Have you noticed that people can't be sick anymore? Lately I have noticed that folks come to the hospital for the littlest of things. I threw up twice today, I have a headache...did you take anything...no....when I raise my arm like this it hurts...and of course you want to say so bad...well don't do that. I see this increasing in pregnant women. They come in at all hours with minor stuff...or with stuff that has been going on for WEEKS and then decide to come in.
We get overflow med/surg in our women's health area, and there has been an increase in admissions for abdominal pain, short term observation. They have a stomach ache!!! No white count, every scan imaginable has been ordered and negative, but they stay overnight with dilaudid ordered for their pain. I tell you, I could be bleeding from my eyes and I would not get admitted to the hospital. The other thorn for me is lap chole's. I had one last year. My surgery was at 0830 and I was HOME by noon. I was waking up from anesthesia and they were putting on my underwear giving me instructions to go home. Now I see this influx of short term observ. lap choles that stay cause PACU isn't open after whatever time and well...instead of just recovering them and sending them home...they stay. Low and behold they are getting big pain meds and need help every single time they get out of bed cause the PAIN...oh my gosh the PAIN. I find now I can't take care of them because I just find it too much to deal with...lol. I want to say look sister....I was home 2 1/2 hours after my surgery and I had to make do...you can too. But, that is me.
This is just a rant. I know somewhere I can rationalize everything I mentioned. It just really gets to me sometimes. ARGH. Double ARGH.
Anyone else get this way? Or am I just really in dire need of a vacation?
I don't claim to to know the details of your particular situation, but wanted to add some food for thought...
It isn't uncommon to leave the ED without a specific diagnosis. I've admitted and discharged many a patient with "Abd Pain, Etiology Unk" listed as their diagnosis. I realize it's frustrating...you have a problem, you want to know what it is and have it fixed. Often times the ED is the place to have things ruled out or excluded rather than pinpointed!
Exactly...the ER doc's main job is to rule out/diagnose/treat an emergent/urgent diagnosis, not necessarily figure out exactly what's going on. That's why we alway tell people to follow up with their family doc/specialist. Frustrating if one leaves still not knowing, but if we got too bogged down in specialized stuff, the waits would be even worse!
Then on the other hand you have the story of one of the young (mid 30s)ER docs where I used to work. One shift (recently, unfortunately) he was feeling nauseated. Went home to his wife and 18 month old. No big deal, right? 12 hrs later when the ambulance arrived at his local ER, he was posturing. He didn't want to bother any of the masses of clinicians who would have rolled their eyes, etc when his symptomatology was still subtle. His wife is now a widow and his child is now fatherless. The symptoms worsened overnight so the wife or the Dr. himself were not able to assess the decline. Yet he was so conditioned by all the people who would have made fun of him that he threw away his life. This is a true story that should give everyone here pause. If you save one human being, one woman's husband, one child's mother as a result of being overly cautious, then to me that's worth all the B.S. pts in the world. This one just knew the system too well and was defeated by it.
Then on the other hand you have the story of one of the young (mid 30s)ER docs where I used to work. One shift (recently, unfortunately) he was feeling nauseated. Went home to his wife and 18 month old. No big deal, right? 12 hrs later when the ambulance arrived at his local ER, he was posturing. He didn't want to bother any of the masses of clinicians who would have rolled their eyes, etc when his symptomatology was still subtle. His wife is now a widow and his child is now fatherless. The symptoms worsened overnight so the wife or the Dr. himself were not able to assess the decline. Yet he was so conditioned by all the people who would have made fun of him that he threw away his life. This is a true story that should give everyone here pause. If you save one human being, one woman's husband, one child's mother as a result of being overly cautious, then to me that's worth all the B.S. pts in the world. This one just knew the system too well and was defeated by it.
Thank you for sharing this story. I feel that the ER staff doesn't always realize how much of an influence they have on a pt..present or future. Their actions and the way they project dislike towards a group of people w/ a certain disease/sickness is picked up and discourages them from getting help.
I'm one of them.
I avoided the ER for my last miscarriage because of all the eye rolling I saw when they thought I couldn't see. Ended up in the OR 20 minutes after arrival. I avoid the ER for migraines at all costs. Even though the risk for stroke goes up after 72 hours.
I feel terrible for his family to have to go through that. No one is immune.
Such empathy....I hope I never have to visit the ER for what you think are the "wrong reasons".
ER stands for EMERGENCY Room. If you come to the ER for an Emergency, it'll be for the right reasons.
