101 things you REALLY want to say!

[DRDARIA]

As a fourth year in the ED (Real conversation)

To older patient who had taken a fall
Me: What sorts of medical problems do you have?
Patient: Looking at me like I'm crazy "I don't have any medical problems"
Me: Staring at a list of twenty-plus medications on the triage sheet "Well you're taking an awful lot of medications..."

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[southerndoc]

As a fourth year in the ED (Real conversation)

To older patient who had taken a fall
Me: What sorts of medical problems do you have?
Patient: Looking at me like I'm crazy "I don't have any medical problems"
Me: Staring at a list of twenty-plus medications on the triage sheet "Well you're taking an awful lot of medications..."

I absolutely hate that. I usually go over their meds, and everytime I call them out, I usually comment on something.

"I see you're on atenolol. Is that for blood pressure?" "Yes." "OK, great, so you have a history of high blood pressure."

"I see you're on Coumadin. I'm betting you have a history of an irregular heart rhythm."

 

[a_ditchdoc]

(Overheard a nurse telling a patient)
"This isn't Burger King...we do things OUR way!"

(My partner saying loudly and matter of factly across a busy ER after being ignored for 4-5 minutes with a critical MI)
"Where do you guys want this patient to die?"

(A few moments of my own weakness over the years)
Once, I brought in an intubated patient that had regained consciousness after an initial presentation of respiratory arrest and bradycardia. The recieving nurse's first question to me was "Why did you intubate this patient!!" (I suppose you would have to hear the asinine, accusatory tone as she yelled it across the ER)

My response: "Well, to be honest, my partner and I were riding down the street looking for something to do...we were really kinda bored. And then we saw this guy walking down the street. So, we grabbed him, shoved him in the ambulance, and stuffed this tube down his throat!" Of course, she then tried to extubate him until I protested...

(To a punk threatening me)
"If you hit me, I am going to call the police on my radio. And then, in about five minutes, you are going to have 20 angry police officers beating you." Patient: "I was just kidding...I wasn't going to hit you...I thought you were going to hit me."

At 3am: "Really, you can't sleep...that's funny, neither can I."

At 4am: "So you woke up afraid and breathing hard...do you think it could have been a bad dream?"

"If you keep moving, and your back happens to be broken, you are never going to be able to have sex again" (to a young male ejected from a car...worked like a charm)

"No, f--- you. Because if you will notice, you are the one bleeding to death, not me."

 

[drifter]

To the thirtysomething year-old able-body unemployed patient on Medicare/Medicaid for whatever reason who is indignant because they are not being seen fast enough and "they have insurance":

No, you do not have insurance, you have my tax dollars, and you are wasting them being treated in the ER instead of being seen by your assigned PCP.

But the absolute worst is the cell phone. If you want to be seen, get off the phone, or better yet don't answer the phone and have a conversation when I'm trying to assess you.

 

[DOnut]

Angry Family Member:
"Whatchoo lookin' at? You never seen BLACK PEOPLE before?!"

Me:
(Dying to say something totally inappropriate such as: "So THAT's what you guys look like!")
er....

You don't know how many times I've wanted to say, "Whatchoo lookin' at? You've never seen a BLACK DOCTOR before?

Here's another one I've always wanted to say: No, I am not the janitor or food prep person as I walk into the room with a white coat and stethoscope around my neck.

 

[boilerbeast]

Lose 100 lbs and you'll feel better.

 

[mikecwru]

To the thirtysomething year-old able-body unemployed patient on Medicare/Medicaid for whatever reason who is indignant because they are not being seen fast enough and "they have insurance":

No, you do not have insurance, you have my tax dollars, and you are wasting them being treated in the ER instead of being seen by your assigned PCP.

But the absolute worst is the cell phone. If you want to be seen, get off the phone, or better yet don't answer the phone and have a conversation when I'm trying to assess you.

I walk out when someone is on the phone, usually with the line "I'll be back in about an hour after your finish your call."

mike

 

[deuist]

You don't like the meds we gave you and you want to leave? Sure, just sign these AMA documents and we'll see you tomorrow when you faint again.

 

[Arctic Char]

v

 

[Paws]

You don't know how many times I've wanted to say, "Whatchoo lookin' at? You've never seen a BLACK DOCTOR before?

Here's another one I've always wanted to say: No, I am not the janitor or food prep person as I walk into the room with a white coat and stethoscope around my neck.

This one's my favorite so far - I think I would have serious lip ulcers from biting them to keep my mouth shut.

As a woman, I have to patiently wait while people slowly absorb the fact that "no, if I wanted to be a NURSE, I would be in NURSING SCHOOL; since I am a MEDICAL student what could that possibly mean ... ?"

Sometimes I get the 'six questions', which is just about how many questions it takes some people to figure out that a female medical student is going to be a doctor. "You mean, you're in medical school? what are you going to be? A nurse? a medical assistant?" etc?

