1. Download free Tapatalk for iPhone or Tapatalk for Android for your phone and follow the SDN forums with push notifications.
    Dismiss Notice
Dismiss Notice
Hey Texans—join us for a DFW meetup! Click here to learn more.

What fraction of ER visits concern actual medical issues?

Discussion in 'Emergency Medicine' started by Lord Humongus, Jul 29, 2015.

  1. Lord Humongus

    Lord Humongus Membership Revoked
    Removed Account on Hold

    Joined:
    Jul 29, 2015
    Messages:
    107
    Likes Received:
    137
    Status:
    Medical Student (Accepted)
    I'm tentatively interested in EM and have been browsing this forum for a while. It seems that one of the complaints folks in the field have is dealing with drug seekers/crazy people/low-functioning people.

    My own interest in medicine stems primarily from liking the science and wanting to treat real, tangible medical problems related to human physiology. I am definitely not into psychology or social work and have little interest in trying to talk obese people into dieting or smokers into quitting and stuff like that. With that said, I'm curious if the residents and attendings here could share what fraction of your patients & time is spent dealing with real medical issues and what fraction is devoted to drug seekers and crazies.

    Sorry for the rather impolite way of describing the patients but I just wanted to get my point across in the fewest words possible lol.
     
  2. Note: SDN Members do not see this ad.

  3. DeadCactus

    DeadCactus SDN Lifetime Donor
    Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Oct 28, 2006
    Messages:
    2,521
    Likes Received:
    586
    Status:
    Resident [Any Field]
    Medicine is an interpersonal field. Radiology, anesthesiology, or pathology may fit your desires but if your post is an honest reflection of your desires medicine as a whole may be a poor fit for you.
     
  4. hoot504

    7+ Year Member

    Joined:
    Jan 17, 2009
    Messages:
    444
    Likes Received:
    149
    Status:
    Attending Physician
    More like Lord Humongus Douche. Amirite fellas?

    No but seriously, the optics of this question coming from a pre-med such as yourself are so poor that you just aren't going to get any good answers. Go focus on getting into med school, being a decent human being, etc etc etc.
     
    kittykattat and DrDrummer like this.
  5. Angry Birds

    Angry Birds Angry Troll
    5+ Year Member

    Joined:
    Dec 4, 2011
    Messages:
    1,189
    Likes Received:
    1,436
    Status:
    Attending Physician
    A very high percentage.

    Whether they need to come to the ER for said medical issue is another story.
     
    Lord Humongus likes this.
  6. VentJockey

    2+ Year Member

    Joined:
    Mar 12, 2013
    Messages:
    160
    Likes Received:
    86
    Status:
    Attending Physician
    I actually don't think there is anything wrong with the sentiment expressed by the OP. I agree--it sucks to deal with social and behavioral issues. ER and Internal Medicine both have some of that...but you can minimize it with good turfing skills. I send all my fibro to rheum. I send all my chronic pain to a pain specialist. Sometimes we get stuck with social admissions--I let the social worker deal with those headaches. Do you feel sad and hopeless? I'll call psych for you. Are you demented and your family wants to take your car keys? Sounds like a Geriatrics consult to me...

    As long as you're not a psychiatrist, you can skillfully minimize the time you spend on non-medical stuff. The art of a skillful turf is something you have to learn, but once you learn it, it is powerful...
     
    Lord Humongus likes this.
  7. Birdstrike

    7+ Year Member

    Joined:
    Dec 19, 2010
    Messages:
    4,598
    Likes Received:
    3,208
    In any clinical specialty where one sees patients, you will deal with a tremendous amount of psychosocial pathology gumming up the clean and concise "real medical issues" that we all found so interesting as pre-meds and medical students. EM sees its share and then some. It can't be avoided unless your patients are dead (pathology) or in another building (radiology).

    Choose a specialty where you can have a normal life: Good 9-5 hours, little or no call, with little if any night, weekend or holiday work. All other considerations are ancillary distractions and trap doors. I think this is a reason so many doctors are miserable and disgruntled. They risk it all for what they see as the "ultimate career" as if the career itself is the end, rather than the means to the end. It's blasphemy to many on here, and many are likely to vehemently disagree, but this is what I've found likely to be true.

    Yet, as much as I know these things to likely be true, I am conflicted. As much as many of us know these things to be true, we do the opposite.

    Why?

    Is the 1,000th 3am appendectomy and backbreaking sleep deprivation worth it?

    Is the midnight shift on Christmas, taking care of the violent, assaultive drug addict that spits in your face, worth it?

    Is it worth telling the prescription pill addict for the tenth time he needs to seek help, choosing the uncomfortable tense conversation when we could have chosen the easy route and enabled him with a fresh and "customer satisfying" prescription?

    The answer is that it's a calling. Much like one who chooses to be an artist, a musician or a clergyman often times the choice isn't entirely rational from the outside looking in. Yet we do it because we were meant to. If you have to ask, and if you must have an answer to these questions, you possibly are not being called in the same way.
     
