(In reponse to some nervous emails, yes, every patient mentioned had a complete history, review of systems, and physical exam. I’m just distilling the salient elements of the conversation. Okay? -PB)
Actual Patient Interaction Number Six:
“So Mr. Smith, what brings you to the Emergency Department, a place where we handle medical emergencies, at 3AM.”
“My mom is up in the ICU and I just thought I’d come down to get myself checked out.”
“Anything in particular bothering you or is it just a general malaise?”
“Well, my back has been hurting me a lot lately.”
“Is it your usual back pain?”
“Yeah. I’m supposed to see my doctor about it on Tuesday.”
“Does he write you your prescriptions for pain medication?”
“Yeah, but he was out of town last month.”
“Okay, I’ll give you some Tylenol. You need to call him tomorrow to get a prescription for your regular pain meds.”
“I’m allergic to Tylenol, he usually gives me Vicodin.”
“You know that Vicodin has Tylenol in it, right?”
“I’m having chest pain too.”
Actual Patient Interaction Number Seven:
“You need to stop smoking, Mr. Brown.”
“That’s what my doctor says, but he smokes so I don’t see why I should listen to him.”
“You mean a couple of years from now when you’re sucking on oxygen twenty-four hours a day you’re going to take comfort in the fact that your doctor is a hypocrite?”
“Well, he should practice what he preaches.”
“Look, I know your doctor, he’s a fit guy and he smokes, maybe, a pack a week if that.”
“He’s a hypocrite.”
“Yeah, but he’s not coughing up blood like you are.”
“Well, I can’t afford the nicotine patches.”
“Where do you get the money for your cigarettes?”
“My sister gives it me.”
“Why can’t you use the money to buy nicotine patches.”
“So you get the patches instead of the cigarettes. In medicine we call this killing two birds with one stone.”
Actual Patient Interaction Number Eight:
“My dog ate my pain medication.”
“What kind of dog is it?”
“Uh…I don’t know, it’s a dog, man.”
“is it a big dog? A little dog?”
“It’s just a dog. A German Shepard…Okay?”
“Did you take it to the vet?”
“Well, it says here that you’re on 180 milligrams of MS-Contin every day. That dose would kill a normal human being if he wasn’t used to it and your dog ate a whole bottle, 30 day’s worth. That’s enough to drop a herd of elephants. So I’m asking you if you took your dog to the vet in respiratory arrest…or maybe he’s just laying dead under the porch…or something?”
“Oh man, I ain’t got a goddamn dog, okay? My fucking roommate stole them.”
“I hope he’s not laying under the porch…”
Actual Patient Interaction Number Nine:
“I don’t know if you’ve talked to the trauma surgeons yet, Miss Green, but they tell me everything’s fine, no internal organs were injured, and they’ll probably discharge you tomorrow after they observe you for a while. You were very lucky.”
“Where’s my boyfriend?”
“He’s talking to the police.”
“Do you think he’ll go to jail?”
“Do you think he’s still mad at me?”
“I have no idea. Listen, Miss Green, I have two daughters. In fact, you’re young enough to be one of them so I hope you don’t take this as anything other than a sincere concern for you but have you ever considered that you’d be better off without this guy? I mean, you’re young, bright, and obviously very intelligent. You’ve got your whole life ahead of you, completely wide open, and I’d hate to see you end up saddled with a couple of this guy’s kids, without any support, living in some dump, and struggling through life when you could be a real success.”
“But he loves me.”
“I don’t think so.”
“How can you say that?”
“Well, he did shoot you in the vagina….”
28 thoughts on “Circus of Chief Complaints (Your Tax Dollars at Work): Part 2”
One reason why being a doctor seemed attractive to me from my ignorant pre-med perspective is that I previously thought you would make an impact on people’s live – especially those that can be very ignorant. Do you feel that you can never change people’s minds or encourage them to improve their life? Or are these examples just a few very adamant and ignorant individuals?
