Things I hate to hear patients say:

[RustedFox]

"I try to use all-natural solutions if I can."

"My Nurse Practitioner knows more because she considers the 'whole patient' ."

"I like to do things holistically." [Bonus if I ask them what the word "holistic" means and they can't form an answer.]

"I've done my research."

"Vaccines are just a scheme for big pharma to make money."

"I didn't know what to do, so I took my blood pressure, and..."

Following the last one:
"My blood pressure was high and I don't want to have a stroke; so I came in right away."

"My doctor said that [xxx: generally another physician] would meet me here to take care of me."

"I threw my kid right in the car and drove here as fast as I could!" [Good job, SuperMom! Way to endanger motorists and pedestrians everywhere for that 99.4 fever!]

"How long is this going to take?! I have my doctor's appointment at [xxx], you know."

"I didn't want to take [tylenol/motrin/etc] because I didn't want to "mask the symptoms"."

"I didn't want my organs to just start shutting down; so I came in right away." [Zero ****!ng idea what they mean when they say this.]

"I'm going on a long trip, so I wanted to come in to make sure that I'd be okay on the trip."


Take it away, SDN.

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[Tiger26]

"I have a high pain tolerance"

"my temperature always runs low"

"I just wanted to get checked out"

"the nurse line told me to come in"

 

[CleverAdvisor]

"Web MD told me I needed to seek immediate medical attention" - calf pain
"I've had this runny nose for almost two days now and I'm worried it might be CSF or MS"
"Actually, I'm pretty sure it's [self-diagnosis]"
Anything that has to do with Dr Oz

 

[alpinism]

Continuing on the BP train

"I went to clinic they took my BP and told me to come here"

 

[bearstanley]

"i know my body."

"actually, my temperature is always low. so that's a fever for me."

 

[RustedFox]

"i know my body."

I have said this to the right patient:

"I just heard you say that you know your body. If you do; then why are you here? Oh, and your appendix is on the other side."

 

[enalli]

"I'm not leaving this hospital until we figure out what is wrong" for what is invariably some long-standing issue.

 

[deleted480308]

“So I moved here from out of town and my old pain doctor.......”

Also Any long drawn out act about how they pretend they don’t know the word dilaudid and they are allergic to all pain meds except ...can’t remember....don’t even like pain meds but it’s really bad right now....might start with a “d”

“I don’t want to name drop but......”

“Do you know how long I’ve been here?”

“My doctor said you would give me a CT scan/mri/xray/(insert any number of tests)”

 

[deleted245139]

"I'm going to die" when they clearly look like they may

 

[Vandalia]

"I got bit by a skunk. I know you would want to check him for rabies, so my brother managed to catch it. It is in this box here, let me show you..."

My introduction to medicine. First night as an MS-III. We happened to be in the ER.

Nothing good has ever come from an ED patient toting a box.

 

[Apollyon]

"I got bit by a skunk. I know you would want to check him for rabies, so my brother managed to catch it. It is in this box here, let me show you..."

My introduction to medicine. First night as an MS-III. We happened to be in the ER.

Nothing good has ever come from an ED patient toting a box.

But, if they bring WHATEVER it is in a jar, you always have to look at/in the jar.

 

[Perrin]

“So I moved here from out of town and my old pain doctor.......”

Also Any long drawn out act about how they pretend they don’t know the word dilaudid and they are allergic to all pain meds except ...can’t remember....don’t even like pain meds but it’s really bad right now....might start with a “d”

I frequently joke with my nurses that I'm going to change all my passwords to 'dilaudid' because no one ever remembers that name.

"I didn't take my insulin bc I only had a glass of juice for breakfast." "No, I didn't check my sugar."

Sugar >500

Parent brings in kid with asthma exacerbation. Does anyone smoke at home? "Yeah, but we go outside."

"But my family doc always gives me an antibiotic."

"Why can't the ambulance take me home? They brought me here."

 

[Alvarez13]

"I'm allergic to ibuprofen"

"I have diabetes, I need to eat"

 

[BoardingDoc]

"I'm not leaving this hospital until we figure out what is wrong" for what is invariably some long-standing issue.

Yes you are.

 

[Saddleshoes]

"I thought it would go way."
"I'm allergic to Morin, Tylenol, Aleve, Aspirin, but Oxi is good."
"Nobody will accept my insurance" (Sweetheart, you have public aid NOT insurance.)

 

[Melchizedek]

“I’m not...[dozes off, suddenly wakes up when I yell their name].....on heroin!”

