Dakota

Senior Member
10+ Year Member
Sep 5, 2005
2,179
121
Status
Attending Physician
I have been tasked with giving a talk to my Dad's old folks breakfast group in the morning.

I figure I will mix HIPAA compliant funny stories with actual helpful hints for old people to know about the ED.

I'm thinking about covering good chief complaints to come by ambulance vs POV, things that are OK for urgent care, etc.

What do you guys wish old people knew about the ED?
 
  • Like
Reactions: northernpsy
OP
Dakota

Dakota

Senior Member
10+ Year Member
Sep 5, 2005
2,179
121
Status
Attending Physician
Great! Thanks Fox.

I'll kick things off.

If you think you are having a heart attack please call an ambulance, we might be able to get you straight to the cath lab.

If you think you are having an ischemic stroke wait until you are outside the TPA window to come so no one gives you unproven expensive medication (kidding! sort of...).
 

Psai

This space for lease
Removed
5+ Year Member
Jan 2, 2014
11,519
23,501
ヽ(´ー`)ノ
Status
Resident [Any Field]
Don't come to the ed at 3 am for your atypical chest pain x 1 year already been worked up with ecg xray labs stress test cardiac cath coronary cta cardiac mri pet panscan just because you had a sharp twinge and your pmd doesn't open until 8
 

Zebra Hunter

5+ Year Member
Sep 17, 2014
530
724
Status
Attending Physician
Don't come to the ed at 3 am for your atypical chest pain x 1 year already been worked up with ecg xray labs stress test cardiac cath coronary cta cardiac mri pet panscan just because you had a sharp twinge and your pmd doesn't open until 8
Might as well come in now because the pmd is going to send you this way, anyways
 

TrumpetDoc

7+ Year Member
Sep 17, 2009
344
55
Status
Attending Physician
Do not come in at night...after the freakin streetlights are out for social work problems (don't like our nursing home, wife/grandma is too hard to care for, bla bla)!!!!
 
  • Like
Reactions: pencilcase

TrumpetDoc

7+ Year Member
Sep 17, 2009
344
55
Status
Attending Physician
If your a known COPDer and still smoking...just be on F-ing hospice!!!!!!!!!!!!!!!!!!!!!!!!x10^100
 

RustedFox

Go to the ER now, or you'll have a stroke.
Lifetime Donor
10+ Year Member
Aug 21, 2007
4,222
3,853
On a box.
Status
Attending Physician
1. It is your responsibility to know WHO your (cardiologist/nephrologist/neurologist is). Write it down, put it in your wallet (or on the fridge, as suggested above). Answers such as - "He's the Indian guy; I can't pronounce his name, starts with a "R"." are not helpful.
2. Do not go to the supermarket/drugstore/etc and put your arm in that blood pressure cuff. Just don't do it.
3. Following (2): ASYMPTOMATIC HTN IS NOT AN EMERGENCY.
4. The ER is not "just to get checked out". This is the Emergency Department, not the "I'm just not sure, but won't accept any answer that I don't like" Department. If you have anything that sounds like an anginal equivalent, you're not going home without signing lots of AMA paperwork.
5. If you are a snowbird, and you spend 6+ months here in FL (or wherever)... YOU NEED A LOCAL PMD. No, I will not call your PMD in Michigan at 2 AM and ask him what meds you're taking and why.
6. We do not do "medical check-out" exams/visits prior to long trips/drives back to Canada/etc. No, prophylactic antibiotics will not be given to you "just in case you get sick on the way".
7. No, I cannot predict that you'll "be fine to go on the cruise in 3 weeks". I don't have a crystal ball.
8. Yes, you can pronounce the names of your medications. Cou-mah-din. If you can say "Schenectady", you can say "Ma-TOE-pro-lol."
9. The answer to "Why do you take this medication?" is never - "because my doctor told me to".
10. No, I cannot answer questions about your bill. I never see a bill. I never send a bill. I am not responsible for what and how you are charged.
11. Go back to Quebec. Please. Oh, and yes - we have this practice here called "tipping". The French word is "pourbois". Gratuity is generally 18%, you cheap Frenchies. (This one was not ER-relevant, but needs to be said anyways).
12. I am an Emergency Physician. Please don't confuse me with the concierge at your hotel.


I could go on all day. This reminded me that "season" is coming in hot in like... 8 minutes.
 

Siggy

10+ Year Member
Oct 27, 2004
3,602
1,458
34
Status
Fellow [Any Field]
9. The answer to "Why do you take this medication?" is never - "because my doctor told me to".
At least they're taking their medication... better than the "I have cardiomyopathy, but don't take my metoprolol or lisinopril because my BP is good!"

