Are there doctors on duty in the ER? - page 3
Non medically fragile adult woman in her mid forties with mother and grandmother in tow, c/o nausea and body aches x5 days. Previously diagnosed with "the flu or something" (actually viral... Read More
Apr 18, '12Occupation: ED RN, CHARGE NURSE Specialty: 3 year(s) of experience in ED ; From: CA ; Joined: Jun '11; Posts: 287; Likes: 373Sharpeimom: I know teeth hurt, having all my wisdom teeth extracted with just local anesthetic. Just in my area, the teeth to tattoo ratio is a pretty good indicator of socioeconomic status. I give education on proper hygiene because most of them need to realize that smoking cigarettes, drinking nothing but Mountain Dew and never flossing do contribute to dental caries. Common sense is not common these days.
I also give weight loss info to obese patients. It's funny to me when I go over their health history and I mention obesity, they get upset and throw their arms out- not up, they are too heavy to lift straight in the air- and state "Oh, yeah, I am really obese (sarcastic tone). It's water weight, I thought you were in the medical field."
I actually took admission orders on a patient last week, and her diagnosis: morbid obesity. It saddens me when there are more over-sized wheelchairs available than regular sized wheelchairs.
I really try to educate my patients. Especially the ones that complain like many of the examples above. I always open my conversation with the line "what is the emergency today?" When I hear scraped knees on a 13 year old, or a 35 year old afebrile man-flu with mother in tow, or that 'my elbow hurt, my elbow feel funny,' I have to teach them the proper use of the ED and clinics. I hate that I have to half-heartedly apologize time and time again for the length of stay. Sorry I did not get you a Coke with ice, I was helping the doc put in a chest tube on a 90% collapsed lung. Sorry I did not help you go to the bathroom, because how in the world does a 38 year old with nausea/vomiting go to the bathroom by themselves? I hope that when they hear the thick sarcasm coming out of my mouth, they take note of what is transpiring. Yes, the first 3.5 hours of my shift I work go to taxes, medicaid/medicare and social security. Yes, I am upset about not getting a raise, ever. Yes, part of that is due to unpaid medical bills. I am totally ranting off topic, sorry.
Part of the job unfortunately.Last edit by thelema13 on Apr 18, '12 : Reason: typo
Apr 18, '12Occupation: Emergency Nurse Specialty: 39 year(s) of experience in ED RN ; From: US ; Joined: Dec '08; Posts: 157; Likes: 124I just wrote a whole post on this topic and then lost it when I went back to another page. It was quite therapeutic. Thanks for the opportunity. And now for what I need to say in the real world . . .
"We will be happy to see you as soon as we can. We will start _____ while you are waiting to see the doctor and I expect your wait will be _____ hours. Thank you for coming to see us."
Apr 19, '12Occupation: Emergency Department Specialty: ER/Ortho-Neuro-Med-Surg ; From: US ; Joined: Sep '04; Posts: 11,171; Likes: 3,262i have posted this before:
wife comes in at 5 am with husband in tow for intermittent nosebleeds x 2 days. yes she is on coumadin. they get my last hallway bed open (should give you and idea how busy we were for 5 am). i give the wife the same advice the doctor will give: "pinch you nose real hard, like so and hold for 20 minutes." i know this can be a challenge sometimes [i get frequent nosebleeds too] so i mcgyver up a nose-clip (two tongue blades held together with rubber bands - works pretty good ) pt. is annoyed and frustrated but bless her heart, she's a patient trooper. her husband on the other hand, is an absolute jerk. in my face every 10 minutes "why hasn't she been seen yet".
guess i'm chopped liver... but anyways i tell him (the first dozen times) : "sir, i'm real sorry but we're real busy right now and there's only one physician on duty. we've called in additional people. the doc will get to her when he can. i've already sent off her blood work and her vital signs are stable."
"this is crazy! what if there was a real emergency?!"
well, you kinda answered your own question there now didn't you sport?
of course i didn't say that out loud... but i was tempted!
and all i can think of to ask is: "hmmm, wonder who raised them to be this way..."
Quote from sharpeimomi'd rather have all 8 fractures i've had in my lifetime - together - than suffer through another toothache or earache!teeth can really hurt!
Apr 19, '12Occupation: Registered Nurse Specialty: . ; From: US ; Joined: Aug '06; Posts: 3,562; Likes: 5,420I think it's interesting how many crabby waiting patients use that terminology: "are there any doctors here today?" Like, is it supposed to be clever, or shame us in to realizing, gosh darn it, we DO in fact have doctors so why aren't they taking care of THIS patient RIGHT NOW? It's really always said in such a smug way.
Had a patient who was frequently brought in by parents for BS reasons who had a pretty long wait one night when lots of kids were pretty sick. Mom came out to my desk within 5 minutes of being placed in a room and said "There are no doctors here tonight?" And I said "Why yes, there are, and they've been very busy with very sick patients all night." And went back to my charting.
The thing that frustrates me is the talk of moving towards satisfaction/ratings based reimbursement. Because these folks misuse the ED, have long waits, and are often VERY unsatisfied to be sent home with nothing other than instructions for care of a viral illness, yet still take up our time and resources. So will we not get reimbursed now because the vomiting x 1 had to wait a few hours to be given juice and keep it down?
