means CT and LP. Then when you get all huffy and say 'if it you think it was a brain bleed then why did we have to wait three hours to be seen', I can point out the word 'migraine headache' as your self-described self-diagnosed chief complaint.
 
Arcan57 said:
I prophylax against this by saying, at the end of my H&P, that we're going to be looking for life-threatening things that could cause you need to be admitted to the hospital or go to surgery. That way they (mostly) feel relieved when everything comes back normal, or I've already had the discussion about how I'm not going to admit them for work-up of their chronic complaint. This saves about 20 minutes on the back-end and they usually swallow it easier up-front then after they're pissed about the wait.

Also, if you come in complaining of lower abdominal pain giving me a urine speciman ASAP is going to shave hours off of your LOS. Although I wish the nurses internalized this also.
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In addition, if you tell me you are not pregnant, that is not good enough. We still need urine for Upreg. "Surprises" are not uncommon.
 
EM2BE said:
In addition, if you tell me you are not pregnant, that is not good enough. We still need urine for Upreg. "Surprises" are not uncommon.
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Although to be fair, I get frustrated with this as a female when I do know there is no chance I'm pregnant. I get it as a clinician and have my own level of "yea right..." when seeing patients, but when YOU'RE the patient it can be annoying to be perceived as a ticking fertile time bomb before being given care.
 
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If you are going to begin the encounter with "could you hurry this up? I got a party to go to in an hour" - you do not need to be in the emergency room!!! :mad:


hothause said:
Although to be fair, I get frustrated with this as a female when I do know there is no chance I'm pregnant. I get it as a clinician and have my own level of "yea right..." when seeing patients, but when YOU'RE the patient it can be annoying to be perceived as a ticking fertile time bomb before being given care.
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Yup.
I have an IUD, taking BCPs for a separate indication, had my period less than a week ago and my significant other has been away for a month... I still got a pregnancy test before an x-ray... of a foot... :rolleyes: But, having seen enough pregnant "absolutely no way!!!" ladies, I definitely get it...
 
if you are diabetic and you eat sugary foods, by golly your blood sugar might just go up a bit. This is not an emergency, just general stupidity.
 
If you say that, on a scale of zero to ten, your abdominal pain is a "twelve" and refuse to use any other descriptors, and then on exam you state that each and every place I touch on your abdomen is tender, congratulations! you have made me completely unable to evaluate the cause of your pain in any intelligent way. So, you're going to get a CT scan. This means you'll spend at least four more hours here getting a few hundred xray's worth of radiation and you'll probably get a load of IV contrast dye which may cause renal failure...but don't worry, most people's kidneys bounce back eventually.
 
Yes, Lasix and other diuretics make you urinate. That's what they are supposed to do. Stopping them will make your legs swell and make it difficult for you to breathe. Just because you don't feel like urinating does not mean you should stop taking your medication.
 
That lack of preparation on the part of the patient does not (necessarily) constitute an emergency on mine.
 
If you, as the patient, pick the ONE thing that is really your emergency, and you answer my questions with "yes" or "no" rather than "maybe" or "sorta" then there is a good chance that I, as your doctor, will be able to diagnose and treat you with a minimum of needle pokes and other unpleasant things.

If however, you complain of four things and give equivocal answers to all my questions then neither of us is going to enjoy the encounter.

For example, if what's bothering you is a sore throat and a fever, stick with that. I'll have you discharged with some penicillin in a jiffy. However, if you also complain of headache, neck stiffness, chest pain, nausea, abdominal pain, and oh, yeah, you're right leg sure did seem swollen a week ago, and your girlfriend does think she noticed a rash on you yesterday, but isn't quite sure where...well, this is gonna hurt.
 
DrMom said:
If you take an ambulance to the ED we are not obligated to arrange transport back to your home by ambulance, taxi, or other means.
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I recently had a patient request an ambulance ride back home. Her rationale was that she had taken a cab to the hospital "to save the taxpayers money."

I replied, "And now you get to save the taxpayers again and take a taxi back home."
 
DrMom said:
That a fever does not warrant a trip to the ER.

Neither does a cough.

That it is normal for a fever to come back after the Tylenol wears off.

99 is not a fever...even if your kid's "normal" temperature is 97.

If you tell me you're "numb" somewhere and you insist that you mean that you can't feel, not that you feel pins and needles, I will poke you with something (my thumbnail, a broken off tongue depressor, an 18g needle) where you say you are numb.
Click to expand...

We should advertise this :oops:
 
Don't ever ask your doctor how much longer all of this is going to take.

I don't care who your doctor is, ever, except if I am going to call that person. The fact that Marcus Welby/House/The Surgeon general has given you his cell phone number does not put you at the top of the bed queue.