 

[deuist]

Along those same lines:

ME: "I'm a medical student; I'll be working with you today."
PT: "Are you an undergraduate?"
ME: "No, I'm in medical school now."
PT: "Are you pre-med?"
ME: "No, I'm in medical school now."
PT: "Are you trying to become a doctor?"
ME: "Yes, yes... that's exactly what I'm trying to do."
PT: "Oh, well can you look at this rash?"

 

[GeneralVeers]

"No ma'am you didn't lose your prescription, and no one stole it. I checked our hospital Pharmacy's computer and you filled 45 Tylenol #3s yesterday."


This actually happened yesterday. Took two nurses to escort her out.

 

[beary]

"No ma'am you didn't lose your prescription, and no one stole it. I checked our hospital Pharmacy's computer and you filled 45 Tylenol #3s yesterday."


This actually happened yesterday. Took two nurses to escort her out.

You'd think if someone were to go to all this trouble they would do something better than Tylenol 3's.

 

[GeneralVeers]

You'd think if someone were to go to all this trouble they would do something better than Tylenol 3's.

We only can give out T3s in the ER. No vicodin. You'd be surprised at how many people are seeking to get T3s. Most of them sell the pills to finance their crack habits.

 

[krust3]

i sell them to pay for my vicodin habit, which is pricey now that your ER doesn't prescribe them.

 

[Flopotomist]

i sell them to pay for my vicodin habit, which is pricey now that your ER doesn't prescribe them.

HAHAHAHA!! (PS - remind me not to go to that other posters ED if I am in any pain... geesh! Talk about throwing the baby out with the bathwater!)

 

[southerndoc]

We only can give out T3s in the ER. No vicodin. You'd be surprised at how many people are seeking to get T3s. Most of them sell the pills to finance their crack habits.

I've had a couple patients ask me to write "brand necessary" because the generics do not work. Perhaps Percocet is better recognized than oxycodone.

 

[GeneralVeers]

I've had a couple patients ask me to write "brand necessary" because the generics do not work. Perhaps Percocet is better recognized than oxycodone.

At any rate, do you guys confront drug seekers when you have hard evidence they are lying, or do you just cave in and give them a few pills?

 

[8744]

At any rate, do you guys confront drug seekers when you have hard evidence they are lying, or do you just cave in and give them a few pills?

It is so tempting to cave and just give them a few to make them leave....and this is in family practice. Fortunately we have something called a "Pain Contract" which spells out the patient's responsiblities if they want long term narcotic pain therapy. Among other things it specifies that they may only get their prescriptions at an appointment with their regular doctor, they may not "call in" or get an appointmetn with someone who doesn't know them, they will only get a certain amount per month, and they may not get pain meds from any other doctor without disclosing it to us.

If they violate their contract they are discharged from the the practice.

 

[stoic]

We only can give out T3s in the ER. No vicodin. You'd be surprised at how many people are seeking to get T3s. Most of them sell the pills to finance their crack habits.

what about people who are actually hurt? codeine is crapola when it comes to actually relieving pain... do you really send someone with a ct confirmed kidney stone home with a script for T3's?

 

[tkim]

I've had a couple patients ask me to write "brand necessary" because the generics do not work. Perhaps Percocet is better recognized than oxycodone.

Though not widely studied, sometimes there might be a difference in bioavailability between generic versus brand:

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12860486&dopt=Abstract

Though for pain meds the reasons might be more suspect, i.e., easier to sell a pill with better recognized markings.

 

[beary]

codeine is crapola when it comes to actually relieving pain... do you really send someone with a ct confirmed kidney stone home with a script for T3's?

This is the truth. I was given T3's once for post-op pain and it did absolutely nothing.

 

[stoic]

This is the truth. I was given T3's once for post-op pain and it did absolutely nothing.

don't get me wrong, i'm not against giving T3's out if i'm pretty the patient is seeking. i'm just an M1, so obviously i can't write scripts, but the preceptor i work with pretty much lets me decide what she writes for when i see patients and i've already developed a system:
-nsaids if i know you're lying
-T3's if i'm mostly sure you're lying
-ultram if i suspect you're lying/exagerating
-real narcotics for patients who actually appear to be in pain

it's amazing how much different people act/look when they are actually in pain then when they are just claiming pain. sometimes when people come in seeking, i just want to tell them "could you please at least try a little harder to fake it! i'm not a complete idioit. i might even give you some lortab if you'd just put a little more effort into it." one guy was claiming 9/10 pain (lower back) and actually told me to hurry up with the exam because he had some errands to run (wtf?) as he left with his rx for 20 T3's, he quipped "i'll just take the percocet i have at home). (then wtf did he come here for?)

 

[BKN]

what about people who are actually hurt? codeine is crapola when it comes to actually relieving pain... do you really send someone with a ct confirmed kidney stone home with a script for T3's?

Actually NSAIDs are the right drugs for kidney stones. Smooth muscle relaxants, confirmed lowering of interureteral pressure (the stretch ofthe ureter causes the pain). Works for biliary colic as well. Try it, you and the patient will like it.

