Dr.McNinja

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From Edwin Leap's always awesome blog



Three times in the past few weeks I have witnessed our ER staff being threatened. Twice with ‘I'll kick her %&$!,' once with legal action over an issue that was totally nonsensical. This, of course, pales in comparison to the crossed arms and huffing, the screaming and profanity that regularly inhabit our little slice of medical paradise.

So I began to ask myself, ‘where else can you do this?' Try an experiment. Next time you appear in traffic court, scream ‘#@%$ YOU' at the judge. Then ask for a cup of coffee, a snack, and insist on speaking to the criminal advocate. Then, when they take the handcuffs off, e-mail me and let me know how it went.

When you're at WalMart and the clerk makes a mistake at check-out, or when the store doesn't give you a television for free, scream at the manager, ‘I'll take you out back, you &%@# && and beat your ##$!' They love that at WalMart. They'll probably give you a gift-card.

Or better, shoplift an item, then come back and complain that it isn't working up to your expectations, ask for the consumer advocate and pace around staring at everyone in the management office until you get what you want. They might just drop all the charges for shoplifting!

Even better, do it at the Post Office, or in the security line of the airport. Postal inspectors and TSA officials are very patient and forgiving, right?

Fine, I'm on a tirade here. But what I don't understand is why the hospital is the one, consistent place where everyone's courtesy and manners go out the window. Why do people feel that nurses and physicians should be subject to all of their venom, all of their threats and violence and anger, and should then desire to show compassion and kindness? Especially when many of those doing it, but not all, are doing it without ever paying a dime for their care?

Is it, as my friend Mike W. says, because ‘it's the one place they have any power in otherwise powerless lives?' Maybe. Or is it because our culture is abandoning civility the way a snake sheds its skin? Television and movies, music and talk-shows, websites and blogs are windows into the collective soul of the land; hateful speech, disrespect and rude behaviors are ubiquitous.

Sometimes it seems as if all roads converge on the ER. Act badly and you'll end up in the emergency department. In other words, if you do what I suggested above, all you need to do, on the way to jail, is say, ‘I have chest pain,' or ‘I think I'm having a seizure,' or ‘I want to kill myself now,' and all of your craziness will end up in the ER for a pre-incarceration physical. As if the ER were the expected repository for profanity, screaming, threats and souped-up, confabulated drama.

Of course, what I'll be told is that it's because people are frightened and in pain. But that doesn't wash. I've been in pain, I've seen plenty of people in pain, and the nice ones, the ones who believed in behaving like civilized humans, they didn't curse anyone and they didn't threaten anyone. We aren't animals, we're humans after all!

Life in the emergency department is difficult enough. We try to do our best with injuries and illnesses. We try to move huge volumes of patient's in and out. We often do it with limited help and resources, with reduced staff and minimal space. The very last thing we need is more cruelty, more foul language, more attitude.

Where else can you act this way?

Nowhere, as far as I can see.

Pity. I'd love to spread this behavior around a bit, so that everyone else can enjoy it as much as I do.

Edwin
 

pinipig523

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Edwin,

I agree with you 100%. I thought it was only in my program 2/2 demographics, but I guess not. I have no idea where decency and civility has gone - or perhaps it was never there in the first place? I've been doing this for only a few years so I have no idea what has taken place prior.

The arrogance, the lack of restraint, the lack of decency that some patients display is appalling.
 

Arcan57

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I'm relatively fortunate regarding the amount of entitlement and percentage of substance abusers at our shop. And we still have issues. I had a 34 yr old middle-class man with his wife at bedside threaten to slap one of my nurses in the face if she didn't get the IV in his hand on the first stick. She tried to laugh it off and he said, "I'm not kidding". So I informed him of the penalty for assaulting a healthcare worker in our state and that his behavior was completely out of line. He then got ahold of the charge nurse and while sobbing profusely, complained to her that I didn't listen to his side of the story. He then said he wanted another doctor...
 
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i work in the state prison: same thing happens, threats of violence or lawsuits. but they're in chains, so i just ignore it.

we are a society of cry babies.
 

