10 things you might not know about the emergency department

by | September 12, 2018

KevinMD.com

  1. Wait times in most emergency departments are ridiculous. But, if you have a real emergency, you won’t have to wait. If you have abnormal vital signs, a worrisome ECG, or concerning chief complaint, you will be seen long before the person who checked in with a sore throat to get a work excuse.

Patients with chief complaints like “GSW abdomen” and “found down/unresponsive” don’t wait to be seen.  And if the day ever comes (God forbid) that you have one of those problems, you won’t either.

(Insider tip for non-emergencies:  show up around 6 a.m. on a Sunday morning and you probably won’t have to wait.)

  1. Your nurse may look like Nurse Ratched or Yosh Takata. Your doctor may look like Ben Carson or Doogie Howser. Or me. It may blow your mind, but the first man who walks in the room is not necessarily your doctor, and the first woman who walks in the room is not necessarily your nurse.

A person who starts kindergarten at age 5, graduates at 18, finishes college at 22 and med school at 26 can finish residency and be a fully licensed/practicing physician at the ripe old age of 29 years old.  So if someone introduces himself/herself as your doctor, please don’t respond with, “You’re too young to be a doctor,” or “You’re too pretty to be my doctor.”

If someone says he/she is your nurse/doctor, he/she is not lying to you.

  1. An MD/DO is not the same as a DDS. I know this is confusing because both doctors and dentists get called, “Dr.,” but no one in the emergency department went to dental school.  We see patients with “tooth pain” all the time, but we are not the right people for the job.
  2. You may be the most honest person in the world, but a little bit of skepticism is part of doing our job well. We have patients who prick their fingers to put drops of blood in their urine. We have patients who get discharged from a nearby emergency department and check in at ours an hour later to get more pain medication and another prescription. ($10 per pill street value can help pay the rent).

These few patients make the waters of trust murky for everyone.  Which is why every person of reproductive age with a uterus is getting a pregnancy test! (See “Idioms and axioms provide a glimpse into medical culture.“)

  1. Please put down your phone while we’re in the room. We say things like, “We’ve got a positive cell phone sign in room 6.”

This is medical lingo for, “That person doesn’t look very sick!”  If you answer your phone while I’m talking to you, it tells me that although you came to see a health care professional you are, in fact, more interested in speaking with someone else (and that makes me want to walk out of the room).

  1. If you’re the patient, don’t expect to eat until your workup is over. Nurses spend ridiculous amounts of time trying to track down doctors to ask if the abdominal pain patient in room 18 can eat.  Every shift I hear a patient literally complain about hunger. (Which is probably a good sign that he/she is not that sick.)  If there is any possibility you might need to be sedated for a procedure, you don’t get to eat.  You won’t starve.  I promise.
  2. Pain has never killed anyone and sometimes zero pain is unrealistic. When you put your hand on the stove, pain tells you to pull it away to avoid deeper, more serious burns.  Pain is a safety mechanism, a warning.  Acute pain is miserable and all-consuming, but it won’t kill you unless the cause will kill you.

Herniated discs?  Torture.

Killer?  Not likely.

Chronic pain is depressing and debilitating but if the cause is not life-threatening, the pain is not life-threatening (it just feels like it).

If you’ve been a patient in a hospital in the last ten years you know you repeatedly get asked to, “Rate your pain on a scale of 1 to 10.”  While we like to hear “0,” sometimes the only possible way to take away all your pain is to give you so much medication you stop breathing reliably.  You living on a ventilator until your neck strain gets better just isn’t an option.

  1. Pain can’t kill you, but narcotics can. Narcotics were instrumental in the early deaths of talents like Philip Seymour Hoffman, Chris Farley, Cory Monteith, River Phoenix, and John Belushi.

Most opiate addictions start with real, painful injuries.  If you’re miserable and you take something that makes you feel better, you will crave it again just for the pure relief of relief.  Add to that the fact that it is truly addictive in the sense that your brain develops a hunger for it, and you have a set-up for serious trouble.

I once saw a patient who had dried exposed muscle and tendon where she had done her own cut-downs to get to veins for heroin.  She wore “arm warmers” to cover her bandages.

I took care of an addict who got pneumonia by snorting liquid heroin when he didn’t have a clean needle.

I dare you to Google images of “skin popping” (the practice of injecting the drug under the skin — rather than into a vein — so that it diffuses more slowly and prolongs the high).

This is ugly stuff.  Desperate stuff.  The stuff of eye-shielding scenes in movies like Trainspotting and Traffic.  But some addicts look like the person you see in the mirror in the morning.

I wish I could introduce you to these patients.  I wish you could hear them weep and beg so you could understand why narcotic prescriptions are such a big fricking deal.

Pain patients cry real tears and get whip crack angry when faced with not getting what they want — what they came for — what they’ve been given by so many doctors before you.

Give it to them and they love you and are happy, but you continue the cycle and perpetuate a dangerous and destructive pattern.

Try to break the cycle and deny them narcotics and suffer threats and outbursts.

It’s a tough choice every time.  Every shift.

  1. Hospitals are putting a huge emphasis on service and “customer satisfaction.” But we are busy. If I’m rushing to get back to a patient with a heart rate of 160 and you ask me for a blanket, it puts me in a bad spot.  I have to acknowledge your request, but it’s hard for me to justify going to get it right at that moment.

I can’t tell you the number of times I’ve finished running through a plan with the patient (my priority) when a family member asks me to get him/her some food or coffee.  Administration wants us to serve you, to look out for your comfort, but most of us would really appreciate it if you wouldn’t ask us to wait on you.

If you are a family member, you can ask for a blanket at the desk and ask anyone for directions to a drinking fountain, vending machine, or the cafeteria.  You helping you, helps us (and ultimately our patients).

  1. We don’t want you in the ED any longer than you have to be in the ED. We’d love to discharge you!  We’d love to get you a bed upstairs!  But if these things aren’t happening, it’s not because we’ve forgotten about you.

Triage doesn’t end in the waiting room.  You could be ready to roll to CT with abdominal pain and get bumped by a patient with a possible stroke.  If you get labs and an imaging study, no less than seven people will have been involved in your ED course.  Your care may not be efficient, but it should be thorough and excellent.

Sometimes, your expectations won’t be met.  This may be because your expectations were inconsistent with sound medical guidelines; or it may be because, despite our best efforts, we failed to provide you with ideal care, but I swear everyone is genuinely trying to do right by you.  If you have concerns, please voice them (as calmly and respectfully as you can).  We want to figure everything out, make you feel better, and get glowing follow-up survey responses.

My best advice is to avoid the emergency department altogether if you can.  But if you have a real emergency, there’s no better place to be.

Kristin Prentiss Ott is an emergency physician who blogs at her self-titled site, Kristin Prentiss Ott

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