I remember in residency a little quick bedside teaching point that a very funny, sarcastic ER attending with a dark sense of humour gave me. I asked about the workup of a woman with vaginal bleeding and started blathering on about the huge differential diagnosis, etc. He shushed me and drew me the following flow sheet for their management. I always fall back on it when things look like they are getting all complicated. For the most part, it is very true – at least from the ER doc’s point of view!
Hilarious and accurate. I hope I come across some ER attendings with the same sense of humor.
Actually, this is great. It all comes down to “OR” or “don’t care”. Can’t get more simple than that! If they go to the OR, does that mean you automatically care? Is a hug in order? LOL
Happy New Years to you and yours.
Love it. I need to start making these diagrams for my law practice. Most of them would end up “don’t care.”
That’s great. I love it.
I like flow charts that end up in “Don’t Care”
This guy sounds like a smart man!
I know “don’t care” means pass her on to the OB-GYN because the ER doc isn’t going to treat bleeding in a stable patient – but he had better keep his “don’t care” well-concealed because the bleeding pregnant patient most likely cares desperately.
“Don’t care” is one more blow, one more insult piled on overwhelming fear or grief… and it lingers, and matters, later on.
It means “Not my problem” or in other words, out of the scope of emergency medicine.
Or, as I say, NMO- Not My Organ.
“The patient’s problem is NMO. Neurology signing off.”
@ elsi:
It doesn’t mean what you’re reading in to it. It just means what ERP said. Outside the scope of emergency medicine. Go see your OBGYN for a followup, because it’ll wait till then. Next patient!
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Don’t care just means Follow up with your OB/GYN. I get these patients in the ER all the time. Most have OB/GYN doctors. If you have time to come to the ER, then you have time to go to your GYN for evaluation. Its usually not life an death.
I find the majority of patients (+ pregnancy test at home without insurance) want a free ultrasound and to be referred to the clinic. Be nice and come in during the day time so we don’t have to call the ultrasound tech in during the middle of the night.
I’m not sure I understand. Do you do an ultrasound?
I went in with cramping and bleeding at what I calculated at 12 weeks and they drew blood saying I was 6 weeks…I knew it was wrong because I had known longer than that but couldn’t get any answer except if it persisted go to the doc on monday.
I was tortured all weekend and getting worse until they gave me an ultrasound mon. but didn’t give the results I was refered to an ob who did an ultrasound in his office telling me that was why my blood work said I was only 6 weeks, the baby had been dead and my levels were dropping.
Had the ER just done an us to begin with I wouldn’t have gone through all that misery for days
I’m just saying that “don’t care” meaning “not my problem, organ, bailiwick” (yes, I got that) often comes across as “don’t care, your loss or fear of loss is of no significance in this world or to me.” I’ve seen it a few times.
And ERPA, we’re not talking about patients with a positive home pregnancy test – we’re talking about bleeding pregnant patients. Don’t let the home testers with no insurance mis-using the ER desensitize you to the women losing their babies.
A while ago I took care of a woman in her second trimester who’d been to the ER with cramping one day – no problems found – and lost her baby at home the next – and the paramedic was making little jokes to her. To lighten the mood, you know. She was stable, so all was good…
Don’t forget you can substitute “call hospitalist” for “don’t care”
“Don’t let the home testers with no insurance mis-using the ER desensitize you to the women losing their babies.”
I think you are missing the point elsi…he already is desensitized.
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I’m just a dumb layperson here, about to demonstrate my ignorance. But the geek in me just wants to point out that if your first decision point were then you’d get all of those unstable patients to the OR without having to go down another level. The way you are doing it, you are making a pregnancy check first on everyone, even on unstable patients where it doesn’t matter. Why not just send the unstable patients straight to the OR as soon as you know they are unstable, regardless of whether or not you know yet if they are pregnant? Obviously, you still have to do the pregnancy test. But you get to the disposition quicker my way.
Theoretically true Teresa however the procedure to deal with an unstable patient who is pregnant is very different (and has medico-legal consequences) than with a nonpregnant one.