Literally any complaint you have today will be helped or fixed entirely by losing weight.

ED docs/RNs/techs absolutely love it when we are treated with respect and thanked for our time. If you do this you will get treated like a king/queen.

If you dramatize for effect, you are going to increase the time, cost, and pain of your workup. It's ok to say "this doesn't hurt that bad but I justed wanted to be sure."

The fact that grandpa, who is 88 with end stage dementia and parkinson's has a decub is not entirely the fault of the nursing home for which you are paying nothing. No I cannot help you sue them.

In the bed next to you is a 62 year old mother of 4 with 2 little grandkids dying of met breast ca who has debilitating pain from bony mets. She is handling her illness with grace and poise, and politely asking for IV narcs because she "just can't take this pain any more." The fact that you are writhing around screaming because you tripped on the stairs at home and skinned your shin is not making you look good.

I am going to hate you when you bring in a 15 m/o who is off the chart for weight because he's "just not eating" for 2 days.

We cannot listen to your story, do 30 min worth of tests, and then tell you your chest pain is nothing serious.

If your complaint involves your vagina or your nuts, you are going to have those parts examined. Don't tell me about discharge and bleeding and then say "what?!" when I tell you we're doing a pelvic.
 
A little graphic, but seriously!
Your vagina is not a bottomless pit/black hole and it doesn't have teeth. Then a string comes off your tampon, instead of coming to the ED and complaining about waiting for 4 hours to be seen, you should have at least tried reaching in there and pulling it out yourself...
 
Tiger26 said:
I'm not any more likely to admit you because you brought your suitcase . . .
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In fact I would argue that I'm less likely. If you had time to pack before coming in it's likely not and emergency.
 
If you tell you currently feel or have felt suicidal in the last 24 hours and/or have swallowed all your pills, don't be surprised when you are forced to be admitted to a psychiatric ward. Also, don't be surprised when you get the $800 ambulance bill for the transfer. No, I'm not going to let you drive yourself over there so you can save $800.
 
When you get drunk and decide to swan dive off of a 2nd story balcony, leading to unstable fractures in multiple cervical levels, you're going to get a foley. There's two ways to do it, my way or the hard way. Either way, it's going to happen.
 
I watched you smiling/laughing and walking without difficulty down the hall into your room with your back/dental pain.

****as a further extension of this, I will not probably not believe you have severe pain when you suddenly start fake crying and writhing around when you find out I am your doctor and not your nurse.

We are neither a restaurant nor hotel....I will make no apologizes for waking you up to provide medical care and certainly will not let you sleep a little longer. Also, I don't have a magical supply of sandwiches. I would actually like one myself, since I haven't eaten/peed all day.

However, there does always seem to be a magical supply of cheetos in our ED...
 
emrox said:
However, there does always seem to be a magical supply of cheetos in our ED...
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Those are diagnostic though as we all know that perioral cheetosis essentially rules out anything actually being wrong resulting in a dispo that doesn't involve narcs, a CT scan or an LP.
 
gutonc said:
Those are diagnostic though as we all know that perioral cheetosis essentially rules out anything actually being wrong resulting in a dispo that doesn't involve narcs, a CT scan or an LP.
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good point. the magical supply must exist for diagnostic testing. i don't know why i didn't see this before.

i wonder what the sensitivity/specificity of perioral cheetos is for overall badness.
 
Sorry, wow, I was tired when I posted and apparently had some reading issues. Going off to review the whole reading for comprehension thing . . .
 
Last edited:
1. The ambulance is not cheaper than driving yourself.
2. GERD is not life threatening.
3. #2 is not an indication for the conveyance in #1.
 
Yes, Mr. Multitrauma, you are going to get physical therapy. No, this will not involve a massage.

Or a jacuzzi.
 
EM_Rebuilder said:
One of the places I moonlit at was the only hospital in the county and a few surrounding counties. They had problems with really rural people calling EMS, then the patient bolting at the door because it was a 'free ride' into town.
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Oh my god. As a med student, this sickens me.
 
How about the "patient" who changes her chief complaint 3 times during transport, and when we arrive at the hospital, a "gentleman" walks out, in hospital scrubs with an employee ID, and yells "Bitch! What the F#$% took you so long to bring me my smokes?"
 
Farmer2DO said:
How about the "patient" who changes her chief complaint 3 times during transport, and when we arrive at the hospital, a "gentleman" walks out, in hospital scrubs with an employee ID, and yells "Bitch! What the F#$% took you so long to bring me my smokes?"
Click to expand...

That's just a feel good moment.
 
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