“Well then why do I have this pain?” UGH!

[Birdstrike]

I find pain, suffering and death.

You should be a Marvel villain.

TENK: From the Galaxy Emergihell
Superpower: Finds pain, suffering and death, regardless of time of day or insurance status. Defies all circadian rhythms.
Achilles Heel: Being asked for a refill on percocet.

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[Vandalia]

Well, the one thing that kept me going for a few seconds was the realization that the patient actually thought me better and smarter than every other physician in the area and that I alone could solve the mystery that stumped everyone else. For a few seconds.

 

[Tenk]

You should be a Marvel villain.

TENK: From the Galaxy Emergihell
Superpower: Finds pain, suffering and death, regardless of time of day or insurance status. Defies all circadian rhythms.
Achilles Heel: Being asked for a refill on percocet.

I would snap my fingers like every shift

 

[GeneralVeers]

I would snap my fingers like every shift

I'd create a universe without fibromyalgia or Press-Ganey

 

[deleted836128]

"I don't know why... really I don't"

Our shifts are filled with uncertainty. I think your job satisfaction might improve the more you can accept this. And some shifts are harder than others for sure.

Thanks. Question. Do you really say “I don’t know”? When I’ve said that patients look at me like I have three heads. I took the advice of another poster today - had a patient with six months of flank pain and of course her CT was negative. When I told her the CT was negative I said basically what one of the posts above mentioned - “A negative CT is a good thing. Usually when I “find something” it’s really bad. Like the last guy I saw with flank pain had a huge kidney mass. So it’s a good thing we didn’t find anything.” The patient was super nice and said “Yes! I am so glad!” And seemed happy and then when I left the room, she started going on a rampage per the nurse. You can’t win!!!

 

[theseeker4]

Thanks. Question. Do you really say “I don’t know”? When I’ve said that patients look at me like I have three heads. I took the advice of another poster today - had a patient with six months of flank pain and of course her CT was negative. When I told her the CT was negative I said basically what one of the posts above mentioned - “A negative CT is a good thing. Usually when I “find something” it’s really bad. Like the last guy I saw with flank pain had a huge kidney mass. So it’s a good thing we didn’t find anything.” The patient was super nice and said “Yes! I am so glad!” And seemed happy and then when I left the room, she started going on a rampage per the nurse. You can’t win!!!

I say I don't know all the time. If a patient comes in and lists all the specialists they have seen who haven't been able to help them, I start the conversation saying "I can pretty much guarantee that I won't be able to find the answer to what is going on with you today. I will treat your symptoms and we will do what testing is needed to make sure nothing dangerous is going on right now, but your specialists have access to many more tests and experience that we have here. We rule out things that are emergencies, but we can't necessarily give you the answer you are looking for today. I will order tests to make sure you are safe, and will give you some medications to get you feeling better while you are here, but I won't be able to explain why you are having these symptoms for the past three years." Generally, people have been understanding, if not happy, with this. This works a LOT better than leading them to believe you will give them an answer today, regarding their chronic complaints multiple experts haven't explained/fixed. THOSE patients, the ones you say "we are going to get to the bottom of this" and then 3 hours of tests later you tell them "I don't know" who flip out, usually.

 

[GeneralVeers]

I tell patients up front if I think we won't find anything. A significant number will just get up and leave with no testing, thus saving us from wasting everyone's time.

 

[thegenius]

Dude that is sweet....I like this. I say a variant of this often but your approach is much more direct.

I’m using your lines

@Tenk

I used your lines today. Worked like a charm. Young guy with LLQ pain and all the testing was normal. He's like "I feel swollen, I've gained weight, why do I have pain here and why is my stomach swollen?"

I'm chomping at the bit. I'm remembering my lines.....I respond

"Sir, when I find things that are wrong with people I find death. I find metastatic cancer. I find things that require me to rush you off to surgery. You don't want me to find anything bad. And I didn't. This is the best news you could possibly get."

"Oh yea man...you're right. <big smile on his face> I'm going to see my doctor and discuss weight loss options."


F'ing love it!!!!!!

 

[thegenius]

Thanks. Question. Do you really say “I don’t know”? When I’ve said that patients look at me like I have three heads. I took the advice of another poster today - had a patient with six months of flank pain and of course her CT was negative. When I told her the CT was negative I said basically what one of the posts above mentioned - “A negative CT is a good thing. Usually when I “find something” it’s really bad. Like the last guy I saw with flank pain had a huge kidney mass. So it’s a good thing we didn’t find anything.” The patient was super nice and said “Yes! I am so glad!” And seemed happy and then when I left the room, she started going on a rampage per the nurse. You can’t win!!!

Sometimes I say I don't know. I'm tired of making up stuff and fake diagnoses.

I tell them "I'm just an ER doc. that's all I am. If I was a doctor that could solve all your problems, I would be a billionaire and not working."
(I've said that before)

"All I'm trained to do is save your life if you are dying in front of me. that's all I do."

I end up just making up something. One of these days I'm going to say "It's possible you have a little gremlin in your left kidney causing you pain. You should see your doctor for that."

 

[Tenk]

@Tenk

I used your lines today. Worked like a charm. Young guy with LLQ pain and all the testing was normal. He's like "I feel swollen, I've gained weight, why do I have pain here and why is my stomach swollen?"

I'm chomping at the bit. I'm remembering my lines.....I respond

"Sir, when I find things that are wrong with people I find death. I find metastatic cancer. I find things that require me to rush you off to surgery. You don't want me to find anything bad. And I didn't. This is the best news you could possibly get."

"Oh yea man...you're right. <big smile on his face> I'm going to see my doctor and discuss weight loss options."


F'ing love it!!!!!!

Haha, good stuff.

 

[deleted109597]

Haldol works really well for pain in all these patients.
Just saying.

 

[EsTxDr]

A lot of physicians do not understand the role of the emergency medicine and ER in general. The number of patients referred to the ER 'stat' for their asymptomatic blood pressure of 180/95 directly from their outpatient physicians' office confirms that fact.

This.

When my patient tells me her doctor sent her straight to the ER and the surgeon is waiting on her. To find out her OB/GYN thought (incorrectly) that she had a thrombosis hemorrhoid and spoke with the vascular surgeon's nurse and then sent the patient to me per EMS. Yes, it was "that" vascular surgeon on call, and after the OB tells me she has never actually seen a thrombosed hemorrhoid but I must call the surgeon and tell the surgeon to call her. I actually made the call, because I wanted to experience the response this vascular surgeon would have. We had a good laugh about it, good times. I'm sure that specific OB will never do that again.

 

[Educated ConsumeRX]

You are far nicer than I would have been. I don't prescribe narcotics for pain that is resolved that "might" come back. I also wouldn't have given her a pain pill to go home with....since she had no freakin

Duuuuude..... it’s a STONE; the pain WAS coming back.... you know that , right? # Savage. Lol

 

[thegenius]

I'd create a universe without fibromyalgia or Press-Ganey

Hell...I would just snap my finger and transport 1/2 of the patients to another city 300 miles away.

P O O F

 

[dchristismi]

My line is "We're really good at the stuff that kills you. We're not so good with the stuff that makes you miserable."

 

[killerleaf]

My line is "We're really good at the stuff that kills you. We're not so good with the stuff that makes you miserable."

I would like to hear that as a patient. In fact, there have been several times I have heard something so similar (when accompanying family). That seems to help the thought process of "OMG what is happening? I am dying" that have occurred in the instances I have witnessed.