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What the public needs to know about the ED

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NREMTP

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I just got this in an e-mail and thought I would pass it along to people who would understand what this nurse was ranting about. Enjoy!!

1. The world of the ER does not revolve around you.
There are sick people here, and you aren't one of them (to those in the ER for a cold or something else non-emergent!)

2. Our definition of sick is not your definition of sick. If a member of the ER staff says that someone is sick, it means that they are in the process of DYING. They have had a massive stroke, are bleeding out, having a heart attack, or shot. We don't consider a tooth injury sick. Painful, yes. Sick, no.


3. At any given time, one nurse has four patients. One doctor has up to 15. There is a law (similar to Murphy's) in the ER.
If you have four patients:

-One of them will be sick (see #2 for definition)

-One of them will be whining constantly

-One of them will be homeless

-and one of them will be the delightful patient.


-Don't be the whiner. Please.


4. Physicians and nurses are not waiters. We are not customer service representatives. This is not McDonalds, and you very well may NOT have it your way. Our job is to save your life, or at least make you feel better. If you want a pillow, two blankets, the lights dimmed, and the TV on channel 14, go to the Ramada.


5.
If you have one of the three, go to your own doctor in the morning:

-A cold

-The flu

-A stomach virus

6. If your child has a fever, you had better give him tylenol before coming in. Do NOT let the fever remain high just so I will believe the child has a fever.
Do you want your child to have a seizure? Do you?

7. We have priorities. We understand that you have been waiting for two hours in the waiting room. If you don't want to wait, make an appointment with a doctor. The little old lady that just walked in looking OK to you is probably having a massive heart attack. That's why she goes first.


8. Do not ask us how long it will be. We don't know. I don't know what's coming through my door 30 seconds from now... so I surely don't know when you'll be getting a room upstairs.


9. We are not for primary care. Get a family doctor, and go see them.


10. If you have diabetes and do not control it, you are committing slow suicide.


11. We know how many times you've been to an ER. We can usually tell if you are faking it on the first 5 seconds of talking to you. Do not lie to us. If you lie about one thing, we will assume you are lying about everything. You don't want that.


12. If you are well enough to complain about the wait, you are well enough to go home.


13. If your mother is a patient and we ask her a question, let her answer it.


14. If you see someone pushing a big cart down the hall at full speed and you hear bells going off.... do not ask for a cup of coffee. Someone is dying, you inconsiderate %#@^. In the ER, bells don't ring for nothing. Sit down, shut up, and let us work.


15. If you have any sort of stomach pain or nausea/vomiting and you ask for something to eat, you are not that sick.


16. If you can complain about the blood pressure cuff being too tight, or the IV needle hurting, you are not in that much pain.


17. If you want to get something, be nice. I will go out of my way to tick off rude people.


18. Do not talk badly about the other members of staff I work with. The doctor that you hate? I work with him every day, and I know that he knows what he is doing. I trust him a lot more than I trust you. I am not here to be your friend, and neither is he. I will tell him what you said, and we will laugh about it. If you want a buddy, go somewhere else.


19. Every time I ask you a question, I learn more about what is wrong with you. I don't care if I ask you what day it is four different times. Each time I ask, it is for a reason. Just answer the questions, regardless of if you have answered them before.


20. Do not utter the words "It's in my chart." I don't have your chart, and I don't have the time to call and get it. Just tell me.


21. Do not bring your entire posse with you. One person at the bedside is all you need. It is really difficult to get around seven people in the event that you are really sick.


22. If you know what pain meds to ask for, then you know too much and are probably a drug seeker.


23.
I know the charcoal you have to drink tastes terrible but keep these three things in mind:
- I did not create the stuff
- I did not order the stuff
- I did not take the drugs that require you to drink the stuff... you did
THEREFORE do not take it out on me by telling me how bad it is,or even worse, spitting it at me or vomiting it in my direction.


24. Do not get mad at us because you called the ambulance for hand pain that has been there for 3 weeks, and we send you out to triage.


25. If I ask your allergies and you say "Yeah, some antibiotic" we may have trouble treating your infection.


26. Glaring at me from the doorway will not make me move any faster. In fact, you'll only wait longer.


27. Please don't tell us how to do our job.
Do we go to your place of business and tell you how to do your job?
 

GeneralVeers

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Completely wrong. They are not patients, they are customers. We want them to come back for repeat visits for their "complaints". We should go out of our way to get them whatever they need, including a foot massage if necessary. If they complain of pain, we should prescribe them whatever they want, after all, it's a JCAHO goal that we treat all pain regardless of how infantile it seems. Did you wait too long? It must be the doctor's fault. Here are some free movie tickets. Don't feel the need to pay your bill? That's okay, the law says we have to treat you for free, and sure have a turkey sandwich on us.
 