If you listen to most of the complaints, it's about people who come because they don't have anything better to do, who come for things that any person with a shred of common sense knows isn't an emergency (child throws up once, for a pregnancy test, etc) or to treat problems that have been going on for weeks without being seen first by a primary physician.
If a doctor's visit costs 50 bucks and a pregnancy test 10 bucks, both visits in the ER cost 300 bucks. It's frustrating that people will tax the system because they know that, if they don't want to pay the ER, they really don't have to. If we were hanging around playing cards, it's be OK. In reality, most ERs are overwhelmed and every BS case taxes the system and takes time and resources away from people who really need attention.
There was a woman in Houston that called 911 every day for a year, sometimes, twice a day, so she could have some company. She'd get to the ER and ask for aspirin. Every one of these calls necessitated Ambulance calls and ER evaluations.
I've seen medicaid patients wait in the ER for hours just to ask for a prescription for motrin so that medicaid will pay for it. 1. medicaid won't pay for it because it's OTC, and 2. it's like 2 bucks a bottle at Walmart. I could empathize if it weren't for the 50 dollar manicured fingernails and 75 dollar hairdos.
What you are hearing is us complaining about flagrant abuse of the system. If you are worried about our empathy, then I hope you never find cause to flagrantly abuse the system, too.
As far as the medicaid rant - I'm not against medicaid, I'm against the pervasive attitude that it's not a gift from my tax dollars; it's a 'right' to be abused as the recipient sees fit. This isn't a cast on the majority of recipients, but we all know that the few bad apples make the most memorable examples.
Bottom line: how high and mighty for you to comment that I have no empathy because I'm tired of the people who take advantage of my empathy. Walk a mile in my shoes. My empathy is a commodity.
Then on the other hand you have the story of one of the young (mid 30s)ER docs where I used to work. One shift (recently, unfortunately) he was feeling nauseated. Went home to his wife and 18 month old. No big deal, right? 12 hrs later when the ambulance arrived at his local ER, he was posturing. He didn't want to bother any of the masses of clinicians who would have rolled their eyes, etc when his symptomatology was still subtle. His wife is now a widow and his child is now fatherless. The symptoms worsened overnight so the wife or the Dr. himself were not able to assess the decline. Yet he was so conditioned by all the people who would have made fun of him that he threw away his life. This is a true story that should give everyone here pause. If you save one human being, one woman's husband, one child's mother as a result of being overly cautious, then to me that's worth all the B.S. pts in the world. This one just knew the system too well and was defeated by it.
You get a large AMEN from this corner, Bluesky.
And to you ER nurses: While I respect your right to rant, and I truly do understand your frustration with some of these folks you see, please try to keep an open mind. Many times we've gotten admissions that look like drug seekers or whiners at first glance (or even second or third) but who turned out to have some life-threatening problem that was missed or not even addressed.
Just this past week I had a patient who refused to come to the hospital for her problem with garbled speech. Hey, it only lasted a few minutes, she reasoned. So since there were no continuing symptoms, she didn't want to go to the hospital for something unnecessary.
She's now a hemiplegic, nonverbal, and is fed through a Peg tube, but alert and oriented.
All because she didn't want someone to laugh at her. What a price to pay.
I avoid the ER for migraines at all costs. Even though the risk for stroke goes up after 72 hours.
I have no problems with coming to the ER for migraines, unless you want to tell me, and people have, 'I'm allergic to all non-narcotic pain relievers'.
Actually, if you have a true migraine, 10mg of IV reglan is a miracle worker. I've seen it time and time again. It doesn't work po or im, so you have to have an IV to get it. Even if you need pain management for migraine, it's cool so long as it's not your 5th time this week. (if you're having them that badly, you need to see YOUR doc sometime in there, yeah??).
As far as the sick ER doc - that's BS to say that because a doc chose not to get care, it's our fault cause 'we have an attitude'. Docs are more likely than anyone to think that nothing can go wrong with them. That is such a bad example.
This is exactly what I thought when I read that post. Many times doctors do not pinpoint what the problem is, especially ER docs. When I was in my teens, I ended up in the ER with very heavy lady partsl bleeding. ER doc checked me out, said he couldn't tell where the blood was coming from. That's it, sorry we couldn't help you, have a good life. I lost so much blood that I lost consciousness. To this day I still wonder about what happened. I guess if there was no objective data to back up my claims of cramping, I would have been labeled a drug-seeker, drama queen, attention-seeker, or worse.
She's now a hemiplegic, nonverbal, and is fed through a Peg tube, but alert and oriented.
All because she didn't want someone to laugh at her. What a price to pay.
The attitude to avoid treatment because you don't want to be embarrassed: that has nothing to do with the rants in here.
