Tuesday, February 1, 2011

Readers Guide to Triage

Triage is the part of the ER visit with which the general public seems to have the most difficulty.

When in triage, I usually greet patients by asking, "What can we do for you today?". I think it is so much more friendly than saying "Why are you here" (just sounds too confrontational), or "What brings you here today" (because the average asshole will say, my car, my mother-in-law, or a taxi. It is unfunny and unproductive and makes the patient look like an idiot, frankly).

By asking "What can we do for you", it is opportunity for me to collect information and to create a dialog about why the patient is in the ER, and and gives the patient an opportunity to state their expectations. We are in the business (and business it surely is, make no mistake about that) of helping people, but it does require a little bit of effort on the patient's part.

What is not helpful are the following responses:

1. "I don't know, you tell me"

2. "My doctor told me to come in" (also the school nurse, trainer, day care provider, home care nurse, my neighbor who is a nurse's aide. Oh, and my mother is also a big one)

3. "Kill me" (also I want to die, or simply lying on the floor moaning while texting all of your friends)

4. "I'm sick".

Each of these answers will earn at minimum a withering glance, such as the one Nurse Jackie is offering. I don' t even respond anymore, except to possibly say "Is there anything you'd like to add to that?"

Other less than helpful responses include:

5. "Well, it all started with _______ in 1998.....".
Please, just keep it to a single compalint if possible. Sore throat. Migraine. Shortness of breath. Chest pain. Cold symptoms. Vomiting. Very simply, I don't need to know every aspect of your medical history. And, you will just wind up repeating it to the doctor, who also really doesn't need to know you had a colonoscopy or a mammogram in the last 5 years. Sheesh. Plus being long winded in triage only delays your care.

6. "You have my records"
I might, but why should I look them up? It takes time away from other patients. If you don't have the ability (are short of breath, mentally debilitated, or require resuscitation) I might look them up. But, if you don't care to provide me with the information or it is too much of a chore, consider that may also be for me.

Things triage nurses never say, but are always thinking. If thought bubbles were visible, we would all be screwed:

7. It's not nearly as bad as you think. (Actually, I do say this quite often for things like lacerations especially for frightened kids. Especially if I'm pretty sure they won't need sutures)

8. You aren't as sick as you think you are. (Mostly for the Man-Cold; a blog in and of itself)

9. Did you call your doctor about this chronic/long time/insignificant issue?

10. If you already have percocet and oxycontin at home, what more did you think we could do for you?

11. You aren't really wheezing if you are consciously making the noise yourself in the back of your throat.

12. You are not unconscious if you are merely lying with your eyes closed

13. You have got to be on crack if you think I believe that you weigh only 250 pounds/smoke 3 cigarettes per day/have no money in your Coach bag next to your Iphone to buy an inhaler .

14. Did you think to try ice/Tylenol/ibuprofen?

15. You injured this a week ago, have been playing sports and going to school, it's not swollen and a bone isn't sticking out, but it's just "not better". Are you an idiot?

16. You have had an antibiotic for 24 hours and you are not all better. Are you an idiot?

17. You don't know any of your medications; don't you think that you should? (For this I usually offer a handy little plastic sleeve and a medication list card; people love giveaways)

Also: if I offer you a wheelchair it is because I am concerned about liability, not necessarily that you shouldn't be walking on it since clearly you have been walking around on it for days.