(The first in a series of public service articles for our many non-medical readers.-PB)
In the Emergency Department Waiting Room
Welcome to our Emergency Department. I hope we can take care of your problem. The fact that you are here at 3AM predisposes us to take you seriously. Nobody who wasnâ€™t really sick would drag themselves out of their comfortable bed to sit on ersatz ergonomic plastic chairs reading six-year-old Newsweek Magazines rubbing elbows with the kind of people who have nothing better to do at 3AM.
That just wouldnâ€™t make sense.
While waiting, keep in mind that unlike other customer-service enterprises, the Emergency Department is not first come, first served. We have a system to rank the severity of your complaint which we call â€œtriage,â€ a French word meaning, â€œYou ainâ€™t really that sick, Maurice.â€
The nurse will take you vitals, listen to your story, and if it sounds serious you will go to the head of the line. If your story is not that compelling, well, you may get bumped down a little. So donâ€™t storm the counter demanding to know why the guy vomiting blood went right in while youâ€™ve been waiting for two hours nursing a wicked post-nasal drip.
With this in mind, we come to our first important concept: If youâ€™re not sick, donâ€™t come. Despite the truly astounding medical advances of the last fifty years, we canâ€™t do much for a cold, a mild case of diarrhea, gas, and any number of annoying but non-serious medical conditions. Over-the-counter remedies for symptomatic relief will work just fine, are available 24-hours a day in most cities, and you can be in and out of Wal Mart in ten minutes. That and some of your grandmaâ€™s common sense are all you really need and all weâ€™re going to give you ourselves. Why spend eight hours waiting to be told this when you could be no better or worse in your own bed or on your own couch watching something other than the Fresh Prince of Bel-Air?
So stay home. I know you may not have health insurance but in this case it doesnâ€™t matter. The common cold is the great equalizer afflicting king and peasant alike.
But letâ€™s assume youâ€™re sick. The second important concept is that you did not arrive by ambulance. This means that you may have had time to think about coming in. Did you bring a list of your medications? I most certainly do not expect you to remember them all but we need a little more guidance than, â€œI take three little white ones in the morning.â€ Think about either making a list or at least bringing your pill bottles. Most pharmacies will even print you a list and if you get everything filled at one place this is perfect.
It was a good thought bringing your pill organizer and I guess we can always painstakingly match each pill by shape, color, and marking in the PDR. But this takes time, a whole lot of time. We do have other patients and we are not just sitting back there drinking coffee talking to our stock brokers.
No we donâ€™t have your medications on our computers. Amazingly enough, we probably do not have access to your medical records in our Emergency Department. There may come a time when everything is on a universal database but for the time being, at 3AM your regular doctor in Muncie, Indiana might as well be on Neptune for all the contact we can make. With this in mind, maybe a list of your medical conditions would be helpful. (I see that by-pass scar so Iâ€™m not buying that you have no heart problems.) Pretend that you want to get the best and most efficient treatment from a doctor who has never met you, knows absolutely nothing about you, and will never see you again.
In other words, make our job easy. I once had a lovely 94-year-old lady as a patient who had a binder with her medication list, a list of her allergies, her living will, and copies of her last four or five discharge summaries. That lady instantly got eight points on the ten-point scale. (Most of you start at a four or five) and more importantly, she got the best care possible because there was no guesswork involved. Hell, she even had the names and phone numbers of all of her doctors.
On the subject of being a walk-in, we make great allowances in our patients. Hell, if youâ€™re sick, youâ€™re sick and maybe you were too embarrassed to call the ambulance even if you should have. It is true that some people will dial 911 for a paper cut and some will drive themselves who are later admitted to the ICU. But if youâ€™re not that sick, would a little attention to personal hygiene set you back on your schedule all that much? You may sit around your house in your underwear eating pork rinds indifferent to the daily routine of showering, brushing, and wiping your ass but seriously, dude, a visit to the doctor, while not requiring your Sunday best, is a special occasion.
A word on Children.
You know, if youâ€™re poor you can get them insured under Medicaid. Really. And you wonâ€™t pay a dime for doctorâ€™s visits or prescription drugs. It might take some effort on your part to look in the phone book for the county Office of Social Services but once you get them signed up and find a pediatrician, you will never have to bring them in again.