WilcoWorld

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I wonder what the legal ramifications are if I were to kick out a patient who is physically but not mentally ill after he or she has made a threat of violence against my staff. Because I would sure have wanted to kick out Arcan57's patient.

When they're intoxicated though, which they usually are, we're stuck with 'em.
 

docB

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I wonder what the legal ramifications are if I were to kick out a patient who is physically but not mentally ill after he or she has made a threat of violence against my staff. Because I would sure have wanted to kick out Arcan57's patient.

When they're intoxicated though, which they usually are, we're stuck with 'em.
That's a great question.

I frequently run into patients who refuse the majority of their work ups. The can't tolerate the exam, they refuse blood draws and imaging, they usually accept their narcotics. Then when you go and ask if they want to sign out AMA they don't. They just want to sit in the bed, not getting worked up. Do you have them removed? Do you wait them out? I have seen docs who give them some more pain meds in the form of a B52 and then get the work done.

What do you do when someone clearly needs to be removed but claims they can't walk? What do you do with the patient who signs AMA but really can't walk?
 
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GeneralVeers

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That's a great question.

What do you do when someone clearly needs to be removed but claims they can't walk? What do you do with the patient who signs AMA but really can't walk?

If someone is clearly malingering (i.e. they were spotted getting up to go outside and smoke) then I have security escort them out.

In stable patients, who are ambulatory and have no evidence of life-threatening medical issues, I have security escort them out if they refuse reasonable testing like blood draws and x-rays.
 

pinipig523

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I've had an attending NOT at County but at a private hospital kick people out for rude behavior. He gives them a warning and then 2nd offense = security there to take you back out.

I've always wondered of the ramifications of this... another reason for me to move to Texas where there is tort reform.
 

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Here's my opinion. Disclaimer: I don't necessarily even know what I'm talking about, so take this post with a grain of salt. Or a heaping spoonful.

If a patient makes a verbal threat of violence:

-If triage vitals do not indicate acute distress, c/o is not "chest pain", "sudden loss of visual acuity", or "profuse bleeding from one or more orifices":

Inform the patient that threats of violence are taken very seriously in this facility, calmly walk out of the room, and note this exchange in their chart. Next, call a "security consult" and work on a different case. Perform the rest of the workup in the presence of your facility's security personnel. If they're unhappy with this, perhaps next time they'll hesitate before threatening the people trying to help them.



If a patient makes a verbal threat of litigation (one that obviously is not meant in jest, but as a threat to assert intimidation):

-If triage vitals do not indicate acute distress, c/o is not "chest pain", "sudden loss of visual acuity", or "profuse bleeding from one or more orifices":

Inform the patient that they need to speak with someone more suited to address their statement (i.e.: more senior resident, attending, facility risk management or in-house attorney), calmly walk out of the room, and note this in the patient's chart. Contact the appropriate individual and work on other cases until either the individual comes down to speak to this patient or instructs you to continue with your workup. If they're unhappy with this, perhaps next time they'll hesitate before threatening the people trying to help them.
 
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GeneralVeers

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I've had an attending NOT at County but at a private hospital kick people out for rude behavior. He gives them a warning and then 2nd offense = security there to take you back out.

I've always wondered of the ramifications of this... another reason for me to move to Texas where there is tort reform.
I've kicked someone out for smoking in the patient's restroom before. She was complaing of "back pain after falling down a flight of metal stairs". She had not a scratch on her, and amazingly could ambulate 50 feet to the bathroom to smoke with no problem.

After I escorted her out she was later caught loitering up in L&D at which poin the police were called.
 

EvoDevo

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That's a great question.

I frequently run into patients who refuse the majority of their work ups. The can't tolerate the exam, they refuse blood draws and imaging, they usually accept their narcotics. Then when you go and ask if they want to sign out AMA they don't. They just want to sit in the bed, not getting worked up. Do you have them removed? Do you wait them out? I have seen docs who give them some more pain meds in the form of a B52 and then get the work done.