(Yes, you can have an impact on people.Â But you need to revise your expectations.Â The impact you’re going to have is on their medical problems.Â Why this isn’t enough or why people think that they’re missing out if all they do is address the chief complaint is beyond me.Â On the other hand, you have to also understand that the doctor is the only authority figure in many patient’s lives who isn’t beating them, selling them drugs, neglecting them, or otherwise making them feel unwanted…which leads me to the secret to being a good doctor (I mean other than the extremely important requirement for an extensive command of medical knowledge).
When you talk to any patient, they should be the entire focus of your existence for the time you spend with them.Â Even if all they have is a cold it needs to be the most goddamn interesting cold you have ever seen.Â They have to feel that you want to help them and that you’re doing it because they have a legitimate medical complaint that you take serously.Â I assure you I give everybody the benefit of the doubt when I walk in a room.Â The nurses can afford to be cynical but sometimes the whiner, the difficult patient, the one everybody else laughs at really has a problem.
On the other hand, I wasn’t born yesterday either and I know perfectly well that many patients, as I allude to, who have a relative in the hospital have nothing better to do and will come down to score some drugs, or some attention, or validation, or whatever they are looking for besides medical attention.Â And making the patient your focus doesn’t Â mean you have to kiss their ass and tell ’em everything they want to hear. -PB)
9 is an instant classic.
Panda – obviously, only the funniest and most absurd things are worth writing about in your blog. These patients that you write about – what percentage are they of all the patients you see?
(It’s hard to say. Most of my patients are decent people, even if they come in with silly complaints.Â Off the top of my head, assuming I see 18 patients a shft, two or three will be totally ridiculous, often sublimely so, a few will beÂ extremely minor complaints that make you scratch your head and wonder why anybody would come in to be seen, most will be urgent but not emergent, and two or three will be flat-out, no fooling, medical emergencies that require rapid intervention. But you see, if we triaged the silly and the extremely minor home, that would solve a big part of our over-crowding problem in the ED. The really, really sick spend a lot less time in the Emergency Department by the way.-PB)
No. 7 is hilarious! I can almost picture the bewildered look on the patient’s face uttering “Uh…”
Take a long list of these conversations and send them to risk management (and your congressman if you have extra time). There is no reason why everyone who comes into the emergency department should be treated like an emergency.
#9 is the straw that broke the camel’s back for social work for me and why I left it with only a year to go. It wasn’t enough that the people in it constantly complained about the lack of money that they’d make once they got out and how much they knew they’d not be liked, but when one of my professors came to class with the “umpteenth” bruised eye and I heard from faculty that her husband was in jail but that they were working on their relationship, I knew it was time to get out before I got into the mindset of thinking that if someone thought enough to abuse me that they cared and that the relationship was good.
Can you imagine what clients who were having a hard time getting out of bad relationships were thinking when she counseled them? Probably what #7 was thinking.
These are pretty classic. My personal favorite was #8.
â€œWell, it says here that youâ€™re on 180 milligrams of MS-Contin every day. That dose would kill a normal human being if he wasnâ€™t used to it and your dog ate a whole bottle, 30 dayâ€™s worth. Thatâ€™s enough to drop a herd of elephants. So Iâ€™m asking you if you took your dog to the vet in respiratory arrestâ€¦or maybe heâ€™s just laying dead under the porchâ€¦or something?â€
Hehehe! Yep, that would drop at least 4 elephants.
Wow, I just discovered your blog yesterday. Good stuff.
Accurately reflects my experiences.
Nothin’ says lovin’ like a round to the vag.
I think it goes without saying, but #9 deserves to be in the doctor-patient conversation hall of fame.
Also sad though, that you had to provide an example as obvious as this.
I didn’t know if I was supposed to laugh or cry, so I laughed hard enough for tears to come out.
Well done. To distill absurdity takes effort. But the first question is the obvious response, How can one find meaning in the face of such? And that is the nature of the compassion of medicine…
These are just hilarious. You could probably publish a book with these stories, I bet lot of people would buy it.
It’ll be really REALLY great if shot-in-the-vagina lady can work things out with that guy. They sound like they’re right on the cusp of something beautiful.
