Primaries Abusing the ED

[ThrowEdNurse, BSN, RN]

How about primaries abusing the ED? As though the ED is some branch of their private practice. I am so sick of people coming in saying, "I saw my MD, Dr. Big Douche and he said to come here for x,y, and z." ARRRRGH!!!!

My first question is always and "When do you plan on finding a new MD?" TO THE GENERAL PUBLIC: Your doctor should never send you away from his office after having made an appointment with him to go to the ED for:

1) A pelvic exam. As in "he said I needed to come here because I need a pelvic exam. He sent these cups..." Are you sh#tting me? It's time to find a new doctor!

2) "He said to come in here because I need blood work." No, you may think this means go to the lab with your order for blood work, but alas, no. It should read, "Just go to the ED to see a real Dr. because I don't have a f#cking clue."

3) An EKG. This is self explanatory.

4) Because you're wheezing. Please see #3.

5) Because you need medical advice. When you call the doctor to ask medical advice, you'll never speak to the MD personally. The CLERK (please note, not the nurse) wil say, "You should go to the ED." Why? Not because you're sick but because the doctor is tired of being sued. You wore a tshirt advertising your town's local ambulance chaser to your last appt, what do you expect?

In summation, the only time you should leave your PCP's office to go to the ED is when the ambulance is called. If your doctor doesn't feel you need to go by ambulance, you probably don't need to go. Also, I don't care what your doctor told you. We're not "holding" a room for you. If he cared, you would have orders in your hand. You do know he's not really "meeting you here," right?

The only thing worse is when the God-doctor actually shows up and expects you to be at his beckon call. "Sorry, I have an emergent pt, you'll just have to replace that peg tube without me holding your hand. Maybe your office nurse who you pay to do your bidding personally can lend you a hand."

[canoehead, BSN, RN]

Yep, when you come to the ED you get triaged with everyone else, and someone declared stable enough to drive themselves over, by a their PCP, gets a lower score than someone who hasn't been assessed yet. But by the same token, if your doc sends you by ambulance, or calls ahead with his/her concerns, we pay attention. Most of the time "go to the ER" is a matter of lack of appointment time, laziness (sometimes), and liability.

[TraumaNurseRN]

Exactly...They don't call ahead unless you should be seen in the ER. And most of the time it's a brief history and a verbal to be seen and treated by the ER doc. (Hello...everyone who comes to the ER is seen and treated by the ER doc) Primary's do abuse the system as well, and that's because they schedule patients for 10 minutes of their time in their office and always end up going over that 10 min. They dbl book apointments just like the airlines overbook flights.

[racing-mom4, BSN, RN]

Devils advocate here---I have taken a sick kids to the ER cause the family doc could not get him in for 3 days. Kiddo had a fever, was wheezing and resp were almost uncountable...I knew he needed a breathing tx and started on some steroids, same doc, another kid also could not get in for a few days, tonsills were HUGE. I kept apologizing to ER staff knowing yes my kids were sick, but not really emergent sick.

Yes I ultimatly did find a new family Doc.

Former family doc always made it out of the office by 5pm. New Doc has been known to say "I cant see them today but come in at 5:30pm-you may have to wait a bit but I will squeeze them in"

[traumaRUs, MSN, APRN]

I work in a specialty practice (nephrology) but most of my nursing experience is ER. That said, I do refer my pts to the hospital for things which I can't do in the clinic. However, I provide my pts with a script for labs, xrays, EKG (if not active CP), etc.. Some of my patients are more compliant than others and I do get calls from the ER asking why I sent my pt there for routine lab work. However, I always point out that the pt has a script and if they have no new problem, they need to follow my advice.

So...its not always the PCP's fault - sometimes our pts don't fully understand the reasoning and sometimes they are just noncompliant.

[TraumaNurseRN]

Again, I think the majority of us know when it's IMPORTANT to go to the ED. No-one is questioning that. But for the parents who do not even feel it important to own a thermometer...(yet carry cigarettes,cell phones, blah blah bla around) we take issue, and rightly so wouldn't you think? I have witnessed many times a baby drinking from a bottle with a soft drink in it, brought in for fever and a runny nose that the mother lets run down their face so the baby has to lick it off as it rolls over their lips....discusting! Their pajamas are so sticky/stinky gross, the baby smells like it hasn't had a bath in a week. (I'm not even gonna comment about what the mother looks like) It gets frustrating to watch these parents neglect the care of their children. They don't own a thermometer??????Come on people.....come on. Their primary's should either provide thermometers or educate these mothers when they come in.

[racing-mom4, BSN, RN]

I am NOT an ER nurse, but have picked up a fair amount of shifts down there so have some stories of my own---What is the deal with parents who say " I didnt give them any Tylenol so you could see for yourself what their fever is" OK---lets let them suffer so we belive you!! Magically once Tylenol was given the kiddo is now bouncing around the room happy as can be.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Mom4 not being able to get in to see the doc is one thing,.but actually going to the doc to be told to go to ER is another. Obviously if your child is wheezing and needs a breathing tx you should at least go to urgent care. Imagine going to your reg doc and being told you need to go to ER for a breathing tx! Although in my opinion, unless it's in the middle of the night and can't wait until morning, your reg doc should be able to see your wheezing child ASAP!

[ThrowEdNurse, BSN, RN]

I also love it when they find they won't be rushed to the back for their abd pain. "I'm going to call him." Alright, go ahead and step back to the waiting room and do that. If he chooses, he can go ahead and write admit orders for you and you can go upstairs, otherwise, it's gonna be a minute. I am done being uber polite with these doctors. I am not above talking smack about them to their pts when the doctors are repeatedly abusing the system and the pts are jerks. Fair warning, I will say, "Yes, I understand he sent you here, but that's pretty much meaningless. There are a multitude of avenues your doctor could have used to expedite the process for you and get your care managed faster, but he pretty much sent you here to rot in the waiting room. Feel free to phone him and ask him why." I have nothing to lose but one more pt in the waiting room.:chuckle

[soulofme]

but he pretty much sent you here to rot in the waiting room.

:yeah:LOL I LOVE it!

[Vito Andolini]

I work in a specialty practice (nephrology) but most of my nursing experience is ER. That said, I do refer my pts to the hospital for things which I can't do in the clinic. However, I provide my pts with a script for labs, xrays, EKG (if not active CP), etc.. Some of my patients are more compliant than others and I do get calls from the ER asking why I sent my pt there for routine lab work. However, I always point out that the pt has a script and if they have no new problem, they need to follow my advice.

So...its not always the PCP's fault - sometimes our pts don't fully understand the reasoning and sometimes they are just noncompliant.

If all they need is labs or EKG, can't they go to the lab, Radiology, etc. directly?

[ThrowEdNurse, BSN, RN]

If you are sent with a Rx, there is no need to present in the ED. The only reason to come to the ED is because you need to see the MD.