 

[deleted859535]

"___" (When I am trying to explain something and keep getting interrupted by either the patient or family talking about something that has absolutely nothing to do with why they are here in the emergency department tonight; most recently, family members going on about their own medical issues and who are not being seen as patients. Hey, let me take care of your son/daughter/husband. Thanks.)

Need to start a "things I love to hear patients say" thread to balance out my own increasingly high blood pressure.

 

[gutonc]

Need to start a "things I love to hear patients say" thread to balance out my own increasingly high blood pressure.

"There's nothing wrong with me, I just really thought you guys could use some cookies."
[/thread]

 

[Psai]

"I'm in a lot of pain because of my fibromyalgia"

 

[deleted859535]

"There's nothing wrong with me, I just really thought you guys could use some cookies."
[/thread]

"Nope, I'm just here for my (reasonable ED complaint). Totally fine otherwise."

 

[Apollyon]

"I'm in a lot of pain because of my fibromyalgia"

"End stage"

God's honest truth, I think I was the one that pointed that out when someone on SDN mentioned a pt with "end stage fibromyalgia". What, next event is spontaneous human combustion? I'm not that lucky.

 

[deleted836128]

As I am walking out the door after discharging the patient: “Oh, by the way, while I am here I might as well ask you...” (I had a patient who twisted his knee come in and pull this on me. Put on his Ace wrap and walked out (he had been in a room for two hours at this point) and he says “I had a sudden onset of testicular pain last night when I sprained my knee and it hurts so bad...”)

When you ask a patient if they have any medical problems and they get a dramatic look on their face, look at their family members amused, throw their head back and laugh before listening their many medical issues. Bonus points if those medical issues are “Fibromyalgia, chronic back pain, interstitial cystitis, I am allergic to cheese, I had my tonsils removed...”

When you ask a patient what hurts and they say “Todo mi cuerpo” (my whole body in Spanish)

When I ask if they had a fever and they say yes and I asked what their temperature was, and they say “102, 103” and I feel BS is at play and say “Did you actually check it?” They say “No, but I could tell how high it was.”

When patients come in with basically a positive ROS. I had a lady a few months ago - absolute nightmare - tons of chronic issues and came in with fevers, double vision, neck stiffness, chest pain, bloody stools, intractable vomiting, right leg swelling, vertigo, possible seizure, rash, worsening of chronic back pain with urinary incontinence, and couldn’t walk. Oh, and also had altered mental status and turns out she was just narced out.

When I ask for the history “Ugh, can’t you just ask the nurse? I just told someone.” When I ask about their medical history - “Just look in the computer.”

 

[DrMcCoyDO]

Also Any long drawn out act about how they pretend they don’t know the word dilaudid and they are allergic to all pain meds except ...can’t remember....don’t even like pain meds but it’s really bad right now....might start with a “d”

I had one once in my last EM rotation as a student who had a legit reason for getting dilaudid but said she needed benadryl; because, “Dilaudid always makes me itch.” She was so ticked when the resident told her, “That’s fine, we can give it to you PO.”

 

[Perrin]

I had a 40 y/o female patient that called 911 at 1am for a 4 week flare up of her chronic Lyme disease and had EMS bring her 2 counties over to my ED. After some basic tests showed nothing emergent, I let her know I was discharging her.

"Can you call the ambulance to come take me home?"

Sorry ma'am, that's not how the system works. We can call a cab for you or a family member can pick you up.

"I don't have the money for that and all my family is asleep. My insurance will pay for it."

Well, it'll probably be a few hours till they have a free rig to send all the way over here.

"The ambulance people are supposed to know to stay here until I'm either admitted or discharged, so I don't have to wait."

Me: .....

 

[engineeredout]

“My period has been irregular” = you want a pregnancy test

 

[GonnaBeADoc2222]

"Metroprolol"
"Met-O-prO-lol"

 

[Fox800]

So you've had a headache/fever/URI symptoms/whatever for 11ty days. Have you taken anything to treat it? Tylenol, Motrin, anything?

"No".

 

[RustedFox]

"Metroprolol"
"Met-O-prO-lol"

Patient: "Metropanol."
"Metropranon."
"Metalpronoun."

 

[ArteryStudyPainting]

Am EMT, but took 406 pound lady out of ED and up her 12 steps to a bum home.

C/c: Leg pain

Unfounded. Possible DVT, unfounded.

I could have told her that.