Maybe a little counseling…
Shooting is but one of the many ways to express affection for a significant other
Careful Panda – if a hospital admin finds 9, you will have to go for diversity counsling. You just dont understand their culture, and how dare you judge it!?
(All individuals involved were white.Â White as snow.Â Tatoos and all.Â Did I mention I live in Yankeeland now? -PB)
Oh no no no. These would be almost funny if I didn’t know they were absolutely true. Add “cognitive deficit” to everyone’s discharge diagnosis list, eh?
“â€œIâ€™m allergic to Tylenol, he usually gives me Vicodin.â€
â€œYou know that Vicodin has Tylenol in it, right?â€”
ROFL. I laughed pretty hard at that one (along with “Well, he did shoot you in the vagina…”). You should do one of these a week!
Panda, you are too funny. I second the motion – please keep these coming. (We’re all assuming that your patients will continue to provide material.)
Your stories are another reason why I’m glad I’m not doing ER. Usually by the time you folks call the surgeons, you’ve sorted out 80-90% of the crazies; if they’re still crazy when we see them, it’s because they’re crazy + actually sick. Usually.
OMG THAT WAS FUNNY ESPECIALLY THE LAST ONE…I WAS LIKE “SHUT THE FUCK UP!”
You’ve got to be kidding me. Sheesh.
OMG…these bits about patient interaction have me just about ROTFL hysterically, particularly since I’ve gotten a taste of what MDs and other medical practitioners see parading through their offices and/or EDs via a recently acquired job in medical records. The stuff people come out with (or maybe it’s in with) is truly amazing sometimes…but that shot in the vagina lady was just mind-boggling. Wow. Does it ever seem like the crazies outnumber the truly sick people? That wouldn’t surprise me much anymore.
Oh good gosh.
I just laughed for a good 3 minutes.
My favorite part:
â€œOh man, I ainâ€™t got a goddamn dog, okay? My fucking roommate stole them.â€
â€œI hope heâ€™s not laying under the porchâ€¦â€
One word: priceless.
I just found your site tonight…I totally dig it!! I will be back for sure…
I’m a respiratory therapist with hopes of going to med school some day…I’ve seen the patients you speak of and if I scratch my head any more, I’ll go bald I’m sure….
thanks for entertaining me this evening…
I’m a pharmacy intern and I have to say I see alot of people like #8 come into the pharmacy for refills but usually the don’t own up. I also see #6 sometimes when I’m working the night shift on the weekends when all the druggies come in. But the people I love that come into the pharmacy you don’t see in the hospitals probably, come in and ask if we stock a specific ‘brand’ of generic as it has to have the right markings on the pills otherwise it’s not worth as much on the street.
To: Panda Bear
I believe you may find the following article from MercuryNews-dot-com interesting.
Surprise finding on ER crowding
Study says the uninsured aren’t to blame
By Suzanne Bohan
Bay Area News Group
Article Launched: 04/12/2008 01:38:54 AM PDT
Contrary to popular perception, the uninsured aren’t to blame for emergency room overcrowding, according to a new study from the University of California-San Francisco.
“There’s an extremely wide misunderstanding that it’s the uninsured” flocking to emergency departments, said Dr. Linda Lawrence, a Fairfax physician and president of the American College of Emergency Physicians.
From 1995 to 2005, the number of annual visits to ERs rose from 97 million to 115 million, according to the Centers for Disease Control and Prevention – a 20 percent increase. Yet between those years, the number of U.S. hospitals offering emergency care declined by 9 percent.
During roughly the same time frame, the number of visits to ERs by the uninsured actually declined from 15.5 percent to 14.5 percent, the study reported.
Meanwhile, from 1996 to 2004, the number of insured patients visiting an ER who also had a regular doctor increased from 22 percent to 29 percent.
The primary cause of emergency department overcrowding, the new study noted, is a lack of capacity to admit ER patients into the hospital. These patients can be “boarded” for hours and even days in emergency departments, occupying a bed while ill or injured patients idle in waiting rooms.
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