Add the narcotics or ultram for supplementation.

p.s. phenothiazines or triptans for migraine, reduction and immobilization for fractures. There are few reasons to hand out big loads of narcotics from the ED.

And if your institution gets the street rep of being hard, you won't see the drug seekers much.

 

[ERMudPhud]

In terms of T3's don't forget that a decent chunk of the population can't metabolize codeine to morphine and therefore gets no pain relief.

http://www.ncbi.nlm.nih.gov/entrez/...t_uids=8845855&query_hl=3&itool=pubmed_docsum

In blinded trials T3's sometimes do no better than tylenol but do cause more nausea.

If I think someone is seeking I check to see if they have been warned before. If not, I give them the benefit of the doubt and treat them. Then I tell them that in the future they need to address their chronic pain issues with their PCP and not the ED and not to expect further narcotics from the ED. Then I have no problem sending them away the next time around.

 

[GeneralVeers]

This is the truth. I was given T3's once for post-op pain and it did absolutely nothing.

We can write for Percocet, Oxycontin, etc. I reserve those for people who have a real medical problem, not vague "pain".

 

[southerndoc]

At any rate, do you guys confront drug seekers when you have hard evidence they are lying, or do you just cave in and give them a few pills?

I confront them, and in fact, got one arrested. She claimed she was from out of town (true), that her prescription was left in the passenger seat of her car and the passenger window was broken out and her meds subsequently stolen (not true). I asked "did you file a police report?" "No, not yet." So I called police. They came by and got her story. Then they went out to see her car. Guess what? The passenger window was intact.

So after I gave her the prescription for Motrin, the police officers arrested her for filing a false report.

 

[GeneralVeers]

So after I gave her the prescription for Motrin, the police officers arrested her for filing a false report.

As it should be. It's one thing to abuse the ED with bogus medical complaints, it's another to committ prescription fraud and lie to the doctors.

We had one lady arrested for 911 abuse. She kept calling 911 on a weekly basis for non-medical complaints (like med refills).

 

[Telemachus]

We had one lady arrested for 911 abuse. She kept calling 911 on a weekly basis for non-medical complaints (like med refills).

That reminds me of a couple of stories in the news lately of old ladies getting arrested for calling 911 50, 60, 70 times in one day. Not medically related though.

One called incessantly to complain that the pizza delivery man was late.

The other was complaining about someone walking past her house, then repeatedly called to harrass the 911 operators because she didn't like their attitude.

 

[deuist]

The Crisis Center gets the same kind of losers calling. You'd think that for a suicide hotline, only people in bad shape would call us. Instead, we get horny men trying to have phone sex with the volunteers.

 

[LaCirujana]

Seriously, you drove 8 hours, in a car, with your [family member] who is in excruciating pain, bypassing the hospital 20 minutes from your house, which I am absolutely certain has the ability to administer pain medication as well as about 5 other hospitals along the way, in order to wait hours in our over-crowded ED to be seen by a physician because:

1. your [physician] is out of town, although he will be back tomorrow and you have an appointment with him the subsequent day
and
2. you want a 2nd opinion about the management of your [family member's] untreated non-Hodgkin's lymphoma that has spread throughout their entire abdominal cavity

Seriously, a 4am second opinion, in the ED? Seriously.

 

[southerndoc]

Seriously, you drove 8 hours, in a car, with your [family member] who is in excruciating pain, bypassing the hospital 20 minutes from your house, which I am absolutely certain has the ability to administer pain medication as well as about 5 other hospitals along the way, in order to wait hours in our over-crowded ED to be seen by a physician because:

1. your [physician] is out of town, although he will be back tomorrow and you have an appointment with him the subsequent day
and
2. you want a 2nd opinion about the management of your [family member's] untreated non-Hodgkin's lymphoma that has spread throughout their entire abdominal cavity

Seriously, a 4am second opinion, in the ED? Seriously.

Unfortunately, the bigger the name of your hospital, the more they will drive for their "second opinions," even if their second opinions are bogus. (Often times you get real interesting cases presenting to the ED for second opinions because their primary care physician refuses to refer them, their HMO won't pay for the referral, etc.)

 

[LaCirujana]

Unfortunately, the bigger the name of your hospital, the more they will drive for their "second opinions," even if their second opinions are bogus. (Often times you get real interesting cases presenting to the ED for second opinions because their primary care physician refuses to refer them, their HMO won't pay for the referral, etc.)

I have no problem w/people seeking 2nd opinions from our institution--we ARE the so-called "big name" around here. In fact, these people HAD a referral to meet w/our onc folks, just that the appt wasn't for a couple of months. This was apparently their way of expediting the process. Never mind the 8 hour drive for pain meds...

 

[Gimlet]

This has probably been posted a bunch of times on this forum, but I just ran across it again today and thought it was pertinent to this thread:

http://theunderweardrawer.homestead.com/Id_ER_01.html