The following are some things patients tend to open up my interview with that drive me nuts.
I generally start with something like “So, I see you are having some ______. When did that start?”
Unacceptable answers are:
- “Well Doctor, let me start from the beginning…”
- “Wait, I don’t know you. Where’s my Doctor?”
- “Give me something for pain”
- “Fuck you”
- “Well, it all started way back when….”
- “You don’t know my history, do you?”
Feel free to add some of your own painful conversation openers.
“Haven’t you reviewed my records? I gave them to the girl up front.”
“I told this to the nurse already. Don’t you guys talk to each other at all around here?”
“Ugh… are you going to make me tell the whole story again”
“it’s all in the computer. Can’t you go look it up?”
And
“oh, it’s been going on for a while now.” How long is a while? A week, a month, a year? “Oh, a loooong while.”
I second the comment about “a while!” Also, any history that involves a trip to Wal Mart, especially with extended family members, will be interminable and probably useless.
I called my PCP/cardiologist/oncologist/surgeon already and they said that they would see me in the ER. Why are you here?
(approaching triage counter from waiting area) Is this gonna take long? Cause I’m hungry and I have to go to the john, but if I get up I’m gonna lose my seat.
I’ve been reading a lot of these blogs where physicians and nurses almost constantly vent about addicts. Have you not heard of addiction medicine? Do you not “believe” that addiction is a serious medical condition? http://www.asam.org/ Just as you have heart specialists, lung specialists, neurologist on call, why is there no immediate consult with an addiction specialist when an addict presents in the ER? This mystifies me. You either cave in and give them narcs, or you deprecate and despise them. Not good medicine
Mine is totally “It’s all in the computer”. But I have to agree with “a while” and “don’t you ever talk?” as well.
“A while” is a good one, but my favourite is “Well, about ten years ago, [totally irrelevant thing] happened, and ever since then I’ve had this pain…”
“I’m allergic to tylenol and motrin”
“I’m allergic to benadryl, unless you give it IV”
Any pain score greater than 10.
DavidHowardOjai: “Do you not “believe” that addiction is a serious medical condition?” — No, I don’t. It’s a choice. Seeking help — instead of drugs — is a choice, too.
I agree with some others–”It’s all in the computer, I go to your clinic.”
Or, “Well, I told the first nurse I couldn’t breathe but I’m really here for vaginal discharge/medication refill/chronic pain x5 years.”
“This all started in 1968 when I had my gallbladder removed…”
Ojai, you’re reading the blog of an emergency physician, and I daresay that most of the blogs you read that vent about addicts are the ones involved in emergency medicine.
Drug seeking is not an emergency, yet the emergency dept. is full of drug seekers. These people are not there because they are ready to seek help for their addiction. They use up resources of time, effort, money, and empathy. I praise the doctors and nurses who snark, because they have found a healthy way to blow off steam. I have a lot of love for a good snark.
3am “emergency” call regarding flatulent dog
On Call DVM: This is Dr. Tired from Caring Vet Clinic, returning a call.
Insomniac Client: Oh, hi. I assume you’ve reviewed Fluffy’s chart?
OC DVM: No, sir. I’m at home, not in the hospital.
IC: Oh. Well, that’s too bad, ’cause it’s a doozy……..
“Uhhhhhh… ”
Which is followed by sudden-onset aphasia and pseudo-tonic posture, forcing me to play a guessing-game based on their reported complaint.
Addiction is a serious illness, and people die from it every day. But it doesn’t belong in the ER unless it’s an OD. People seeking drugs in the ER are using up time and resources. And there’s not much you can do in the ER for a drug seeker besides snark at them or give them what they came for.
Totally agree with Emma’s “Well it all started 10 years ago, when [totally irrelevant thing happened] and ever since then I’ve had this pain…”
Followed by “…and I’ve also had [list of totally unrelated and obscure symptoms]…”
Followed by a family member or friend breaking in to offer their own version of the whole story, and then the patient and this person spend some time arguing the finer points of said story.
AND they tell you the whole journey of how they got to the ER…”I was gonna come yesterday but [long stupid story] happened, then I was gonna come this morning but [more irrelevant stuff] happened…”.
UGH. It’s awful.
I wonder what would actual help to make patients better at giving a useful history? Posters up in the waiting area? Give’em something to write it down on? I arrive with a single typed sheet of A4 with current diagnoses and physicians and a basic background, and another with prescriptions… how do we teach everybody else (particularly those with complex conditions like mine) to do similar?
Addiction is a “disease” in the same way necrophilia is a “disease.”
And LOL @ quoting the ASAM.
I must agree with the above comments about drug seekers who eat up our time and resources in the ER. And I would LOVE to make an addiction medicine referral, if there were adequate programs available in my rural area; AND if patients were willing to make use of them. The great majority of seekers in the ER show NO interest in getting better.
Seekers are a huge problem. No two ways about that. However, stating addiction is a choice… Please tell me you are not a healthcare provider.
“I see you’re here for chest pain. When did that start?”
“Oh, I’m not having chest pain. I just said that to get back faster. I’m actually here for penile discharge and an STD check.”