A few months ago we had a pretty scary and dramatic patient rushed back through the waiting room. A parent in a room looking towards our trauma room kept pulling her curtain back so she could enjoy the show. I kept closing her curtain and she kept opening it right back up. Guess who still complained about the wait to see the doctor?
Apr 22, '12Joined: Apr '10; Posts: 3,383; Likes: 1,922Quote from hey_suzOr they demand to be seen immediately because they think their earache or sore throat takes priority over the patient that is being coded next door...I think the barrier is, they have so many times gone to the ER and waited, with their earaches and sore throats, and know that this new thing, this thing happening now, can't wait, so they think they will wait that long this time (following me here? ).
Apr 23, '12Specialty: ED ; Joined: Sep '07; Posts: 194; Likes: 293had a full load of 5 pts in rooms and 3 in my hallways and was also responsible for the trauma bay in my area which had been blessedly empty for an hour or more when we got a notification of gsw to the head and neck 27 yo male 2 minutes out - we all kicked in to high gear as we do - i quickly eyeballed all my pts (some of whom were very sick – but not dying!) and closed doors and curtains as the fd ambulance and pd escorts came flying into my trauma bay....sadly the young man did not survive - he had been shot by the jealous former bf of his fiance. we worked really hard on him and family arrived in shock, and everyone was a wreck, docs, rns, techs....it was really sad because we had a couple moments when we thought we had him back...
i shook it off best i could and went to quickly re-asses my district and this one lady, walkie-talkie, who was there for abd pain n,v x 1 day was standing in her doorway where she had seen everything, and grumbling. i wasn’t surprised, she had been loudly moaning and complaining about the wait all night. i always kill em with kindness because i hate to let them know how much they irritate me. she gave me a nasty look and said “i pay just like he does, i shouldn’t be left to pee in my bed!” i go in her room and see she peed all over the bed and floor! a 48 yo woman who, all night, had walked to the bathroom in her room - a &*#$!^% ensuite bathroom mind you – had just urinated all over the place! i was livid and knew i could not open my mouth because i would regret what would come out. so i just stripped the bed, cleaned up the mess, gave her a new gown, called housekeeping with a mop and walked out of the room.
when i had to return to give her more zofran i was like a robot. she kept trying to bait me with her whining and complaints but i could tell she had some awareness she had crossed the line. gee was it the mournful sobbing of the family across the hall maybe?
i gave her zero energy and zero attention. in our ed the residents d/c the pts so i was just done with her. she tried to catch my eye as she left, dramatically, holding her belly and practically limping. ugh!
another pt, a little old lady who had also waited patiently during that whole trauma, who was really feeling low and was getting transfused and was going to get a ca dx in a few hours, was the opposite – it always amazes me the spectrum of human behavior – i came in to re-assess her and she was all “i’m fine, you look tired, that poor fella, oh the poor family, i’m fine, you should go get a coffee!” i wanted to hug her.
thank god i meet more like her than the a##hole who left with seemingly no appreciation of her decent health status. i sometimes feel like people don;t know how to be sick – like if your symptoms are minor have a chat with your doc on the phone get into bed with a tea or gatorade and lay around for 2 or 3 days for heaven’s sakes!!! every illness is not an emergency but some folks never learned that......
Apr 1, '15Occupation: Emergency Department Specialty: ER/Ortho-Neuro-Med-Surg ; From: US ; Joined: Sep '04; Posts: 11,171; Likes: 3,262Sorry for diggin up an old thread.
Quote from Armygirl7Do you remember, back in school we were taught that when people are sick they don't act themselves? That their illness/stress/anxiety etc. make them 'act out'? That we as nurses shouldn't take this personally?thank god i meet more like her than the ******* who left with seemingly no appreciation of her decent health status. i sometimes feel like people don;t know how to be sick
I take that with a good pinch of salt now.
I've come to the conclusion that some people are just ********, no matter what. Their current illness may play a part in their behaviour but I believe it isn't a major part of their genuine personality.
How often have you had that cancer patient with mets to the bone, shivering because of illness and pain, ask you in that small voice the genuinely sick possess "I know you're terribly busy dear but when you have a moment, could I please have something for pain and a blanket? I'm feeling awfully cold and this miserable pain won't go away." Heck, I've even had patients in the throes of agony - from acute nephrolithiasis to obvious fractures who were quite 'colourful' while in the acute phase of their illness, but who once calmed down apologised profusely for their earlier conduct. Or those genuinely frustrated by the bureaucracy that is our healthcare system.
No, I get that. Totally.
As compared to the 30 year old belly pain x 3 hours, with normal vitals, who has already been assessed, labs drawn and sent complain loudly that "I've been here an hour and you've done nothing for me!" (i.e 'I didn't get the meds I wanted')??
I mean you should hear some of the comments I get when I'm out in triage!
In other words, decent people - be they sick or well, behave with dignity. ***holes, be they sick or well, behave like ... well, **holes. IMHO.
cheers,Last edit by traumaRUs on Apr 2, '15 : Reason: added 'earlier' before 'conduct' - added clarity