Wednesday, April 27, 2005

A typical night patient in the EC, part II

Part I is here.

Doc: Help me understand how getting a CT now will prevent you from having to see the neurologist later today? Oh no. How am I going to get out of this one?

She: Well, if the CT scan is normal, I won't have to see the neurologist. I don't like him.

Doc: You've seen him before? What is going on here?

She: (angrily) Oh, yeah. Right after this started, my doctor sent me to him.

Doc: What did he think was wrong with you?

She: He doesn't know. He thought I might have multiple sclerotosis. He wanted to get an MRI, but I missed the appointment.

Doc: When was that?

She: Oh, about a year ago.

Doc: And you haven't rescheduled the MRI? Wait, a year ago? I thought this just started six months ago.

She: Well, his office never contacted me.

Doc: And how many times have you called his office? Oh, right, that would mean personal responsibility. I don't think a CT is the answer. You have a completely normal neurologic exam right now. The test I can get in the middle of the night is nowhere near as good as an MRI for looking for multiple sclerosis. Or sclerotic multiplications or whatever. By the way, did your family tree have any branches?

She: What do you mean? You have to do whatever I want.

Doc: Oh, no. Another "ER is Walmart" patient. I can't order any test just because you or I want to without a valid medical reason.

She: (Screaming now.) I CAN'T BELIEVE YOU WON'T HELP ME!

Doc: Please help me. Get me out of here. Someone call a Code Blue, please.


Doc: Who said prayers aren't answered? I'm sorry, I have to go. I will come back and tell you the results of your flu test and the strep swab.

Nurse: I thought you needed a break. Here, have some ice water.


Doc: Nurse, please come with me. I can't go back in there by myself...Ok, your tests were negative. I think you were exactly right, you seem to have a cold.

She: But what about my CAT scan?

Doc: I'm so glad the witness, I mean, the nurse is with me. I don't have a valid reason for that test and I won't order it.

She: (Screaming again) WHY WON'T YOU DO A CBC OR A CHEST X-RAY?

Doc: What the f? Where did that come from? Why is that nurse trying to stifle a laugh? You have a normal lung exam and I don't think either of those tests will change what we are going to do. You don't have a cough or shortness of breath.


Doc: Will this never end? When is my shift up? How many things do I have to order to be able to turn this nightmare over to my relief? I'm sorry, this is the first I've heard of this. Let me...

She: (interrupting and screaming even more loudly)


Doc: I'm sorry, I can't do this right now. I'm becoming frustrated and can't talk about this right now. Give me just a minute. And shoot me if I ever have to work another night shift, please.


Doc: Nurse, please order the CXR and the CBC and come with me to let the patient know what we are going to do.

Nurse: You're going to give in to her.

Doc: Hey, gotta keep them happy to keep my job.

But, alas, the patient had left.

This scenario is fictitious, but the patient is real times infinite. This is really an amalgam of multiple visits. There is no real diagnosis, sorry anonymous. I just wanted to share some of the frustrations of the EC in the middle of the night. Thanks, folks, I feel better now.