10. No, I cannot answer questions about your bill. I never see a bill. I never send a bill. I am not responsible for what and how you are charged.
11. Go back to Quebec. Please. Oh, and yes - we have this practice here called "tipping". The French word is "pourbois". Gratuity is generally 18%, you cheap Frenchies. (This one was not ER-relevant, but needs to be said anyways).
 

dchristismi

Gin and Tonic
15+ Year Member
Dec 4, 2003
1,042
473
Central Florida
Visit site
Status
Attending Physician
Ug... Foxy, I worry that Season is already here. Got my ass handed to me tonight... gotta love the unstable is-it-just-rapid-AF-with-rate-related-ST-changes-or-is-it-posterior-STEMI in the midst of "damn, pancreatic cancer is a bitch" +/- sepsis/PE/what-the-hell-grown-ups-aren't-supposed-to-get-intusseption kind of night. I was kinda surprised the rad didn't call me on that one. Geez.

Got killed all weekend. I'm afraid the snowbirds are returning early. It's going to make for an ugly winter. I had 4 hospice referrals this weekend alone. (As in 4 "go directly to hospice house, don't even get admitted" hospice referrals.)

On a brighter note, 2.5 parts vodka + 1 part St Germain + splash vermouth + olives is helping a great deal.
Ok, back to your regularly scheduled bitching, erm, I mean, programming.
 

njac

Senior Member
10+ Year Member
Mar 20, 2005
11,665
6,053
36
Now headed all the way west!
Status
Pharmacist
It's ok to go a day without pooping.

Drug interactions are real. If you take warfarin, double check with the pharmacist before you start taking amiodarone/Levofloxacin/etc
(Saw an inr of 24 this weekend who wasn't told to decrease her warfarin when they started amiodarone. Oops.)


Sent from my iPhone using SDN mobile app
 

RustedFox

Go to the ER now, or you'll have a stroke.
Lifetime Donor
10+ Year Member
Aug 21, 2007
4,222
3,853
On a box.
Status
Attending Physician
dChristismi and I used to work together at the same shop. Her place has crazy high acuity.

I feel yah, amiga. Embrace the suck.
 
OP
Dakota

Dakota

Senior Member
10+ Year Member
Sep 5, 2005
2,179
121
Status
Attending Physician
Thanks for the replies everyone, epecially the humorous ones.

Spent most of my 15 minutes discussing end of life care. Many folks there already had advanced directives but no one had considered if it is hidden in a safe deposit box and no one knows about it, well, it is pretty useless.
 

KLPM

5+ Year Member
Dec 15, 2012
473
40
Status
Resident [Any Field]
At least they're taking their medication... better than the "I have cardiomyopathy, but don't take my metoprolol or lisinopril because my BP is good!"
This is like the lung transplant patient who stopped taking anti-rejection drugs because "I thought once I run out I don't have to take it anymore".
 

JustPlainBill

Attending
10+ Year Member
Jan 5, 2007
2,568
2,933
Status
Attending Physician
I do not mean to hijack the thread, but as a PCP who sees my partners patients for acute illnesses as a courtesy a lot of these complaints are similar --- If I may --

1) Presenting with a complaint of "I don't feel good" without being able to elucidate a specific thing is either a) not going to go anywhere and no, you don't get antibiotics, steroid shots, Norco or anything else or b) a million dollar workup that you'd better be prepared to pay for, depending on your insistence. And yes, the ER did do something for you the last time you went there on your own --- you were discharged after they did a complete workup and found nothing acute/life threatening/worthy of admission -- the 2 bags of NS likely resolved the hyponatremia that I told you to follow up for in one week but you elected to blow off.

2) Do not decide to present to me as a new patient after stopping all of your meds including: digoxin, amiodarone,insulin,synthroid so that we have a "clean slate" to start from -- works well in engineering but no so good in medicine.

3) Research -- do not confuse a Google Search with research -- you tend to piss me off when you insist that you've done your "research" and insist that the 50 pound weight gain after 3 children is a result of you not being on Armour Thyroid yet you can't tell me the journal article title or present an abstract from the PubMed database.

4) yes, we will have to take the opinion of someone who did 4 years of undergrad, 4 years of med school, 3 years of IM, 2 years of cardiology/electrocardiology fellowship and has been practicing as a board certified cardiologist for 10 years over one Reader's Digest article.

5) No, the pain management specialist will not start reissuing prescriptions for pain meds because I call them since you admitted to SI and were hospitalized for it. You need to go to the new specialist that has agreed to take care of you.

6) I regularly give you ER warnings that are legit. Quit using them as a PCP office for every little sniffle/cough/joint pain.

7) Yes, your diet is likely a component of the abdominal pain you just presented for -- How do I know? Well, when you tell me that you had abdominal pain with nausea this morning which began resolving but you decide to test your ability to tolerate PO with chips, salsa and a coke and the pain returns with a vengeance, I can guess that the root of the problem is likely diet mediated....oh, by the way, spandex is a privilege, not a right.
 
Last edited: