Saturday, April 30, 2011

When Stupid is Not a Concealed Weapon

New Cathy and I worked last weekend and I think we might have seen about 10 patients total, which amounts to DEADLY slow shifts. Wednesday, Thursday same thing. I managed to read about half of "1984", which I can't remember having read in high school but know that I did; I picked out lighting for my new kitchen and did most of my schoolwork for the week. And was bored out of my gourd, having to resort to watching a rerun of a ridiculous singing version of Gray's Anatomy; we saw in total 5 patients in 8 hours. All that quiet we have more than made up for in my last few shifts; it has been pants crappingly busy with actual REALLY SICK people.
I like to work with the Talker, he doesn't hurry people, which is why they love him.  He has no urgency to to boot them out the door no matter what the complaint.  This goes equally for dental paineurs (they get antibiotics only if they have more than one visit for same), antibiotic-seeking mothers whose kids have had a temp of 99 degrees for 10  minutes, back pain (chronic), and not-magically-better boo boos and viral illness after 12 hours. 

Of course this can backfire when it is really busy.  He largely ignores Bobo's mandate that all patients be seen within 20 minutes.  Sometimes it is as much as an hour.  Or more.  It gets complicated because the Talker doesn't automatically get xrays or order labs simply because the patient expects it; it is definitely not "Have it Your Way" ER when he is on.  If it will not affect how he will treat the complaint, he is all about not exposing patients to radiation or paying tons of money for lab work.  Have a UTI?  We dip it, he treats with antibiotics.  The common sense approach rules.

There were about 7 patients sitting in the waiting room; Ellen was buzzing around, dealing with a lot of non-emergent whining "how long is the wait".  This really bothers her because she hates to ask us when we are busy, and is just not hard-wired to be firm with the idiots.  Generally she is stuck in the middle where she never wants to be.

At 9:30 PM I looked over the charts in the rack:
Cough x 1 week in an 8 year old.  Not worse, just not better.

"Asthma attack" in a tween girl (drama, drama, drama).  Not wheezing, not coughing, not short of breath, sats 100% on room, lungs clear. Take a number honey, and get off your fucking cell phone.

Vomiting x 2 in a 20 year old frequent flier female who has been seen 8 times for "menstrual cramps" and always gets vicodin.  WTF.  Does not look sick and is drinking an iced coffee

Laceration in an 18 year old male.  Microscopic.  Will not require stitches.

"Flu-like symptoms"; nausea, no vomiting, no fever, no cough, no other symptoms except "I don't feel good".  History of fibromyalgia.

Dental pain, first visit for same; accompained by 23 year old boyfriend who has had innumerable visits for same

Dental pain, 10 visits between the us and the Mother Ship.  Known to have altered a presctiption in the past.

Of the patients in rooms and getting workups, two were being admitted with all the bullshit that entailed.  At least they would be gone by 11 PM.  One is getting antibiotics for cellulitis and is ready to leave.  One is awaiting disposition for a UTI.  Two kids with earaches waiting to be seen.  The Talker usually doesn't prescribe antibiotics for all earaches automatically. 

He spent 20 minutes in a circular argument patiently explaining to a woman who was strongly advocting for her 24 year old daughter for antibiotics for yet another viral illness.
"But we had them last time"
"She is not better so she needs them"
"If she doesn't have antibiotics how is she going to get better"
"But she had them last time and got better"
"She is sick, so she needs antibiotics"
"Couldn't you just give her some samples"
"She needs antibiotics because she is sick and not getting better"
"We will just come back tomorrow and get them"
You can't win any of these arguments when people are stupid

It may be time to start looking around for a new job.  At least in a regular ER, most of this time-wasting crap and parade of idiots would go to the fast-track.  Where I never want to work.