Sent from my Pixel 2 using SDN mobile

 

[engineeredout]

10 years of abdominal pain? Seen by multiple GIs? Multiple hospitals? multiple scopes through multiple holes?

"I want to find out what's wrong with me tonight"

Shockingly, my work up was unable to answer his question

 

[BoardingDoc]

10 years of abdominal pain? Seen by multiple GIs? Multiple hospitals? multiple scopes through multiple holes?

"I want to find out what's wrong with me tonight"

Shockingly, my work up was unable to answer his question

I literally ask these patients what they were hoping to have happen in the ED tonight. When they invariably answer as you said with "I want to know what's wrong", I flat out tell them up front that this is almost certainly not going to happen, that I'm going to do some tests to make sure that they don't have an emergency condition and that if I don't find anything they'll be going home.

I've found that blunt expectation setting up front is very helpful in diffusing this particular breed of neurotic patient.

 

[Fox800]

“Any unusual bleeding, pain, or hallucinations, anything strange like that?”

That knocks out ten systems right there.

 

[CajunMedic]

"I only came by ambulance so I can be seen faster"
"My lawyer says you need to put that collar thing on my neck and take me to the hospital. Can I get a copy of the report? He's meeting me there"-After being rear ended at the equivalent speed of a sloth on valium, with said ambulance chaser's billboard at the intersection

 

[GonnaBeADoc2222]

"My doctor said..."

Insert any ridiculous expectation of service after these three words.

 

[BAM!]

I frequently joke with my nurses that I'm going to change all my passwords to 'dilaudid' because no one ever remembers that name.

"I didn't take my insulin bc I only had a glass of juice for breakfast." "No, I didn't check my sugar."

Sugar >500

Parent brings in kid with asthma exacerbation. Does anyone smoke at home? "Yeah, but we go outside."

"But my family doc always gives me an antibiotic."

"Why can't the ambulance take me home? They brought me here."

I like sugar > 500. easy dispo.

 

[Rendar5]

I like sugar > 500. easy dispo.

I usually discharge them after hydration unless there’s an infection, infarction, or some other emergency.

 

[smq123]

"You have to..."
I don't HAVE to do anything, except offer you reasonable medical care. And if you're abusive and yelling, I don't even have to do that!

"I have pain; that can't be normal."
Pain is a normal part of life. Especially once you're >60 years old.

"There's no way that a cold can last a week. I definitely need antibiotics."
Yes, yes it can.

 

[Rendar5]

“Let me start from the beginning... [followed by 5 minutes of talking and they still won’t tell me the chief complaint]”

 

[Zebra Hunter]

“Let me start from the beginning... [followed by 5 minutes of talking and they still won’t tell me the chief complaint]”

I cut them off almost immediately when they start with that unless they have some complicated medical history where I do care (although this is rare).
“I apologize for cutting you off, but we’ll get to your past medical history in a second, however, I was wondering what the specific symptom today was that made you decide to come to the ER.”

 

[theseeker4]

Me: " so what brings you in today?"
Patient: "I don't know"
M: "Well what is bothering you?"
P: "I'm not sure, that's why I'm here."
M: "Well why did you decide to come in?"
P: "To figure out what is wrong."
M: "does something hurt?"
P: "Not really."
M: Well what symptoms are you having?"
P: "I don't know"

Continued forever......

 

[Apollyon]

Me: " so what brings you in today?"
Patient: "I don't know"
M: "Well what is bothering you?"
P: "I'm not sure, that's why I'm here."
M: "Well why did you decide to come in?"
P: "To figure out what is wrong."
M: "does something hurt?"
P: "Not really."
M: Well what symptoms are you having?"
P: "I don't know"

Continued forever......

Circular story is circular.

 

[GeneralVeers]

"I'm afraid of needles"

"I'm friends with the CEO, and I'm going to call him"

"Pain medicine is my right as an American!"

 

[gutonc]

"I'm afraid of needles"

Bonus points if they have a positive UDS for meth or opiates.

 

[alpinism]

Bonus points if they have a positive UDS for meth or opiates.

Double bonus points if they're covered in tattoos and piercings.