What do you do when someone clearly needs to be removed but claims they can't walk? What do you do with the patient who signs AMA but really can't walk?
Wave a 19g spinal needle in their face and say, "If you can't walk.."

It's worked so far.

*sigh*
 

docB

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A few years back I got randomly assigned to some Census Bureau study on workplace violence. They must have had a great grant because they would not let you ignore them. If you didn't answer the phone calls they'd show up at the door. So for 2 years I got surveyed about workplace violence every 6 months.

It was always weird because they were clearly not set up do deal with EM people.
Survey - Have you ever been physically assaulted or threatened at work?
Me- Yes.
Survey - Oh really (getting excited to have a positive)?!? What happened?
Me - What do you mean what happened? I work in an ER. I get threatened once a week and assaulted every few months.
Survey - What do you mean:confused:?
Me - Society dumps all the drunks and psychs and homeless into my workplace every day. Naturally it gets threatening and violent.

They never really could figure out how to record what I was telling them. They were obviously doing some longitudinal study hoping to pick up a few people who had incidents along the way. They had no clue how to deal with us.
 

VeerTheTIGuy

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I'm at medical school in the UK, and though I've not seen first-hand anyone be violent towards staff, there are signs warning patients and visitors around the hospital that if they are violent or aggressive they will be removed from the premises, and can actually be denied treatment in the future:

Violent patients can now be denied NHS treatment

"Health Secretary Alan Milburn today gave the National Health Service the go-ahead to deny patients treatment if they attack NHS staff as part of the sustainedGovernment'zero tolerance zone'campaign."
 

Katydid

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Oh, you get people threatening physical violence in retail settings.

And, they usually get their way, because management is so afraid of customer complaints and/or litigation. Granted, it's not exactly on the same par as medical malpractice claims, but still....enough customer complaints, and a manager is out of a job.

However, the pharmacist I work for has told a couple of people who were outright nasty to me that I did NOT have to deliver to them if they could not behave themselves, so it was shape up or you can drive your own lazy arse to the pharmacy to pick up your meds. So...while I occasionally get the nutjob who thinks he/she can threaten me? It doesn't last long.
 

pinipig523

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I'm at medical school in the UK, and though I've not seen first-hand anyone be violent towards staff, there are signs warning patients and visitors around the hospital that if they are violent or aggressive they will be removed from the premises, and can actually be denied treatment in the future:

Violent patients can now be denied NHS treatment

"Health Secretary Alan Milburn today gave the National Health Service the go-ahead to deny patients treatment if they attack NHS staff as part of the sustainedGovernment'zero tolerance zone'campaign."
I like this zero tolerance campaign. When do we get ours??
 

Kubed

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A few years back I got randomly assigned to some Census Bureau study on workplace violence. They must have had a great grant because they would not let you ignore them. If you didn't answer the phone calls they'd show up at the door. So for 2 years I got surveyed about workplace violence every 6 months.

It was always weird because they were clearly not set up do deal with EM people.
Survey - Have you ever been physically assaulted or threatened at work?
Me- Yes.
Survey - Oh really (getting excited to have a positive)?!? What happened?
Me - What do you mean what happened? I work in an ER. I get threatened once a week and assaulted every few months.
Survey - What do you mean:confused:?
Me - Society dumps all the drunks and psychs and homeless into my workplace every day. Naturally it gets threatening and violent.

They never really could figure out how to record what I was telling them. They were obviously doing some longitudinal study hoping to pick up a few people who had incidents along the way. They had no clue how to deal with us.
I was just waiting for you to say the census worker replied with something along the lines of "no, no. I mean REAL threats or violence." ... getting kicked doesn't hurt any less if the person doing the kicking is actively hallucinating
 
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This whole thread is why I am leaving the D.C. area and never coming back. The patient population around here is utterly disgusting and totally lacking in any sense of humanity. There is no money in the world that would convince me to stay here and practice in my chosen field (OBGYN), let alone in EM. I really feel for you guys working in other large cities with similar patient demographics and hope you all see the light one day and head for the hills like I am (matched to a program in WV specifically to get away from certain patient types).

