At times of high volume at Pseudocity Medical Center the waiting room often seems like a combination of bus depot, bomb shelter, and the morning after a party gone horribly wrong. Regardless of the complaint that brings them in for their non-emergent emergencies one thing is certain: they all know where they are in the queue. Never mind that various posters remind the huddled masses that patients are not treated on a first-come, first-served basis.
It is a high stakes, competitive game that is run in the waiting room; the frequent customers all know the rules and have developed a Survivor: ER mentality. Alliances are developed, a few with outstanding warrants are "voted off the island." They never tire of challenging the system.
On a recent very busy shift, I was in the penalty box (AKA triage box, otherwise known as goal-tending). The truth is, I really like being in triage and would rather do that than anything because it is the shortest possible contact with complete idiots. Also, it is a challenge to get my really sick people into a treatment room ASAP which I sort of enjoy. But I digress.
One of my patients was SICK. Pale, sweaty, nauseous, looked and felt like absolute crap but with pretty normal vitals. He was of the scary category of patients who are Young Enough to Die, so I wanted him back into a room. I got a wheelchair, but he would have none of it, so I explained my strategy in the Survivor: ER game:
"Look, sir, I know you want to be all macho and walk out back, but the truth is the natives out there are pretty restless. Now, I could let you walk, but an angry mob scene would be really bad for business, and they would probably do some serious damage to me when I come back; not to mention IF we even get out of this box in one piece. The only way I can protect you is if you sit in that wheelchair. I know you can't keep up with me walking, and the triage motto is "No One Gets Left Behind". I'll draw their fire: you go in the chair, it's our only chance".
The patient took the chair; his wife was laughing so hard she could barely walk.
Another strategy to avoid the "I was here first" scene is to call a patient from the door and tell them they have a phone call, or that there is some problem with their insurance, or that we made a mistake and they are supposed to be in XRay. We have a non-urgent side that is strictly first come, first served, but for a returning wound check, IV antibiotic etc (and they are nice people who don't deserve to be sitting with the rabble) we can try to expedite their visit. Hey, it makes us feel good, and scores one for us. There isn't much we can control so we take it when we can.