Sunday, October 14, 2012

Just Doing my Job

My colleague Madness has a post up about the seasonal influx of patients with nausea, vomiting and diarrhea that are lining up in the ER.  She offers some (partially) tongue-in-cheek helpful hints for patients who aren't really sick enough to be in the ER.   Blame lack of common sense, blame a need for instant gratification or a magic bullet, blame lack of knowledge, but Madness is right on point:  patients with viral illness / vomiting, regardless of severity, do clog up the system.

However, one of her commenters took the pissy road.  He/she (anonymous, of course) snidely suggested that if ER's didn't want to be bothered with people who lacked the medical training to determine if they were sick enough to go to the ER, well then maybe hospitals should go on an information campaign to educate the public before they do something galactically stupid like go to the ER for frivolous reasons.

Excuse me.  Hahahahahahahahahah!  Haha!  HAAAAAAAAHAHAHAHAHAHAHAHA! (pauses to wipe tear from eye) HA!  HAHAHAHAHAHAHAHAHAHAH!!!!!!!!

That's rich.  Can you imagine any hospital endorsing that idea?  I can just see administrators foaming at the mouth on that one.  Public service announcements telling people NOT to go to the ER would be shooting themselves in the foot don't you think?

No, the responsibility for that task does not lie with hospitals, the ER, or ER nurses, at least not until people actually come in.  It would never work anyway, for several reasons:

1.  "I have been sick for 10 minutes" You  may be able to educate the stupid, but there is no cure for it.  Individuals who lack common sense are never going to be willing to do anything other than run straight to the ER at the first sign of a sniffle, so, vomiting?  Really?

2.  "My doctor told me to come" Many times patients do indeed do the right thing and phone their doctor for some advice about when they should worry. This is not unreasonable but they mostly talk to an office manager or triage nurse who then tells the patient go to the ER.  The office doesn't want vomiting people and there is a certain amount of liability telling people "it's a virus, you will get better".  This is enormously frustrating for people who, after enduring unnecessary labs, IV fluids, and hours of their lives are told, "it's a virus, you will get better".

3.  "Dr. Google told me to come".  People have access to all kinds of information online, watch way too much Dr. Oz,  and will often show up having already made their own diagnosis.  Information is not a bad thing, but when people come in with their treatment plan and choice of antibiotics already in place based on their research it can get ugly.  See, the problem is that we just don't see that much bubonic plague anymore.

4.  "YOU told me to come".  What I actually said was, "I cannot give any advice over the phone, if you feel like you need to be seen in the ER, we will see you".  For liability reasons,  I am obligated to end every single phone call to the ER for free advice in this manner.  Unless you are having crushing chest pain, then I might go off script and tell you if you were my family member I'd call an ambulance.  I understand that people want some guidance, but sorry, I'm just not allowed to give you any advice and every call ends up with the caller being frustrated and taking me away from the patient in front of me.

5.   "I am sick.  I'm never sick."People have their own individual perception of what constitutes an emergency.  Feeling crappy or scared, regardless of how minor a problem it seems to ER staff in the grand scheme of things is often a big deal to the patients.  People who are rarely ill can be frightened by vomiting.  As ER nurses we just don't get excited about some things, and remember, you may feel quite ill but you are probably not my sickest patient right now.  Perspective goes both ways.  It is important to note here, though, that being a drama queen about it does not endear you to my heart.  I can only reiterate Madness' wise words: "Man up".

6.  "I'm not dead yet".   Conversely, trying to educate people when and when not to go to the ER for their symptoms will not help someone who is insistent on going to work and spreading their germs around to others.  Some tough it out beyond their ability to cope.  These are very stoic people and people in New England who will simply stay away getting increasingly ill and dehydrated until it is late in the game.  Now not only are they really sick, but because they didn't lay low initially have infected dozens of others.  You can't change that mindset, it's useless to even attempt  doing so.

Please remember, people, we are speaking from a perspective of volume.  ER's are busy places, and are inundated with so many that don't really need to be there, as Madness pointed out.   Neither Madness nor I are referring to people who are genuinely ill, who are truly dehydrated and are physiologically unable to cope with their illness; the very young, the very old, the very compromised.  When people come into the ER and ask for change for the vending machine, well, maybe you can see why we are just a little frustrated at times.