WilcoWorld

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But I don't like turkeeeeeeey (last syllable drawn out in a decreasing pitch to emphasize my discontent).
 

paramed2premed

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Eh. Heard most of this stuff before.

Now, I'm not going to chastise anyone for blowing off steam in this forum (What good is a semi-anonymous forum if not for that?), and I'm not going to deliver a sanctimonious sermon on treating people like the little angels god made them. Mostly I just sick of seeing this sort of tirade trotted out so often.

Ok, I have factual issues with a few points - #6, say. The use of antipyretics doesn't really change the incidence of febrile seizures, and chiding parents for not using APAP just feeds into the rampant fever-phobia that brings us more business.

#12 is silly. Haven't you ever had to convince someone with a nasty-looking EKG or vitals to stay?

If people knew they had a benign, self-resolving illness with no curative therapy available (point #5), they wouldn't waste all day in the ED waiting room. Problem is, a few of us keep giving people antibiotics for colds and coughs, and so what is the public to believe?

I could go on, but the worst part of this is that this kind of rant is cliched. God save me from yet another RN/MD/tech who is "here to save your ass, not kiss it." Please, employ some cleverness or subtlety next time.
 

dchristismi

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A better answer is "I'm allergic to turkey."

(And yes, I have heard that.)
 

Seaglass

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I'll second the antipyretics-fever thing. Drives me crazy.
 

EM2BE

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My favorite is "I'm allergic to morphine. It makes me dizzy and tired."
 

DrMom

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I recently had a beta blocker allergy listed for "making my blood pressure drop"
 

igcgnerd

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recently saw
Allergies include: tylenol, ASA, ibprofen, morphine, keteloric, beta blockers, BENYDRYL!!!!
Are u kidding me?
 

EM2BE

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recently saw
Allergies include: tylenol, ASA, ibprofen, morphine, keteloric, beta blockers, BENYDRYL!!!!
Are u kidding me?

Actually have seen an anaphylactic reaction to benadryl.
 
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MedicFL

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recently saw
Allergies include: tylenol, ASA, ibprofen, morphine, keteloric, beta blockers, BENYDRYL!!!!
Are u kidding me?


I too have had a patient that was allergic to both Benydryl and Cimetidine. I followed the standard approach for her allergic reaction and ended up making her worse. I am just a paramedic but kind of made me wonder. She ended up getting 125mg Solumedrol and .3mg of EPI..
 

Drawing Dead

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The best part about this post is I was working with my attending one day, and some of these things came up. I said to her, "We should make a sign and put it out in triage." She brings me out to triage and showed me that she actually made a handout that summarizes what the OP has written (of course more tactfully, since the people reading it are probably the people being addressed).

One thing I would like to add to this list, that is on this handout in some form or another:
Your doctor probably is NOT meeting you in the ED, even if he said so. And no, you probably will not see the specialist here in the ED either, since it's 11 pm and he will probably tell me he will see you in the morning when I call. You will see me, the EM doc, who is working at this hour. Take it or leave it.
 

igcgnerd

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Well they loose credibility when they have both fibromyalgia and bipolar disorder on their history
 
D

deleted6669

" I'm allerigc to 1 mg of dilaudid IM but not 4 mg of dilaudid IV"...
 

emtcsmith

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"I must go to X hospital, I called my doctor and he said he would meet me there"


".....no that hospital is to far away and no he won't be meeting you at any hospital."
 

Drawing Dead

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"I must go to X hospital, I called my doctor and he said he would meet me there"


".....no that hospital is to far away and no he won't be meeting you at any hospital."

What's funny is that I was just at a site that had the only psych facility in the area. EMS would pick up patients that called 911 because they felt suicidal, or wanted detox, or whatever, and EMS would bypass 2 or 3 different hospitals to bring them to us.

But yes, I have yet to see a patient's personal physician meet them in the ED, unless they are on call that day and already in the hospital rounding (once).
 
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Rendar5

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Nice list, though I don't really agree with 6 or 12 at all, and have some issues with 22.
 

The White Coat Investor

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But yes, I have yet to see a patient's personal physician meet them in the ED, unless they are on call that day and already in the hospital rounding (once).

This is only a function of where you've been. At many community hospitals you DO call the patient's doctor who DOES come to the ED and admit them.

The primary docs (and surgeons) even arrange at times to meet their patient at the ED (we save a room for them) if their offices are closed.