That's a human characteristic. These people aren't thinking, "I know those ER nurses make fun of everyone, if I go in, why, they'll make fun of me, too." What they are thinking is that they'll feel silly if it's nothing. They don't want to be embarrassed, etc. But that's not because of what is being ranted about here.
And for the record, I think it's pretty unfair of you to say that's my fault.
I am ALWAYS sympathetic to people who need an emergency evaluation or who truly think they do whether I think so or not.
And I do know that things can be different than they appear. BUT! This is why each BS admission to the ER takes valuable time away from truly sick patients. Why? Because whether you are BS or not, you will get a full evaluation.
The rant was about people who know dang well that what is going on isn't an emergency, but just don't care cause they don't have to pay for it.
The attitude to avoid treatment because you don't want to be embarrassed: that has nothing to do with the rants in here.
That's a human characteristic. These people aren't thinking, "I know those ER nurses make fun of everyone, if I go in, why, they'll make fun of me, too." What they are thinking is that they'll feel silly if it's nothing. They don't want to be embarrassed, etc. But that's not because of what is being ranted about here.
And for the record, I think it's pretty unfair of you to say that's my fault.
~faith,
Timothy.
No one is saying it is your fault. I am sorry to say that there DEFINITELY IS a connection between the culture of satyrizing people with subtle symptoms and the unwillingness of clinicians to show up for treatment themselves.
In the past, I have worked in the ER environment for 5 years. I have known many many nurses, techs and other clinicians who have had subtle symptoms and elected not to go in because of the culture of negativity about such cases. Not because they are embarassed. And even if they are embarassed, why would that be? Because of the unprofessional culture of gossip and commentary that exists in the ER setting as it would in any other high stress setting where people work so hard at such close quarters. No one is being blamed.
However we must acknowledge that this culture, while understandable in it's origins, can contribute (not be responsible for, but contribute) to poor outcomes.
While I am currently working SICU, I plan to return to the ER as soon as my 2 years are up. I am married to an ER nurse and have the utmost respect and admiration for you. Part of pursuing excellence is understanding how our attitudes effect our practice, even in indirect and subtle ways like this. I can list any number of related issues that ICU nurses need to work on, so please don't take this as an attack. It's an observation.
Not a well thoughtout, both sides of the story...reasoning out, of a situation. But a diatribe on a bad night/week/month of someone's job. One of those things that we do to eleviate burning out due to the stupidity of the job.
We all have horror stories of the person that nearly or did die from a misdiagnosis from the ER/MD/Clinic. Why does that occur? Because the ER is a lousy place to get continuity of care..it is for acute emergencies only...your PCP is the best person for continuity of care.
I come from a military family where you do not see an MD unless you are projectile vomiting/bleeding out a liter or more/have a temp>103. This philosophy nearly killed me during chemo, when anything over a temp of 100.5 is sign of a lifethreatening infection.
Later in life, I got bitten by a raccoon in area with a known rabies outbreak...I actually called the Insurance company/ER to see if it rated as an emergency to go to the ER or could wait to see my MD. Yes, it did, yet the ER did not start rabies prophylaxis..they wanted to wait 10 days to see if animal control found a raccoon!!!!! (Yes, I just know I can personally ID the exact raccoon that bit me....NOT). They prescribed a pain med that was not available in a 3 county radius and an antibiotic that was not readily available. I also developed sepsis within 18 hours of the bite..scarring from the infection was later found by CT on my lungs, spleen, liver.
Some people use the ER responsibly...some do not. The fallout harms all of us.
But we still all need to vent ocasionally. I doubt if any of us are utterly heartless..we just need to vent ocasionally.
I never did find out! The ER doctor did at least rule out pregnancy/ miscarriage. When I saw my GYN, she said that it would be very difficult to determine a cause after the incident. I guess it was nothing serious (hopefully) as I've had 3 pregnancies since then and no abnormal tests or anything. Actually I was wondering if it might have been caused by an allergy to latex.:imbar
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That's it, sorry we couldn't help you, have a good life. I lost so much blood that I lost consciousness. To this day I still wonder about what happened. I guess if there was no objective data to back up my claims of cramping, I would have been labeled a drug-seeker, drama queen, attention-seeker, or worse.
ERNurse752, RN
1,323 Posts
Exactly...the ER doc's main job is to rule out/diagnose/treat an emergent/urgent diagnosis, not necessarily figure out exactly what's going on. That's why we alway tell people to follow up with their family doc/specialist. Frustrating if one leaves still not knowing, but if we got too bogged down in specialized stuff, the waits would be even worse!