    #6 Birdstrike, Jul 30, 2015
    Last edited: Jul 30, 2015
    Lord Humongus and Mr Cousins like this.
  8. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD
    Physician Partner Organization 10+ Year Member

    Joined:
    Nov 18, 2002
    Messages:
    5,145
    Likes Received:
    2,222
    Status:
    Attending Physician
    If you have a terrible dislike dealing with patients who have psychiatric issues, whether that is the reason they came in or not, DO NOT UNDER ANY CIRCUMSTANCES choose emergency medicine. 50% of patients have some kind of psych issue.

    That probably applies to most specialties in medicine, although the percentage might be a little lower.
     
    Lord Humongus likes this.
  9. emergentmd

    10+ Year Member

    Joined:
    Jul 6, 2008
    Messages:
    1,164
    Likes Received:
    1,124
    Status:
    Attending Physician
    I agree. If you really dislike this, don't go into EM. Actually don't go into anything with patient care. People in general have alot of Psych issues.

    Gas, rad, path would be good choices. Even if they have Psych issues, you don't really have to talk to anyone much.
     
    DrDrummer likes this.
  10. Lord Humongus

    Lord Humongus Membership Revoked
    Removed Account on Hold

    Joined:
    Jul 29, 2015
    Messages:
    107
    Likes Received:
    137
    Status:
    Medical Student (Accepted)
    Thanks for the replies. Reading over my OP again I realize I could have phrased it a lot better. I have no issues with talking to patients or even with dealing to some extent with psych issues. I simply don't want psych/behavioral issues to occupy the plurality of my mental space in my practice of medicine. I've had exposure to dysfunctional people growing up outside of any medical context, and at some point you realize that for many of them, they're not going to change, it's not anyone's fault but their own, no amount of money thrown at them will matter and there is nothing you can personally do to make a difference in the way they lead their life. In fact, your best bet is to leave them be and focus on something else lest you become dysfunctional yourself lol.
     
  11. emergentmd

    10+ Year Member

    Joined:
    Jul 6, 2008
    Messages:
    1,164
    Likes Received:
    1,124
    Status:
    Attending Physician
    That is a beauty of EM. You deal with alot of psych and social stuff. But once you d/c them, you never have to see them again unless they return again. I could not imagine being a PCP and having to see these patients over and over for the same somatic complaint.

    I think we all realize that most of these patients (drunks, drug seekers, psych) will not ever be fixed. That is why I find the national hysteria about not being able to find a solution to all of they Psych mass shootings. There is just no fixing these pts.
     
    Lord Humongus likes this.
  12. link2swim06

    Physician 10+ Year Member

    Joined:
    Dec 14, 2007
    Messages:
    3,287
    Likes Received:
    784
    Status:
    Attending Physician
    EM sometimes feels like trying to herd cats. I don't think you would like EM.
     
    vtucci and kittykattat like this.
  13. GeneralVeers

    GeneralVeers Globus Hystericus
    Physician 10+ Year Member

    Joined:
    Mar 19, 2005
    Messages:
    4,847
    Likes Received:
    1,929
    Status:
    Attending Physician
    I don't generally deal with the psychs. If you have psych complaint and aren't suicidal, homicidal or a threat to yourself, I discharge you. If you have any of the prior three issues, then I medically clear you and have the appropriate psychiatric service evaluate them. I never talk to them about why they are sad, paranoid, suicidal, or any other issue. I explain to them that I am only a medical doctor and not qualified to talk about those things with them, and that my job is simply to evaluate any "medical" complaints they might have. Usually I can get out of the patient's room without having to have lengthy discussions about their psycho-social makeup or their poor life decisions.
     
  14. emergentmd

    10+ Year Member

    Joined:
    Jul 6, 2008
    Messages:
    1,164
    Likes Received:
    1,124
    Status:
    Attending Physician
    Psychs and drunks are the easiest pts. They take not thinking. Drug seekers on the other hand takes alittle more out of me.

    I spend less than 1 min with the psych pts and usually don't check on them again.

    Me - Sir, whats going on. Are you suidical.
    Him - Yeah, I want to kill myself.
    Me - OK, we will make sure you are medically clear and get you some help.
    Me - Call Social worker and I am done.

    I can honestly say I barely touch them. They are breathing, talking, have no physical complaints.
     
    Angry Birds likes this.
  15. Arcan57

    Arcan57 Junior Member
    10+ Year Member

    Joined:
    Nov 21, 2003
    Messages:
    2,804
    Likes Received:
    1,162
    Status:
    Attending Physician
    It's not the straight up "I'm sad/depressed/suicidal/off my meds pt" that's an issue. It's the player that's got Axis II issues or a compensated Axis I disorder that's presenting with somatic complaints. They exist in all branches of medicine with pt contact and the prior post about efficient turfing becomes a critical survival skill re: maintaining sanity.

    As a point that I didn't at all appreciate in medical school, treating medical diseases in general is not a satisfying long term occupation. I can't speak for surgical pathology (I imagine fixing things with your hands stays satisfying longer). The best, most satisfied doctors treat patients. It sounds like wankery but if making people's lives better doesn't do it for you then medicine is the wrong road. Very few of your best moments are going to be mentally dismantling a disease and "fixing" things. It's much more common that the soft stuff ends up having a bigger impact.
     
    emememem likes this.

Share This Page