For some reason, it seems that rudeness and sense of entitlement towards healthcare workers (or retail workers) is inversely proportional to socioeconomic status around here. On a 3rd year rotation here at GW last year, a homeless patient had the nerve to be pissed off about the selection of donated clothing we offered him at discharge. This guy had FREE major emergency neurosurgery done and was miraculously intact after a horrific assault, SOO much to be grateful for, but actually felt like he could call the shots about when he should be discharged and complain about the color of his pants?! Seriously??

I'm a very modest person and really don't like people to get all gushy and thank me for caring for them or anything, but I still feel like I deserve the same basic respect that any human being ought to receive from my patients. It is just amazing how little respect some people have these days for people who are not only more intelligent, educated, and hard working than most others in society, but choose to do the work we do to help others.

Thank God I'm leaving this craphole of a town and all the nasty people in it. I may be headed for what some might consider to be the middle of nowhere, but that part of the world is stunningly beautiful and quiet and the people there still have respect and gratitude towards the doctors and nurses busting their *sses to care for them. Please reconsider working in big inner city hospitals!

EM was one of my top specialty picks for a while, but I realized I just can't tolerate ignorant, trashy people anymore. The ER definitely gets the brunt of it (my favorite brought-in-by-cops-for-exam patient had a cc of "wrist pain -- cuffs"). The month before I had the lovely experience caring for the Holocaust museum shooter while on trauma surgery and got to endure all of his deranged hatred and racism/sexism while he was here.

I definitely think any patient that's not obviously mentally ill or on drugs/etoh or having some massive trauma ought to get the boot out the door for any behavior that's not 100% polite and respectful. Would make life so much easier.

Thanks for doing what you all do (I couldn't, I realized I had the scary urge to strangle the bad ones I saw in the ER).
 

NinerNiner999

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But what I don’t understand is why the hospital is the one, consistent place where everyone’s courtesy and manners go out the window. Why do people feel that nurses and physicians should be subject to all of their venom, all of their threats and violence and anger, and should then desire to show compassion and kindness? Especially when many of those doing it, but not all, are doing it without ever paying a dime for their care?
The answer, sadly, is simple - because we as physicians have allowed it to become this way. Instead of treatments, triage, and rational testing being the rule of the hour - patient satisfaction, customer service, and fear of legal action have become the markers of our success.

The general public will never understand why we do what we do, but they will continue to demand it faster, better, and first. They will expect to have a return policy if they don't like what they bought, and they will never have any obligation to put others first.

Yes - I would like fries with that.
 

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Although I have not had to go to the ER many times, at each of my visits I have been treated professionally and courteously by all. I truly am sorry that you all have to deal with this type of behavior. It is rampant everywhere--as the retail situation illustrates. I am a teacher and get the most absurd and insulting treatment from the students and their parents when most often is is their own behavior causing the problems. The bullying and threats of litigation are astounding. But at least I can give a failing grade to those people-
I just don't know how you all do it all the time. Thank you.
 

Pharmavixen

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I've worked in a jail for the past 13 years, and while threats are commonplace, physical attacks are rare, tending only to happen if the inmate is profoundly psychotic. Reason: the inmates know that if they attack us, they are in deep ****.

The nurses who also work in general hospitals report the frequency of sexual harassment. In the jail this also hardly ever happens; same reason as above. Typical event one nurse told me about: elderly guy starts stroking her arm and says, "I just loooove chocolate-coloured skin," before grabbing her butt. But in general hospitals it gets excused because the pts are either medicated or ill, and not in their right minds.

In the jail, abuse is abuse, and patients don't get away with it. If someone is dangerous, we are offered lots of big people to protect us when we have to interact with them and if they start getting out of hand, the big people will (sometimes literally) sit on them.

IMO, some people are abusive if they can get away with it. There needs to be more security for you people, and less hand-wringing over the root causes of why people behave badly (feeling "disempowered," or whatever).
 

