I Feel So Dirty and Used! - An ER doc unloads his frustrations

Specialties Emergency

Published

I offer the following examples of manipulation that anyone in a busy ED will recognize.

  • The post-arrest event: I don't mean cardiac arrest; I'm talking Miranda rights. Immediately before or after arrest, these people fake seizures, complain of chest pain, or discuss suicide, and so are brought to the ED so the police may avoid liability.

  • The unverifiable pain complaint: These patients have been diagnosed by some medical minion of evil with an unsubstantiated chronic pain condition. When contacted, his physician says, I'd go ahead and treat if he looks uncomfortable. Wow, thanks for the help.

  • The EMTALA junkie: These individuals just can't stay away! The ED is a social scene for this group.

  • The pseudocidal patient: This patient is unhappy or angry, and doesn't want to go home. He complains of being suicidal, stays in the ED until being fed.

  • The chest pain trump card: This clever thespian who is weary of waiting and comes to the triage nurse, fist on chest, and says, I have crushing chest pain with shortness of breath, nausea, and sweating...

  • The 'I have abdominal pain (female) patient': - knows she's pregnant, just wants a free ultrasound.

We are manipulated by those who preach the holy gospel of customer satisfaction, which leads busy EDs to apologize for their life-saving activities by offering movie passes to patients who wait too long to have their bronchitis diagnosed.

We are manipulated by specialists who use us like residents. Patients call their physicians and are told, Sounds bad. Go to the ER, We're busy.

Thanks to EMTALA, we can't do a cussed thing about it. That's the thing, friends, we're the ugly stepsisters of medicine - used, abused, and manipulated by patients and health care because the law compels us and because we're too professional and compassionate to say no.

Wow!

http://tinyurl.com/lhr4r9

or

http://bit.ly/C4eK1

oramar

5,758 Posts

Physicians have unlimited opportunities. You know what they say to us nurses, "if you stay and put up with it the abuse will continue".

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.

the person who wrote this article thinks too much about patients (judges them) and thus sounds burned out. these same patients come to the floor when the ed is tired of treating them and do not want to wait for results any longer. in such cases we floor nurses call their admissions or observations "ed/er dumping"! my favorite are the drug seekers with no medical conditions other then being a drug abuser and test results are pending with the exception of positive labs for opiates. once i figure them out, i let them know my rules and i have no problem with their bs afterwards! in fact, i treat them like they have issues (psych issues, drug abuse issues, and real pain) but i don't let them walk over me. as for the others posted in the article, i treat them like their issues are real too. usually the plan of care on the medical side is r/o whatever and i assist the docs in doing just that... i in no way diagnose patients with faking conditions because it is not my place to do so... at least not until i get my np in trauma/er/critical care nursing someday. if the writer of the article cannot see straight any more (which is understandable given the acute care patient population), then he/she needs to take a break from acute care. all of the floors outside of the ed are the same because the patients and family are the same (real issues or not)... so it would not help to transfer.:twocents:

-med surg for now... ed in the army soon enough!

PAERRN20

660 Posts

Specializes in ER.

I read this article. This excerpt is missing a lot of the material. The MD, PA, and other nurses were passing this article around at work. We all agreed with these. Everyone needs to blow off steam somehow. Until you are in the ER trenches working day in and day out you can't judge.

Ruby Vee, BSN

17 Articles; 14,027 Posts

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

this doc is so right!

the thing is, unless you've worked in the er for awhile, you're not in any position to judge him. so back off the judgement, folks, and let the poor guy vent!

PAERRN20

660 Posts

Specializes in ER.

:yeahthat:

Larry77, RN

1,158 Posts

Specializes in Trauma/ED.

Exactly what I was thinking guys...do not JUDGE until you've lived it completely...I do NOT think it is the same as the floors because the cases he is talking about usually do not make it to the floors. I have worked the floors, including tele, med/surg, and psych...the ED is totally different and you will not understand our frustrations until you've been there...peace!

mwboswell

561 Posts

Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

What?? Explain.