 

[JAFERD_MD]

- I know my body
- I have 10/10 pain (with positive cell phone sign)
- I came to the hospital and you can't tell me what's going on? Ridiculous and a waste of time (CC: atraumatic R foot swelling x2hrs, r/o'ed DVT, normal vitals/labs, not cellulitis)
- I shouldn't be in pain, this is not right, what is your name? (after leaving outside hospital 8hrs prior for an NSTEMI, discovered after admitting hospitalist that covers both hospitals said "is this guy actually going to stay this time?", patient with chronic low back pain, UDS +opiates, and sternal rub required to arouse him)
- Well it all started in 1987 when my right pinky toe started tingling...(attempts to redirect fail)
- My doctor says I should take this hydrochlorothiazide but I don't believe in pills and I don't want to get addicted to them so I'm cutting down on it and he doesn't know about it
- Well, I have this really complicated history and I came here because you have the best X specialty... (comes with 3" stack of papers)
- I feel weak all over, have a fever (not measured), coughing x3 months, blurry vision, nausea, diarrhea once last night...
- Can't I just stay here till the morning? (Answer: no, but you can stay in the waiting room.) You just don't care about me! I'm a rape survivor and a proud black woman and you're a racist!
- Can't I just stay here till the morning? (Answer: no) Patient then proceeds to re-check back in for BS complaint
- I can't afford this tylenol prescription (while sporting a brand new iPhone and Tory Burch bag)
- Can I have a prescription for ibuprofen? ("Ma'am, you can buy ibuprofen 200mg over the counter and take 1-3 of them at a time.") Can I just have it anyway?
- I can't swallow pills (25 year old healthy patient)
- I have an allergy to epinephrine, potassium (literally saw one the other day - reaction: "it burns my veins"), generic medications, steroids
- I have an allergy to penicillins...it makes my eyes blurry sometimes (are you sure that's not your diabetes...?)
- I have an allergy to more than 3 medications

 

[alpinism]

We had a homeless guy in residency who tried to check in 4x in one day.

His final attempt he was triaged to the module of one of our more notorious attendings (practicing 30+ years, handlebar mustache, chain smoker) who just wasn't putting up with his BS today. Saw him being wheeled in by EMS, jumped up from his chair, yelled at the patient (you only get 3 visits per day mother****er), grabbed the stretcher, turned him around, wheeled him out the ambulance bay, flagged a taxi, threw him in the back, and gave the driver 10 bucks to take him to the nearest shelter.

 

[BAM!]

I usually discharge them after hydration unless there’s an infection, infarction, or some other emergency.

me too --> still an easy patient.

 

[WilcoWorld]

I literally ask these patients what they were hoping to have happen in the ED tonight. When they invariably answer as you said with "I want to know what's wrong", I flat out tell them up front that this is almost certainly not going to happen, that I'm going to do some tests to make sure that they don't have an emergency condition and that if I don't find anything they'll be going home.

I've found that blunt expectation setting up front is very helpful in diffusing this particular breed of neurotic patient.

I do this almost exactly, except I flip the emphasis on the last point:

"I'm going to look for emergency conditions, and if I find anything that you need to be in the hospital for I'm going to admit you to the hospital. If we don't find any emergency conditions, then I can let you go home."

Doesn't satisfy everyone, but, like you, I find it helps in a lot of encounters.

 

[HLxDrummer]

When patients come in with basically a positive ROS. I had a lady a few months ago - absolute nightmare - tons of chronic issues and came in with fevers, double vision, neck stiffness, chest pain, bloody stools, intractable vomiting, right leg swelling, vertigo, possible seizure, rash, worsening of chronic back pain with urinary incontinence, and couldn’t walk. Oh, and also had altered mental status and turns out she was just narced out.

Just reading that sucked the soul out of my body. At some point with those patients I'm tempted to just order every test I can think of because there is no realistic way to reason through all of those complaints lol

I do this almost exactly, except I flip the emphasis on the last point:

"I'm going to look for emergency conditions, and if I find anything that you need to be in the hospital for I'm going to admit you to the hospital. If we don't find any emergency conditions, then I can let you go home."

Doesn't satisfy everyone, but, like you, I find it helps in a lot of encounters.

Yep, I've found this is very helpful. If I get a certain vibe, I will state this up front which helps a ton at the dispo end. Also helps with people in pain - just tell them up front they aren't getting narcotics, need to follow up, do therapy, etc. but we will evaluate for other issues.

 

[killerleaf]

I love you guys, and I know the hardships you face, with being caught in the middle between administration and patients. I just want to say thank you for being patient with my daughter (her medical history does make for some interesting reading--33 surgeries from the time she was 2 until she was 11, and some bizarre documented allergies), my mother who had alzheimer's, my grandmother and her dementia, and my dad who was mostly just grumpy old man.