Katydid

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I've worked in a jail for the past 13 years, and while threats are commonplace, physical attacks are rare, tending only to happen if the inmate is profoundly psychotic. Reason: the inmates know that if they attack us, they are in deep ****.
Yep. They know. And they do not want to go into seg. Nobody wants to go into seg. It's boring as hell, and you have no one to lord it over. Can't be the BMOC if you're all by yourself.

The nurses who also work in general hospitals report the frequency of sexual harassment. In the jail this also hardly ever happens; same reason as above. Typical event one nurse told me about: elderly guy starts stroking her arm and says, "I just loooove chocolate-coloured skin," before grabbing her butt. But in general hospitals it gets excused because the pts are either medicated or ill, and not in their right minds.

In the jail, abuse is abuse, and patients don't get away with it. If someone is dangerous, we are offered lots of big people to protect us when we have to interact with them and if they start getting out of hand, the big people will (sometimes literally) sit on them.
In jail? Those big people also have tasers and pepper spray. And inmates do not want to be tased or sprayed. In the hospital? You can't do anything to them, so they get away with a lot of crap, just because they know you can't do anything to them. Inmates know they'll be screwed six ways from Sunday if they pull that crap....the general population knows you can't touch 'em.

IMO, some people are abusive if they can get away with it. There needs to be more security for you people, and less hand-wringing over the root causes of why people behave badly (feeling "disempowered," or whatever).
Nail. Head. Hit it.

That is why people are abusive to workers in retail settings. They know they can get away with it. They know all they have to do is complain to the manager on duty, and they'll get handed half the store, just to make them go away without filing a corporate complaint. And, they know that if they file a corporate complaint, they can cost someone their job.

That is why people are abusive to corporate pharmacists and pharm techs. They can get away with it. Our pharmacy is privately owned and operated, by the pharmacist even, and there are some things we just won't tolerate. If you are abusive to the boss, the tech ladies, or me, the mere delivery driver? You will be told to find someplace else to get your prescription filled. And that no, we don't need your business that badly, because apparently, you can't behave yourself, and we don't need that.

I really believe that if more emergency staff were allowed to throw people out if they refuse to behave themselves, more people would behave themselves. And I still don't get why it's so difficult to act like a human being, instead of a raging arsehat. Even in the throes of childbirth, I was not rude to the doctors and nurses. Even when I was having a migraine so bad that the urgent care doctor sent me to the ER because he was afraid I might be having a stroke, and the pain was the worst I've ever had? I was still not rude. A little abrupt when I had to ask for something to catch my vomit, yeah, I'll own that. But rude? No.
 

pristine21

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What do you think would happen if you (as a resident) refused to take care of people who raised their voice, were rude, threatening or whatever...? Would u be fired? Is that allowed???

Anyone know what the malpractice law is for people with real pathology who act like jerks and get kicked out only to find there was something wrong l8r?
(not drunk not SI/HI not psychotic not head injured etc...)

I know when I am an attending I plan not to deal with anyones BS- they will get an initial assessment to make sure it is unlikely to be life threatening and bye bye
 

southerndoc

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I know when I am an attending I plan not to deal with anyones BS- they will get an initial assessment to make sure it is unlikely to be life threatening and bye bye
Let's revisit this topic after you're an attending and have to answer to the Press-Ganey Gods.
 

AmoryBlaine

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I really believe that if more emergency staff were allowed to throw people out if they refuse to behave themselves, more people would behave themselves. And I still don't get why it's so difficult to act like a human being, instead of a raging arsehat. Even in the throes of childbirth, I was not rude to the doctors and nurses. Even when I was having a migraine so bad that the urgent care doctor sent me to the ER because he was afraid I might be having a stroke, and the pain was the worst I've ever had? I was still not rude. A little abrupt when I had to ask for something to catch my vomit, yeah, I'll own that. But rude? No.

Agree wholeheartedly. I don't but for one second this BS I've heard several times from pts and families "they are only acting this way because they are sick or in pain."

