HCINEPT

Thanks for the responses. I am new to the ER and wasn't sure what to think. True, I didn't hear the entire conversation. The attending does have a rep for being a hard azz though, so I may have judged the situation prematurely. Again, your responses are greatly appreciated!!

This morning, we had a patient come in complaining of a severe, itching, all over rash (ongoing for 4-5 months), with level 3 pain. She had indicated that she had seen 2 dermatologists, 3 allergists and her family phsyician on numerous occassions, to no avail. She had been prescribed many different anithistamines, antibiotics and prednisone, also to no avail. PT was visibly upset, crying and continually clawing at her skin. PT was well dressed, had excellent insurance coverage, paid her co-pay and explained that her quality of life had been greatly impacted in the past 4 days as the rash and itching had dramatically increased over that time period. Patient had gone to diagnostic center one week prior and no results had been released back to her and she explained that coming to the ER was a measure of last resort and she had already called her doc for an am appointment tomorrow. Triage simply indicated a slight elevated BP and no fever. No other work up was initiated. ER phsyician entered PT's room, refused to examine her and lectured her about misusing the ER and released her. I felt badly for her and am not sure what to do. She left the ER in tears. As she left, I asked her what happened and she explained that he had been so harsh, that she felt stupid for coming to the ER with what to her was a serious situation. As she left, she indicated that she had a family history of diabetes, non-hodgkins lymphoma (her mother died as a result) and masses on her sisters thyroid and because previous doctor and labs hadn't been able to diagnose her, she had hoped that we could help by admitting her and running a battery of tests to eliminate any of those conditions, since no prior doctor could eliminate them as possibilities. Attending didn't ask her for medical history or personal history, he only repeated to her that she was in the wrong place, because ER's were for trauma, heart attacks and strokes, not "itchy skin". He told her he wasn't an "itching skin" specialist and she should wait until tomorrow to see one. Based on the patients demeanor, history and lifestyle, I honestly do not believe that she was misusing the ER and that the attending was entirely too harsh on her. I think he should have at least examined her, ran some labs and/or given her a shot to help ease the intense itching until she could make it to her dr. tomorrow. Am I being too sympathetic towards this patient because I feel I can relate to her (same basic backgrounds and lifestyle) or was the doctor out of line?