I have to say, in some cases yes. And I challenge any EM physician to truthfully say no. Now, I am not talking about sexual or racial bias which is another subject altogether. I am referring to “complaint bias”. A recent pilot study was published out of Australia and referred to in the recent edition of “Emergency Medicine News” where the investigators polled EM docs at three hospitals as to what their favourite and least favourite chief complaints were. They then compared this data with data on wait times and found what if you ask me is totally obvious. Patients with the least favourite complaints tended to wait longer than those with the favourite complaints. What complaints were the least favourite? I think the answer is nearly universal in Emergency Medicine: Dizziness, back pain, and constipation. These complaints are almost never either fun, challenging, or satisfying to treat. Dizziness is such vague and common complaint and it is usually completely bogus – ie peripheral vertigo, psych problems, or god knows what. The problem is that it rarely is something like a stroke or serious neurological /medical disorder. We often can’t really make any good diagnosis in the ER and the patients either get lots of drugs and or IV fluids with the hope they will feel better or just get admitted (usually if they are old) for further inpatient workup. Even if psych is not the cause of the complaint, psych problems often are present in these patients concominantly. Back pain is also not fun – most of it is just musculoskeletal or sciatica pain and we just dope people up til they feel better and go home. Often it is a chronic problem and drug seeking is involved. However, rarely it is something like a leaking aneurysm so you can’t just totally blow it off. Constipation is horrible for the fact that once and a while, you have to manually dis-impact the patient – which is foul and no one likes to do. Usually you get by with ordering enemas and magnesium citrate – which nurses hate to give. Rarely however the person may have serious abdominal pathology but it often hard to diagnose without time consuming and expensive CT scans. Since these complaints are rarely serious and since we dislike them so, it is only natural that they wait longer. We simply just hate these patients complaints.
As for the most favoured complaints, it is only natural that they tend to be straightforward and present usually obvious pathology and treatments – fractures, dislocations, and palpitations (although that last one is not one of my favoured unless they are really tachycardic at triage and have SVT or something). It was found that these chief complaints tended to be seen much sooner. Anyway, I am going to make my own list here of top three hated and loved chief complaints – let me know yours.
Favourite:
1. Impending Respiratory Failure – I really like to intubate.
2. Simple Fractures – easy to diagnose, treat, and discharge.
3. Red Eye – either very easy to deal with (like abrasion or conjunctivitis) or interesting to me (iritis, keratitis, glaucoma, or more serious ocular conditions).
Least Favourite:
1.Dizziness – as above is universally loathed
2, Chronic Anything Pain – I can’t stand it.
3. Headache – the spectre of doing an LP when I am very busy is always looming – as well as the constant potential for lawsuits.
Just curious if biased doctors ever get impatient waiting in a line while feeling good.
I am sure – if we are in a line waiting to complain about our cable bill I am sure we will be growing roots.
If you distinguish between “dizziness” and “vertigo,” and more than 20% of your vertigo patients are being diagnosed as psych problems, you are missing stuff.
The thing is Matt that I am talking about the “chief complaint” – ie what the RN writes on triage. If the patient said “lightheadedness” that would be different – most doc’s like that complaint better since it is more likely due to dehydration or hypotension. More straightforward. Dizzy is so nonspecific as to be beyond frurstration most of the time. Also, for whatever reason, many people with psych problems tend to say that hey get “dizzy”.
For the sheer satisfaction I get in taking care of them, my favorite patient/condition is the male with acute kidney stones.
I have to agree with Lou. As an RN, the kidney stoneurs can be tough for the first 10 minutes, but once you get that Dilaudid on board, they are your best friend and usually are pretty straightforward.
And interestingly, I find surprisingly few drug-seekers-by-renal-calculi.
[...] Does your Bias Cause Longer Wait Times? Posted on December 23, 2008 by coptermedic From ER Stories: [...]
I agree with the favorite: kidney stones. Easy to diagnose, happy once they get toradol or dilaudid.
Most hated: vag bleeders. I hate doing the pelvics. There is a reason why I didn’t go into Ob/Gyn, and that’s one of them.
Don’t mind dizzy as much anymore. Do basic EKG, labs if need be, exam, IVF—–and most youngs ones go home. Most older ones get admitted. Very easy to justify. Not as cost-effective as I once used to be, but in today’s med-legal climate have no choice and have caught a lot of sneaky pathology that way.
Male stones are nice. Don’t mind the vag bleeders. Either prego or not. Either bleeding out or not. Either IUP or ectopic or threatened Ab. Then done—dispo.
Hate:
weak and dizzy
vag bleeders
total body dolor
Enjoy:
fractures/dislocations (i enjoy pulling even if it is time consuming)
med refills (seriously easy)
bad traumas
Is this why, when I went to the ER for a severe migraine accompanied by facial numbness, they let me wait for 6 hours until I decided I would rather die in bed than in that stinky waiting room? It takes one shot and ten minutes to fix! And I ALWAYS decline always-offered the narcotics, lol.
For the record, I went to Casualty in the UK with “lower back pain” and was seen immediately.
Why? Possibly because I am a trapeze artist and had injured myself doing a dismount. The docs were fascinated – but then all the other patients were little old ladies with bunions (not kidding – I overheard the lady in the next cubicle).
I would hope that someone with a fracture or dislocation would be seen before someone who is dizzy or constipated. That seems like correct triage to me, not bias.