Why are you here?

{walking into a patient's room}

Me: "Hi Mr. Smith, I'm Dr. Gilman and will be taking care of you today in the ER. So, I reviewed your chart, and I don't see any significant past medical history. The nurses tell me you don't feel well. Tell me, what's the matter today?"

Smith: "I'm sick"

Me: "Okay, but what's wrong"

Smith: "I don't f*ckin' know, you're the doctor."

I hate, hate, it when a patient doesn't have a chief complaint when they come to the ER.

Why are you here? Today? Right now? (i.e. why couldn't this wait until you could see your primary doctor). What changed? What are you afraid of? Specifically, what part of your body is bothering you.

My job is to determine if this...whatever it is you have...is likely to kill you tonight, or tomorrow. If it won't kill you (or severely disable you), my job is done. I do not know why your rash won't go away. I don't have the time or resources to figure out why your toenail fungus medication isn't working. I don't usually adjust medications that your doctor has decided are best for you. And I don't write prescriptions for psych meds, viagra, or refill highly addictive meds without good (and I mean a very good) reason. I am not a substitute for your doctor. If you rely on the ER to diagnose cancer, or manage your hypertension...you'll die from complications related to these diseases. You could go to the ER 10 times in 2 weeks c/o abdominal pain, that eventually turns out to be an gastric ulcer or stomach cancer. Do you know when we, in the ER, will make that diagnosis? Never. Or, not until we see a big hole, or a big mass, on CT. By then, it's end-stage. And to think...you've been coming to 'see a doctor' for weeks.

And another thing: people who 'save up' their medical issues, and then complain of everything under the sun when they go to the ER, bug us. In the ER, you get ONE problem. Choose carefully.

I wish patients could understand the limitations of the ER. I wish patients would think about why they've decided they need emergency care. And I wish they would limit their complaints to 1) emergencies, and 2) one basic problem.


ERnursey said...

I would be sorely tempted to say "Well...if you don't fucking know why your here then get the fuck out and quit wasting my time." But I wouldn't, only think it.

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