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 paperwork 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...!