What two things go great together? Or maybe not. What two things have absolutely nothing to do with each other but somehow, you emphasize them as if they did? Pinky toe pain and chest pain of course! Why not come in to the ER at 5am for that? Why? So you get seen faster! Yes-sir-ee folks, come in for your atraumatic toe pain and mention that you also have been having some chest tightness. Could they be related? No! But since you are 55, are obese, and you smoke, you are going to get a bunch of tests you really don’t want (all you really want are some “pain pills”), and will have to sign out AMA since you don’t want to be admitted to rule out MI. Oh, and you are getting some Naprosyn for your toe. That’s all.

Note the quotes as this is Nurse K’s preferrred spelling for patients afflicted with either psych disease or a very poor grasp of reality.

Last night I just kept seeing them. Crayzee chronic back pain wants something “stronger than OxyContin”, crayzee anxious chest pain who says that “Ativan makes me jittery”, crayzee chronic abdominal pain in a schizophrenic, crayzee ETOH-eur who is now cutting himself, crayzee anxious lady yelling and screaming with epistaxis, crayzee anxious parents with a kid with a viral syndrome, crayzee young woman with bipolar disorder who called EMS for a tiny rash.

Then finally I had a patient in Rapid Afib! Hurrah! Finally a condition I can actually DO something about!!!!

Hmmm. How many cases are a waste of time (and money) during a typical shift? I am curious so I am going to take a pol. All you RN’s, EMS workers, Docs, and other health care workers, tell me how many calls/cases/visits during a typical shift. When I say waste of time, I mean a complete waste. Not something like a minor laceration or URI symptoms (which although simple to deal with, technically is not a waste if you actually perform a procedure or make a diagnosis that you can treat). Tell me what sort of things are total wastes – where literally you can do nothing for the patient but you have to spend time that could be spent accomplishing something productive. The reason I am asking is that lately I have had a run of two types of patients – those that you have real complaints, real diagnoses, and real reasons to be seen in the ER, and those that really have no business being there. These time-wasters I think are a huge percent of our visits. Perhaps 30-40 percent on some shifts. God knows how much money eliminating even half of them would save.

For example:

Floor staff that have to be evaluated in the ER to “make a report” of an incident on the floors – like a tiny scratch from a demented patient or for getting spit on by the same old demented guy. Waste of time – you don’t need to be seen in the ER to make a report – go to employee health next time they are open.

Patients who come in to be admitted for elective procedures – but insurance won’t pay for it unless it is an “emergency”.

People who need a work note when they missed work for some minor reason

Drug Seekers – don’t get me started

Young healthy psych patients who need to come in for “medical clearance” – Bah!

People who stub their toes but can still walk on them. Sorry kids, there is nothing to do except buddy tape them even if they are broken!

Nursing home patients who are DNR getting sent in to die. So the home’s in patient death rate stays low.

People with chronic medical problems who need to be seen in the ER first so they can be referred to the clinic.