Look, I know little Quintravion threw up twice this evening but look at him now. Heâ€™s asleep. Before that he was running around terrorizing the place. Itâ€™s true that our threshold of suspicion is low for children but that boy does not look sick. Maybe a little ginger ale is all he really needed.
If you have Medicaid, shame on you. Your kids need to be in bed, not running around here. Not being able to take time off during the day due to your job is a better excuse than not wanting to pay a buck-fifty for a bottle of Childrenâ€™s Motrin. Come on. Iâ€™ll write you a prescription for it but anybody with a pack of cigarettes sticking out of their purse and a cell phone should be able to scrape together a couple of bucks. Hell, Iâ€™d pay ten time that just to not have to sit with sick people.
No, I will not write you a prescription for ginger ale.
Out of curiosity, how many people, exactly, do you know who are up at this hour? Youâ€™ve been talking on your cell-phone non-stop since you got here. Give it a rest. Iâ€™m a doctor, a pillar of the community, and I like to think I have a few friends but I havenâ€™t spent ten minutes this month talking on my cell phone. Hell, I leave it in the car most days. I just donâ€™t have anything in my life important enough to warrant carrying it around, I guess.
There is no such thing as a volume discount by the way, at least not for us. If your other children arenâ€™t sick donâ€™t say they are just to get them checked because since youâ€™re here, you might as well. In case you didnâ€™t know it, there is a large paperwork burden associated with every patient, even those who are not really sick. A one second lie on your part means fifteen minutes of paperwork for me. Have a heart, lady.
Next: Yes, You Can Have a Sammichâ€™.
4 thoughts on “A Patient’s Guide to the Hospital: Part 1”
Can this be mandatory reading for all patients?
Just found your blog … and I’m awfully glad I did. I didn’t know whether I should be laughing at this (truly hilarious) post, or crying for you and all those who can relate to it from the medical side of the doctor/patient relationship.
Great stuff! Blogrolling you.
I hate to pee on your parade a bit—I agree your essay is a must-read by patients everywhere—but … did you ever consider maybe telling patients these things? I understand that the more urgent patients are not always exhibiting clearly more urgent signs that laypeople can understand, such as vomiting up blood, and you (I mean the triage nurses) are loathe to try to explain these things to impatient patients when you’ve got better things to do. I understand that when an irate or impatient patient approaches the desk, there is a deep psychological urge to be mean to that person by providing little to no information to enlighten them. I understand you don’t have time to explain.
If it is too difficult and impractical to explain these things, you might consider a sign on the wall. Don’t laugh. A sign that says: “If you haven’t been seen yet, it’s because there are sicker people ahead of you. We’re working as hard as we can to get everybody seen.” Engrave the sign in metal or plastic, so it looks “real.” (People won’t give shrift to a computer-printed piece of paper.) I know this sounds stupid, but this kind of signage works on stu– … the kind of people you are describing. It’s all psychology, and it works. Consider road signs that blink how many people were killed by drunk drivers so far this year. Or speed traps that say, “Traffic school is boring! Slow down!” You may find it funny and silly and ridiculous that such signs work, but they do, on most people and not just the nice people who don’t give you any trouble. Of course, there are always people who apparently can’t read. (Don’t Feed the Animals is a commonly unread sign.) But if the signage works on even 30% of the people, most people can see the difference.
Most people who complain in the waiting room are not narcissistic psychos, they’re just parochial and ignorant; they CAN be informed. You just have to value peace and frankness over the indulgence of complaining.
Nice idea , but I’ve been an ER nurse and Medic for almost 20 years and it won’t work. people always think their problem is more important that the guy with an MI or the guy without a pulse. The tootache they have had for a month and that other ER down the road didn’t do “expletive” for must be fixed now. And no I don’t have dental insurance or medical insurance BUT YOU MUST FIX IT NOW. try buying your smokes, beer or gas and ‘saying send me the Bill’ And then we have Press Ganey, customer service in the ER. This ain’t McDonalds.
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