Although I appreciate that you must have great confidence in my clinical acumen, I hate to break it to you but I am not able to figure out what the cause of your sore throat is. See, you’ve had it for three months, have seen two ENT’s, ID, and an oral surgeon, and have gotten CT scans and cultures and blood tests out the wazoo.
Best I can offer you is a viscous lidocaine magic mouthwash. Sorry

No, I don’t mean the 1 am impacted esophageal food bolus, the bane of the the Gastroenterologist’s existence.  I mean the patient bolus.  There is nothing worse than when a boatload of people arrive in the ER at once.  It doesn’t matter if they are sick or not (even a whole bunch of relatively simple and quick patients can screw you). when 10-12 people arrive in one hour, you are instantly overwhelmed. You could be chugging along, dispo-ing 2 patients or more per hour per provider and then, WHAM, you’re done.  It’s even worse when you get a mix of walk-in’s and ambulances.  Even if your ER is fully staffed and on the top of it’s game, you are going to see a rise in the wait times to be triaged, roomed, and to see and doctor. End of story. You can’t be expected to just suddenly see 5 people at once.  You go into a different, damage control mode and just try to see the sicker ones and then whittle away at the pack.

Metrics get worse, patient satisfaction scores plunge, left without being seens go through the roof. That’s life.  Patients, the public, private doctors, and administrators have to realize that.  Eventually you’ll catch up – if you get 2 hours where no one shows up. Not likely in this day and age.

As we have blogged about before, if there is one chief complaint that annoys the crap out of me, it is hypertension.   And when I say that, I mean elevated blood pressure in someone with a long, well known history of chronic hypertension.  Quite simply, it does not matter in the short term AT ALL.  I’m not going to reiterate all the previously mentioned reasons why it is never an acute emergency in an asymptomatic patient but suffice to say, I spend a lot of time educating patients (and stupid doctors as well) about how it is worthless to send come in for some isolated elevated blood pressure numbers.

Anyway, I can’t blame patients too much since they don’t understand. They hear all the time “Get your blood pressure checked!  It’s the Silent Killer!” so if they see a systolic of over 200, they freak.   But what really is upsetting if the number of doctors who don’t get it.  I don’t know if they are just afraid of lawsuits or are just plain stupid.  Acute lowering of BP in an asymptomatic patient  is dangerous – especially in old people.   So we had a lady in her late (!) 90′s get sent in from the nursing home (at night of course) because her blood pressures were over 200 for several hours.  She was not really demented and was absolutely without complaints – except that she says every time she gets her blood pressure checked, she gets really nervous!   So, given this, might you as a doctor think more about treating the anxiety that the blood pressure itself?!?!  No. Of course not. You’d blast her with numerous BP meds and send her in.

Guess what worked?!  A tinesy-tiny dose of Valium!  Her BP came down (almost too far by the way) from 230 to 160.  Thank you very much doctor. Feel free to use this secret technique periodically on your own so you don’t need to waste Medicare money by sending people in for this nonsense.   And no, you don’t need to check a whole bunch of blood tests, an EKG, and a head CT on patients like this.