Los Gatos ER Physician in the News

[CityofAngelsRN]

Anyone have any thoughts on the ER doctor from Los Gatos who has been all over the news today? Apparently a college student came in complaining of an anxiety attack and according to the news, the patient was "taunted." The patient was asking for pain and anxiety meds. I definitely think this is an example of burnout. It seems like the physician didn't think a visit to the ER was warranted and she was upset because she had sicker people to take care of. I'm not condoning how she handled the situation, I just think we really need to address burnout.

EDITED TO ADD VIDEO

[video=youtube_share;aFsADPmU64w]

[Nunya, BSN]

Exactly. What happened before the video? That was my first thought. I thought she shouldn't have tried to pull him up, but I thought she was trying to listen to breath sounds, could be wrong. If ya gotta listen and the latest can't get up on their own.... but she was rough...

This was in reply to comment made by applewhitern at beginning of section.

[Horseshoe, BSN, RN]

This was in reply to comment made by applewhitern at beginning of section.

You can use the quote function when you want to address a specific comment.

[GrumpyRN, NP]

Really?

Symptoms such as feeling like you are choking and chest pain are common symptoms of anxiety/panic attacks. Its why myocardial infarctions are often mistaken to be panic attacks in women.

Talking in full sentences, SpO2 of 100, undistressed steady breathing, lying quietly with no obvious signs of pain - not even tetany caused by hyperventilation? Oh and of course the biggest reason that MI in females was not missed - HE IS MALE!

Perhaps you did not see at the bottom of my posts where it says 30+ years in Emergency and that I am an ENP. This is not my first time with anxiety attacks. Narcotic pain relief will do nothing although may make him feel better. I could have understood if he had asked for a Benzodiazipine, that may have been more therapeutic.

And yes, I still think the doctor was appropriate. The patient was fine and needed to go home.

Before you think I am completely heartless, I have had 2 episodes of anxiety in the past. Both were related to receiving chemotherapy.

[kiwinurse18]

Thank you so much! I've never seen any health professional behave like that so I probably wasn't looking hard enough at the patient. That makes heaps of sense, I did think the lack of symptoms was a bit off, but I missed how weird the father comments and forgetting the script are. Especially as you say, he thinks "it's life threatening".

I've looked up this story since and he genuinely sounds like he was having a panic attack before being admitted (if it takes you 3 hours to be seen I'm not surprised he's now asymptomatic) and is genuinely on medication (klonapine) for it. He alleges she came to examine him with a security guard, which is not on. But I do feel sorry for Ed. It's not their job to fill scripts for people who can't organise their time. Go see an after hours gp.

On a more positive note however "Donald Bardwell did have nice things to say about a nurse "angel" who ordered some tests that showed there were no drugs in his son's system. As a result, he was given some fluids, supplements and pain medication."

[dream'n, BSN, RN]

Definitely more to the story than this video. The family is angered that he had to wait "3 hours", that's when she responded that he was the least sick and that other patients were dying. Her bedside manner left a lot to be desired, but the patient and families behavior was always ridiculous. Pain medication for an anxiety attack? He can't raise his head due to an anxiety attack? Please...sounds like the Dr was having a night from hell and was too brusque and fed up. This patient and family wanted to be catered to; "Oh I'm sorry you're feeling so bad, may I get you some narcotics, a fluid bolus, and a cool washcloth for your head." The father/grandfather argues about how he's seen how horribly sick these episodes make the patient, but I guess they weren't bad enough to make sure the patient had his Klonopin on hand and for such a sickly guy to be out playing basketball. We don't know but the ambulances might have been flying in that night with all sorts of emergencies and the ER staff just didn't have time to coddle this guy. The Dr had already examined him which is obvious from the video, but it certainly appears that they were fighting his discharge when the Dr couldn't find anything wrong with him. I also am not impressed that the father/grandfather immediately pulled out the race card with the video. No, the Dr shouldn't have acted as she did, but everyone is human.

[Kooky Korky, BSN, RN]

My understanding is, although I cannot find the proof of it now, this patient was actually discharged but claimed he could not walk or breathe so refused to leave which is why she went in with security. While I do not condone the rough handling by the physician I think there is much more to this than what is being presented. If the patient was in fact malingering, which I am inclined to believe, being tossed out by security would have been much worse. I'm also fairly certain a psych consult would have elicited a great deal of anger from the patient and family who seemed to have a pre-conceived idea of what the treatment should have been although I think one is definitely needed. A panic attack in a person with a known history of panic attacks who did not pick up his medication does not exactly constitute an emergency. Frankly it would have been more appropriate for him to stay home, take his meds and let his mama fuss over him.

This thread isn't about him, though. It's about the doctor.

[CityofAngelsRN]

This thread isn't about him, though. It's about the doctor.

The thread is about the situation.

[Horseshoe, BSN, RN]

This thread isn't about him, though. It's about the doctor.

You can't talk about the doctor without putting her actions and words in context. So, no...

[broughden]

Talking in full sentences, SpO2 of 100, undistressed steady breathing, lying quietly with no obvious signs of pain - not even tetany caused by hyperventilation? Oh and of course the biggest reason that MI in females was not missed - HE IS MALE!

Perhaps you did not see at the bottom of my posts where it says 30+ years in Emergency and that I am an ENP. This is not my first time with anxiety attacks. Narcotic pain relief will do nothing although may make him feel better. I could have understood if he had asked for a Benzodiazipine, that may have been more therapeutic.

And yes, I still think the doctor was appropriate. The patient was fine and needed to go home.

Before you think I am completely heartless, I have had 2 episodes of anxiety in the past. Both were related to receiving chemotherapy.

Your original post simply questioned shortness of breath and pain as being symptoms of an anxiety attack, as if you had never heard of that before.

I dont read minds.

If you were in fact aware of those symptoms, as you seem to be, awesome.

And nothing in your post says anything about 30+ years of emergency experience or that you are an ENP. A screenshot of your original post is attached.

[TriciaJ, RN]

I don't deal with drug seekers in my role but I'm interested in the other nurses that do and have commented here: what exactly am I looking at that screams drug seeking to you? He hasn't specifically asking for any certain drug, is that something they build up to later on?

They very rarely start off asking for the drug of choice by name. That would look like drug-seeking. They typically go through a lot of machinations, complain of various symptoms so that their drug of choice will seem like YOUR idea. If you have other ideas, they will be allergic to all of them. If you're really slow to catch on, they'll suddenly remember a drug that was helpful in the past. They won't be able to remember the exact name right off, just the letter it starts with.

[Emergent, RN]

They very rarely start off asking for the drug of choice by name. That would look like drug-seeking. They typically go through a lot of machinations, complain of various symptoms so that their drug of choice will seem like YOUR idea. If you have other ideas, they will be allergic to all of them. If you're really slow to catch on, they'll suddenly remember a drug that was helpful in the past. They won't be able to remember the exact name right off, just the letter it starts with.

Would that letter be D?

[TriciaJ, RN]

Would that letter be D?

Sometimes it's a D. My favourite memory is a jail inmate that told me if he didn't get his medication, the doctor told him his heart could just stop. All he could remember at first was it started with "L". Lanoxin? Nope. Good old cardiotonic Librium.