mwboswell

561 Posts

Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
the person who wrote this article thinks too much about patients (judges them) and thus sounds burned out. these same patients come to the floor when the ed is tired of treating them and do not want to wait for results any longer. in such cases we floor nurses call their admissions or observations "ed/er dumping"! my favorite are the drug seekers with no medical conditions other then being a drug abuser and test results are pending with the exception of positive labs for opiates. once i figure them out, i let them know my rules and i have no problem with their bs afterwards! in fact, i treat them like they have issues (psych issues, drug abuse issues, and real pain) but i don't let them walk over me. as for the others posted in the article, i treat them like their issues are real too. usually the plan of care on the medical side is r/o whatever and i assist the docs in doing just that... i in no way diagnose patients with faking conditions because it is not my place to do so... at least not until i get my np in trauma/er/critical care nursing someday. if the writer of the article cannot see straight any more (which is understandable given the acute care patient population), then he/she needs to take a break from acute care. all of the floors outside of the ed are the same because the patients and family are the same (real issues or not)... so it would not help to transfer.:twocents:

-med surg for now... ed in the army soon enough!

did you read the original source article or just the clip that was posted here on allnurses.com?

did you research the author?

dr ed leap is a peer-respected em physician. he writes and contributes to mutliple online and printed blogs, and journals. he is sought after as a lead speaker/presenter at em conferences regionally and nationwide. he spends quite a bit of time on the road, away from his family, lecturing on em topics. he also contributes as an attending em faculty to help train young medical residents. and finally he is a devout christian with principles of charity, stewardship and humility; i only wish you knew him better like i do.

...it sound like you feel un-empowered to deal with some of these same patients. i will propose this, if clinically you feel you can't do anything about the problem; the i adivse people to at least get involved professionally and work with a professional nursing organization that strives to alleviate some of these conditions (such as the ena).

in closing, i find your disparaging comments about dr leap offensive, hasty, and innaccurate - and i do hope you take the time to learn more about this person who is actually doing something about the same problems he discusses.

ps: do a google search for dr leap. you can also find him on facebook as well as his personal blogsite.

respectfully.

Specializes in general surgery/ER/PACU.

The pseudocidal patient: This patient is unhappy or angry, and doesn't want to go home. He complains of being suicidal, stays in the ED until being fed.

This one is my favorite...and soooooo true!

alwayslearnin

76 Posts

Specializes in ER, Labor and Delivery, Infection Contro.

Thank you Dr. Leap and mwboswell!!!!I appreciate the honesty of the article and the following comments on the Physician himself. I am an ER Nurse and I and my ER cohorts have experienced, thought, and felt the same way.

I always chuckle inside when I read about people who have never even worked in the ER get on their high horse about out judgementalism. Honey, it is just REALISM. I have worked the floors and other areas and the ER is a unique type of Medicine and place of practice.

THere are alot of things -EMTALA for one (good principle behind it-sucks in the actual practice, kinda like HIPPA) that make it very difficult for all providers. Makes ya feel like your hands are tied and there is no way to stop the abuse of the system and the providers.

I wish I had the answers-but I do believe that sometimes we got to quit being so "nice" and be a true professional and be honest and call a spade a spade." Let's get honest about your 60 visits to the ER this year " (and the year is only half over) . "We won't treat your chronic pain issues here with narcotics-that is what your PCP is for." You don't have one? I see for the past five years in various dictations that you have said you don't have a pcp-lets look at that.

No I won't write you a prescription for that med because you want it. I is not appropriate-here is why and be honest. ( abuse, antibiotic for virus etc). Just a few examples.

I understand when people lash out because they are hurt/scared. But we can say-"that is not ok behavior and I will come back and treat you when you can treat me with some basic human dignity like I have been treating you."

Again-no great answers, but looking at what we Can do to help with the "Dirty and Used" feeling.

My heart goes out to each and every ER Doctor, Nurse, Tech, Aide, Unit coordinator, secretary, housekeeper and every else who is in the trenches trying to give their best. I hope your energy, hope and hearts are refilled ten-fold.

God Bless,

always learnin

alwayslearnin

76 Posts

Specializes in ER, Labor and Delivery, Infection Contro.

Woops,

Just a clarification.

When people lash-out because they are hurt/scared, I and most people I believe, will be compassionate and understanding, as they should be.

It is the people (patients and family members )who are downright rude, yelling, cursing,threatening, because they are upset with the wait, they didn't get what they want, they don't want X. Those are the type of people that we need to set up some expectations of behavior and say this will not be tolerated. I have talked with other providers who have worked in other countries that they will not put up with that type of behavior-period! and they don't seem to have much problem with abuse from paitents and their families.

Sometimes it is we ourselves who contribute to our own problems by not saying no.

respectfully,

alwayslearnin

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