It's crap. Courteous people are courteous almost all of the time and if they lapse they usually immediately apologize. As docs we obviously see people that are stressed to the max and I have basically infinite patience if they are a little frustrated. Then you get some a****** yelling at you and when you call them on it they say that they're a nice person who is just frustrated.

Nope.
 

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cinapism

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do your PG scores really dictate how you act? are they really that relevant?

I guess I just figure ill try to be normal and nice and itll all work out...
 

Apollyon

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do your PG scores really dictate how you act? are they really that relevant?
Relevant? Yes, when your job is on the line. Valid? Absolutely not. Their statistics are completely, unadulterated, clearly wrong, misinterpreted, invalid, and deceptive. However, even if you point out that you never saw a patient, they say they can't retract one, because it would make their numbers "statistically irrelevant".

PG is an absolute joke, does not reside in reality, and are simply a means to screw the doctor. Period.
 

WilcoWorld

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Relevant? Yes, when your job is on the line. Valid? Absolutely not. Their statistics are completely, unadulterated, clearly wrong, misinterpreted, invalid, and deceptive. However, even if you point out that you never saw a patient, they say they can't retract one, because it would make their numbers "statistically irrelevant".

PG is an absolute joke, does not reside in reality, and are simply a means to screw the doctor. Period.
So why do you put up with it?
 

docB

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So why do you put up with it?
As "contract docs" the majority of us are really at the whim of the hospital administration. If you don't toe the line they are quick to point out that they will find a contractor who will.
 

WilcoWorld

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As "contract docs" the majority of us are really at the whim of the hospital administration. If you don't toe the line they are quick to point out that they will find a contractor who will.
Yeah, I know...I was just being a pest for argument's sake. PG is one of the things I use to convince myself to keep dealing with the frustrations of working in a "County" ED.

However, I would have unending respect and gratitude for the individual or group that took a stand against this practice, which I find antithetical to the philosophy of Emergency Medicine. Myself, I voted with my feet...and now I've found a whole host of other stands that need taking.
 

notinkansas

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Couple of thoughts:

I've learned a lot by noticing what pts are watching on TV (I'm not in EM, I notice this on rounds). The pts who engage in the behavior described in this thread are generally watching something like Jerry Springer. It's part of that culture, sadly, to behave outrageously.

That said, we aren't allowed to insist that the such people behave appropriately. That would violate their rights.

After they are discharged from abusing us, they go get in line for free Obama money, "from his stash". After all, not giving them our tax dollars also violates their rights.
 

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Some of the patients that roll through my department from the ED can be quite intimidating. I do my best to talk them down, but if they ever start making sudden motions and threatening me, then I have a handy little call-switch in my exam room that alerts security that help is needed. Within 15 seconds, several large men with Sig Sauers, Tazers, and pepper spray show up. They will only ask a patient politely once for a change an attitude, after that they will change it...manually. :whistle:I've personally never seen anyone shot inside of the hospital by our security, but these guys know all the pressure points of the body that will make a grown man cry.

I saw a lot more of this working midnights. I work in what can be a rather...unpleasant city, so every night was filled with gunshot/stab wounds/assaults with various blunt objects. And everyone was intoxicated or under the influence of some quality street drugs. Days are a lot more calm but I still meet a few first-call alcoholics that stay at the bar just a little too long until they absolutely have to fight someone and have their teeth and orbits shattered with a brick. Racial slurs and curse words sound so much prettier through a blood soaked mouth.
 

docB

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Yeah, I know...I was just being a pest for argument's sake. PG is one of the things I use to convince myself to keep dealing with the frustrations of working in a "County" ED.

However, I would have unending respect and gratitude for the individual or group that took a stand against this practice, which I find antithetical to the philosophy of Emergency Medicine. Myself, I voted with my feet...and now I've found a whole host of other stands that need taking.
I hear you.

To some degree ACEP and AAEM have tried to stand against this but it's a tough sell. You're trying to convice admins who are not medical. They grew up on business school marketing classes and really believe the key to success is to get the insured patients to be repeat "customers."

