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16 December 2008

Frequent Flyers

One of the things I don't think I've talked about in previous posts are the frequent flyers we get in the E.D. It seems like every E.D. has it's cast of known patients. Most of them, unfortunately, are either alcoholics brought in every several days by EMS after another drinking binge. Or they are the chronic drug seekers. Or patients with chronic back pain or sickle cell disease who need a shot of dilaudid to make it through to their next doctor's appointment.

A lot of ECMC's frequent flyers get greeted with a, "So, what's it going to take to get you out of the E.D. today, Johnny?" Sometimes, the discharge paperw
ork is written at the same time as the dilaudid with a side of zofran order. Of course, we always worry about the possibility that one time a more serious problem is going to be missed.

I have been working at ECMC for the last two days. Along with the sundry assortment of the usual chest pains, shortness of breaths, etc, I have had a number of repeat customers. I don't mind seeing patients again, mostly to see that they have done better. However, I begin to obsess over what I might have missed the first time. Then, I begin to question the patients' true motives for returning to the E.D. Then I begin to get callous about these patients and wonder what exactly it will take to get them out of the E.D.

Of course, the management of the patient then has to be filtered through the attendings' own biases. Some attendings are of the treat and release type. Others make the patients go through a bit of bargaining before giving them their requested drug of choice. Still there are those that subject the patient to a new round of tests and queries, exhausting all diagnostic possibilities before resorting to giving the patient what they came in for. Finally, a patient might get admitted for "pain management."

One of my attendings today was more of the, "I have pain, they should be able to deal with theirs" variety. Made for quick turn arounds today.

Anyway, tomorrow is Grand Rounds Wednesday, then a stretch of three days before the weekend. We'll see what the weekend brings...!


Lisa said...

It's interesting to read this from your prospective. I rarely even went to the doctor (before the BP issues) and going to the ER was the last thing on my mind. I would think that after a time you wouldn't take the frequent flyers very seriously.

When I was in the emergency room for my BP, my husband and I were just watching the staff run around and listened to them dealing with patients and we both came to the conclusion...there was no way we could do it.

I give you major kudos!!!

Julie said...

I remember reading the House of Gods years ago and the residents getting the same outlook, LOL. I love the trauma's and codes but won't work the ER because of all the drunks and people who have been sick for 3 weeks but decide at 0230 after the bars have closed to wander on in and demand instant care. I would indeed become more cynical and callous then I am some days already.

funny your word verification for this post minus 3 letter is so similar to Prozac, LOL

cw2smom said...

I give KUDOS too! I enjoy watching and listening to what's happening around me when I have to sit in the ER with my daughter. Really, I wonder how you guys do it! Blessings, Lisa

a corgi said...

I like that "what will it take to get you out of the ER today" amazing how they just know they can keep coming back and eventually get what they need/want with just figuring out what game they need to play today.


Jeanie said...

I definitely wouldn't want the responsibility that you have in life or death decisions. I think I would be one of those pedantic doctor's who ran all the tests possible until I couldn't be left with a 'what if' after the patient left. I would need to sleep when I got home.
Seeing it go on day in day out though, I expect one getd to know those who are swinging it.
I am full of admiration for you all.
Jeanie xx

Claudia's thoughts said...

What gets to me are the people on disabilities that are healthier than me....For example, "I can't work I have asthma..." Well so do I and I'm working. Or, I have neck pain, so do I..... I would really like to know how some of them get on that disability. I would love to have a job refuting their disabilities. Like the woman on disabilities had a hobby of horse back riding stunts.....

erarein63 said...

We have a provider who hardly ever writes for narcs, makes for quick turn arounds too. De ;)