8/18/07

Take a Guess: Which one do you think is telling the truth?

Patient number 1 is a early 40ish man with no medical history that comes in from his job at a construction site where he suffered a sudden onset of right flank pain. Driven in by a co-worker he is barely able to walk in, hunched over, pale, sweaty, diaphoretic, writhing on the gurney, tachycardic and hypertensive. Shortly after getting to triage he starts vomiting. During triage he seems apologetic when he rates his pain a "7 or 8."

Patient number 2 is a twenty something who is brought in from the parking lot in a wheelchair by a friend, they are laughing and talking on their cell-phones when you bring him in for triage. Chief complaint is a twisted ankle. Despite apparently being able to walk to the car at home he is now unable to walk and has to be brought into triage in a wheelchair. In triage his skin is pink, warm and dry and vitals are normal. He rates his pain a "12."

Patient number 1 is given Toradol and Compazine IV and has complete relief of his pain. He is diagnosed with a small, non-obstructing kidney stone. Discharged home with prescriptions for Motrin, Vicodin and Flomax as well as a urine strainer.

Patient number 2 is diagnosed with muscle strain. He is offered an stirrup splint and a prescription for Motrin. He is unhappy and demands a pain shot, crutches, work note and a prescription for Vicodin. He is told no at which point he jumps off the gurney and stomps out of the ER in a huff, screaming "I'm never coming back to this motherfucking place." Another miracle cure, courtesy of emergency medicine.

This is the kind of thing that clogs up ER's all over our country. America is filled with people that contribute nothing to society but come equipped with a massive sense of entitlement, they want what they want, when they want it, when they want it. Told no, they became belligerent and assualtive, spewing threats toward they staff. Fearing patient complaints or confrontation, more than one practitioner has taken the path of least resistance. Hospital administration, driven by their wish for high patient satisfaction scores, fails to allow MD's to practice medicine and join JCAHO in forcing us to be legalized drug pushers rather than medical practitioners.

Someday, when there is an epidemic or surge of casualties from a natural disaster or terrorist attack the ER won't be able to care for those victims because we will be full of patients with 'chronic pain' who are seeking drugs.

8/8/07

R Privacy Issues

Let's face it, ER's are crowded and noisy. Despite our best attempts to maintain a patients privacy, when the next patient is six feet away with only a thin curtain between them, it is hard not to over hear what is going on next to you.

One night we had an elderly gentleman in curtain area 1 and next to him a prim, middle aged lady. The PA was trying to explain to the man what his diagnosis was but his efforts were being hampered by the fact that the man was very hard of hearing. The problem was something of a personal nature so the PA was trying to be discreet.

PA: Sir, you have pubic lice
PT: What's that you say?

PA: I said you have pubic lice.
PT: What?

PA: You've got lice down there
PT: Can't hear you son, you have to speak up


PA: I SAID YOU HAVE BUGS DOWN THERE
PT: Oh.


Of course we all overheard the conversation, including the prim lady in the next cubicle, who was red as a beet by now. The ER staff, dignified until the end, were draped across the counters shaking with silent laughter until tears ran down our faces.

Most of the time privacy in the ER is an illusion maintained by patients pretending they don't see or hear what is going on around them. Sometimes it is impossible to pretend.