Anyone who has ever had to sit through on of those Disneyland style customer service seminars raise your hand. You know the ones where they try to script you to smile first, then apologize for whatever the patient's issue is then tell them how you'll fix it and them ask them if they want anything else. I'm telling you these guys don't understand the difference between an ED and Disneyland. It's crazy.
 
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This repulsive behavior, while unacceptable, is a reflection of society's angst toward the state of emergency medicine in general. ER docs are equally, if not more so, unhappy with the situation than patients. If this doesn't scream reform, I don't know what does.
 

gkdubey

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Couple of thoughts:

I've learned a lot by noticing what pts are watching on TV (I'm not in EM, I notice this on rounds). The pts who engage in the behavior described in this thread are generally watching something like Jerry Springer. It's part of that culture, sadly, to behave outrageously.

That said, we aren't allowed to insist that the such people behave appropriately. That would violate their rights.

After they are discharged from abusing us, they go get in line for free Obama money, "from his stash". After all, not giving them our tax dollars also violates their rights.
Couldn't have said it better myself. It's unfortunate that there just so happens to be so much of that Jerry Springer Trash that fills up ER's today and its their huge sense of entitlement that is the root cause of the problem. No one cares anymore that docs and nurses are caring for your life, instead its all about how they can take advantage of the system some more and what they can do for themselves. It's selfish, repulsive and outrageous. When I was getting my EMT training in some of the most impoverished neighborhoods in Miami (Liberty City, Overtown, etc) it was clear to me that there were two distinct types of patients. The ones we are talking about here that just don't give a flying f*** about anyone but themselves and ones that maintained a sense of humanity despite their possibly harsh circumstances. Even when I was in the ER when I fractured my mandible in two places, I was never rude to my nurses or doctors once. And I can't even describe how painful a broken face is! But the pain never turned me into someone I'm not! No, it is beyond unacceptable to display such aggressive and indecent behavior. There's just no excuse for it.
 
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da8s0859q

For those who have been out for awhile: when the time comes for me to start looking at attending gigs, in what locales / regions ought I look to avoid as much of the behavior in this thread as possible?

I have had the good fortune to attend med school, and currently residency, in smaller cities which avoid at least a little bit of the more flagrant BS.
 

Perrin

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It's rather funny, in a sick way, that this thread was recently bumped.

This past week, one of our ICU nurses was slashed by her patient. Supposedly, the patient had been acting out and yelling at that nurse all night. The patient's husband brought her a pocket knife that she concealed in her room. The patient then pulled out her art line. When the nurse came in the room, she attacked her. The nurse ended up with about a 7 inch gash from her forehead down to her cheek. The pt is still in the ICU and I've been told she'll be discharged to jail. No word on anything against the husband. The nurse got a couple of stitches and is doing fine.
 

The Buff

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"I have had the good fortune to attend med school, and currently residency, in smaller cities which avoid at least a little bit of the more flagrant BS."

Maybe answered your own question?
 
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da8s0859q

"I have had the good fortune to attend med school, and currently residency, in smaller cities which avoid at least a little bit of the more flagrant BS."

Maybe answered your own question?
Sure, gathered as much as far as smaller cities / suburbia / demographics. Was more wondering about anything else region-wise I might just be unaware of.
 

ABBY109

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Voluntary intoxication is NEVER a legal defense/excuse for assault or threatening behavior. If you think it is, take a swing at a cop sometime after you've had a few beers and watch what happens.

If you cant do it in Walmart, you cant do it in my ED
 

Spinach Dip

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It's rather funny, in a sick way, that this thread was recently bumped.

This past week, one of our ICU nurses was slashed by her patient. Supposedly, the patient had been acting out and yelling at that nurse all night. The patient's husband brought her a pocket knife that she concealed in her room. The patient then pulled out her art line. When the nurse came in the room, she attacked her. The nurse ended up with about a 7 inch gash from her forehead down to her cheek. The pt is still in the ICU and I've been told she'll be discharged to jail. No word on anything against the husband. The nurse got a couple of stitches and is doing fine.