We provide a service for them (a room and nurses and techs) and in return, they provide a service for us (on the on-call list.)

You wouldn't believe how much nicer it is to call a patient's personal physician for admission than calling a medicine resident.
 

Drawing Dead

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This is only a function of where you've been. At many community hospitals you DO call the patient's doctor who DOES come to the ED and admit them.

The primary docs (and surgeons) even arrange at times to meet their patient at the ED (we save a room for them) if their offices are closed.

We provide a service for them (a room and nurses and techs) and in return, they provide a service for us (on the on-call list.)

You wouldn't believe how much nicer it is to call a patient's personal physician for admission than calling a medicine resident.

I've never seen a physician personally come to the hospital to see their patient. It's usually:
Me: Are you familiar with Mr. X? He said you told him to go to the ER.
PCP: Yes, he said he was passing blood rectally
Me: Well, his HgB was 6, so we are transfusing him and putting him in for admission.
PCP: (With or without an attempt to deny admission) Ok, give me the nurse so I can give orders, I'll see him in the morning.

And this is multiple community hospitals that I have worked at, both here, and the east coast as a student. I wish PCPs were like that here. It would save the middle man (The ED physicians) since they would be seen in the ED by a physician (Their own) and the PCP can start the work up from minute one. This sounds like a practice that occurs in much more rural places in this country.
 

Drawing Dead

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Yeah, but my point was do they physically come to the hospital, or do they just phone the orders in like mine do?
 

spyderdoc

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I wish PCPs were like that here. It would save the middle man (The ED physicians) since they would be seen in the ED by a physician (Their own) and the PCP can start the work up from minute one. This sounds like a practice that occurs in much more rural places in this country.

Actually, I am more than happy to see these pts and start the workup in the ED. In the FFS world, this is just a nice bisquit. You basically bill a level 5 for a patient with a dispo....:D
 

kungfufishing

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my thoughts exactly. Meet em, start whatever workup, call PCP, thanks for playing...who's next?
 
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docB

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We don’t work faster when stared at.

It is absolutely downright stupid for you to bitch about how long it took the doctor to see you and then ask your doctor to run a dozen errands for you such as getting a blanket, water, those little non-slip socks and to call your aunt in Topeka and let her know you’re fine. Why do you think dealing with people like you takes so long?

I’m sorry but you can’t just wander around the ED to “check things out.” Stay in your family member’s room.

I know it makes you feel like you have some control in an unfamiliar setting to make all sorts of odd demands but can it. You’re just pissing everyone off and making us all avoid you and your family member.

Having loud phone conversations about how annoyed you are by your ED experience will just make us more certain you don’t have a real emergency.

We do in fact assume that when you came to the Emergency Room that you would clear your schedule so we really don’t care that you have somewhere to be now.
 

Soup

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We don’t work faster when stared at.

It is absolutely downright stupid for you to bitch about how long it took the doctor to see you and then ask your doctor to run a dozen errands for you such as getting a blanket, water, those little non-slip socks and to call your aunt in Topeka and let her know you’re fine. Why do you think dealing with people like you takes so long?

I’m sorry but you can’t just wander around the ED to “check things out.” Stay in your family member’s room.

I know it makes you feel like you have some control in an unfamiliar setting to make all sorts of odd demands but can it. You’re just pissing everyone off and making us all avoid you and your family member.

Having loud phone conversations about how annoyed you are by your ED experience will just make us more certain you don’t have a real emergency.

We do in fact assume that when you came to the Emergency Room that you would clear your schedule so we really don’t care that you have somewhere to be now.

Good day at work or are you just speaking in generalities?
 

southerndoc

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I think it would be a good idea if patients received a printed letter signed by all the doctors of the group explaining that our goal is expeditious treatment and how we strive to follow-up on x-rays, labs, etc. as soon as possible, but explaining that emergencies do happen and if we aren't able to follow-up in a timely fashion that we are treating a patient with an MI, CVA, respiratory failure, cardiac arrest, etc.

When the nurses inform my patients that I'm tied up treating an emergency, they are usually more forgiving. I think every patient should receive a letter stating that.

Trust me, I want to dispo people as quickly (but as safely) as possible so I can get the people out of the waiting room.
 

kungfufishing

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What cracks me up related to this is how surprised patients/families often are that I was away shocking someone or assessing someone who got shot or stabbed. Here?!? Really!?! Ohmygawd/lawdhavemercy!!
 

YOOOUK09

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As a still-somewhat-idealistic med student I find this thread disturbing.