HOLY 5HIT!!!



(On the upside, if you can call it that, this DID happen in the ICU, where the nurse in question could get rapid care. But daaaaaaamn....)
 

Arcan57

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No. People are asshats everywhere. No specific region is better/worse, and thus no reason to be biased towards region.
To some extent you can choose what type of asshat you'll be dealing with based on location. I personally prefer the "I can send you to jail for what you just tried to do" asshat vs. the "I'm going to be sitting in a meeting for an hour with the CEO and hospital lawyer because of your complaint" asshat.
 

WilcoWorld

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To some extent you can choose what type of asshat you'll be dealing with based on location. I personally prefer the "I can send you to jail for what you just tried to do" asshat vs. the "I'm going to be sitting in a meeting for an hour with the CEO and hospital lawyer because of your complaint" asshat.
Agreed, but that distinction is more useful when choosing between county vs private hospitals than between regions of the country, no?
 

JediZero

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Voluntary intoxication is NEVER a legal defense/excuse for assault or threatening behavior. If you think it is, take a swing at a cop sometime after you've had a few beers and watch what happens.

If you cant do it in Walmart, you cant do it in my ED
Or taking a swing at the cop watching you in the ED after you've taken bath salts... in this n=1 study, things did not end well for him.
 

spyderdoc

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We had a meth'ed out guy in our ER attack one of my colleagues. Took 6-8 people to get him down, including a bunch of local PD after we called 911. Guy ended tubed, sedated, and a with a broken arm. Of course, the family immediately said they were going to sue us for harming this guy, even though he was high as a kite, and attacked a doc unprovoked....Craziness.
 

The White Coat Investor

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We had a meth'ed out guy in our ER attack one of my colleagues. Took 6-8 people to get him down, including a bunch of local PD after we called 911. Guy ended tubed, sedated, and a with a broken arm. Of course, the family immediately said they were going to sue us for harming this guy, even though he was high as a kite, and attacked a doc unprovoked....Craziness.
You've got to admit, if there were ever a time that it would actually be fun to be put on the witness stand, this would be it.

"That's right counsel, at this point he jumped out of the bed and attacked me while screaming something about Johnny the Unicorn. It took 8 of us just to get him down without anyone else getting hurt. I kind of felt badly that during the restraining process he ended up with a broken arm, but I was glad the 115 lb nurse helping to take him down didn't lose her baby in the process."
 

FutureInternist

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What do you think would happen if you (as a resident) refused to take care of people who raised their voice, were rude, threatening or whatever...? Would u be fired? Is that allowed???
While many patients have yelled at me, at one point or another, I only have had one patient throw something at me (?coffee mug)
I walked out right then & there, told my attending that I would not be seeing that patient anymore
Initially the attending said I had to, but I stuck to my guns & told her that putting up this crap is why people keep doing it
She ended up seeing the patient for the rest of her stay in the hospital
There are signs all over the VA stating verbal or physical abuse will not be tolerated so why put up with it in a community setting where you are more at rick since security is laxer?
 
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At our ED, the attitude/acuity rule was in play: the attitude of the patient (and visitors) was directly proportionate to the actual acuity of the patient. The higher the acuity, the nicer they were. That meningitis patient? Very sick but polite. The hangnail complaint? Demanding everything (food, scrubs, etc.), stealing supplies, and loudly deriding the staff with expletives.

My theory is that your true colors will show through in the ED. If you are a decent person in normal life, most of the time you will be decent in the ED - exception for altered mental status Sx. If you are a demanding, entitled person in normal life, you will be the same in the ED. It also seems that the latter type predominates in the crowd that thinks going to the ED = fun Saturday night.

Until hospital administration stops worshipping the Press-Ganey gods, things will not change. This isn't likely to happen. With the ACA linking hospital reimbursements to patient satisfaction, it seems things will only get more "customer"-oriented.