I'm sure the BS in the ED can be overwhelming, but I think how we process this sort of thing comes down to expectations. Don't you expect to deal with a lot of BS? It just seems like it comes with the territory.
 

docB

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As a still-somewhat-idealistic med student I find this thread disturbing.

I'm sure the BS in the ED can be overwhelming, but I think how we process this sort of thing comes down to expectations. Don't you expect to deal with a lot of BS? It just seems like it comes with the territory.
Sure but we are being held accountable for things that decrease our "customer satisfaction" scores and many of these things are byond our control.
 

WilcoWorld

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As a still-somewhat-idealistic med student I find this thread disturbing.

I'm sure the BS in the ED can be overwhelming, but I think how we process this sort of thing comes down to expectations. Don't you expect to deal with a lot of BS? It just seems like it comes with the territory.

As a still-somewhat-idealistic med student you should find this thread disturbing. However, it's not because doctors would dare to say such callous things, but rather because the public and the administrators have such unrealistic expectations.
 

GeneralVeers

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As a still-somewhat-idealistic med student I find this thread disturbing.

I'm sure the BS in the ED can be overwhelming, but I think how we process this sort of thing comes down to expectations. Don't you expect to deal with a lot of BS? It just seems like it comes with the territory.

Another naive medical student. I realize that medical school selects for, and trains people to be idealistic and want to save the world. You have endless courses on "patient autonomy", "benevolence", and "professionalism".

Unfortunately what these courses teach often (but not always) break down in real world practice. When you have patients who come to ER for selfish reasons, non-emergencies, and just plain ER abuse what can you do? In reality we have to brush these people off to a large extent in order to focus on those who are actually sick who need our care. Your throat hurts? Well too bad, you are going to have to wait for several hours while I deal with the brain bleed, the STEMI, and the appendicitis that just rolled through the door.
 

YOOOUK09

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The abuses of the ED are frustrating, I'm sure.

I'm just playing devil's advocate, I guess, and pointing out that while this thread is about the public's expectations of docs it could just as easily be turned around to address docs expectations of the public.

I mean, if it were easy it'd be called dermatology.

Of course, the whole "customer satisfaction" issue is where the rubber meets the road and where some lines need to be drawn.
 

GeneralVeers

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The abuses of the ED are frustrating, I'm sure.

I'm just playing devil's advocate, I guess, and pointing out that while this thread is about the public's expectations of docs it could just as easily be turned around to address docs expectations of the public.

I mean, if it were easy it'd be called dermatology.

Of course, the whole "customer satisfaction" issue is where the rubber meets the road and where some lines need to be drawn.

The patient expectations are unreasonable and unfulfillable. They should have one expectation: If I have a life-threatening emergency I should be seen quickly and treated.

Unfortunately their expectations include being given antibiotics for the slightest sniffle, comfy pillows, and hot coffee on demand.
 

DrMom

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The patient expectations are unreasonable and unfulfillable. They should have one expectation: If I have a life-threatening emergency I should be seen quickly and treated.

Unfortunately their expectations include being given antibiotics for the slightest sniffle, comfy pillows, and hot coffee on demand.

You forgot to include work notes for those non-debilitating illnesses, cab vouchers home (since they took an ambulance in to the ED instead of calling family/friends/taxi), and free fills on all prescriptions.

I had a patient a few weeks ago who literally left screaming and cussing because I wouldn't call a surgeon to fix his easily reducible small hernia right now. He said he was going to another ER until he found one that would.
 

kungfufishing

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You forgot to include work notes for those non-debilitating illnesses, cab vouchers home (since they took an ambulance in to the ED instead of calling family/friends/taxi), and free fills on all prescriptions.

I had a patient a few weeks ago who literally left screaming and cussing because I wouldn't call a surgeon to fix his easily reducible small hernia right now. He said he was going to another ER until he found one that would.

I think I saw him, no kidding, assuming you were at TRMC.
 

southerndoc

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You forgot to include work notes for those non-debilitating illnesses, cab vouchers home (since they took an ambulance in to the ED instead of calling family/friends/taxi), and free fills on all prescriptions.

I had a patient a few weeks ago who literally left screaming and cussing because I wouldn't call a surgeon to fix his easily reducible small hernia right now. He said he was going to another ER until he found one that would.
Probably presented at 2 am no less?
 

DrMom

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I actually saw him early in the day shift, amazingly.

Funny thing is his CC was different from the hernia complaint. I was spending much of my exam on his CC and explaining that I could get him the # of a surgeon he could follow up with for his hernia & he got upset that I was examining him for his CC because "that's not where my hernia is." Go figure.
 
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