Ok, so I finally finished a five day run of 12 hour day shifts. During this time, I have developed a grading system based on how my day was. It's the beer system. The more beers I feel I have to drink to get over my day, the worse the day has been.
Let us begin:
Yesterday: 1 beer
Today: 3 beers
A lot has been written about emergency departments in this country being used as centers of primary care. That's not what they're intended to be. We are not Fast Food Medicine. We don't take the place of establishing care with a primary physician. But still, sooo many patients come to the E.D. for basic medical care.
Like today. I don't know who opened the floodgates, but just about every patient I saw started their monologue with "I've had XYZ problem for the last week/three weeks/month/two months/six months." As my eyes slowly started rolling upwards and flitting at the top of my head, I would ask, "And, what was different today that made you come in?"
Seriously.
I know I bag a lot on some of the patients that I see, but I think that comes with working in this environment day in and day out.
Some patients I can sympathize with... most are indigent, living in shelters, they don't have a primary care physician and can't get to clinics, etc. on a regular basis. So they don't come in until they are in dire straits.
Shelters are starting to get ready for winter... by closing their doors. Supposedly they are "refurbishing" to be able to handle the increased numbers that will soon be arriving. So, the E.D. gets a lot of those people who are just looking for a place to sleep and be safe for a while. We even had one person ask, "If I say I am suicidal, can I get a room?"
A lot of people know how to beat the system. If you walk into the E.D.,chances are you will be triaged (sorted according to medical severity) and then sent to chairs to wait your turn. If you call an ambulance, you will be wheeled into the E.D. on a stretcher and most likely get a room somewhat faster. So, therefore, we get a HUGE volume of ambulance patients. But, on days like today, sometimes they get evaluated and sent to sit in chairs... and, they're usually not happy about it.
So then they get to know all the buzzwords that guarantee that they will get a bed sooner rather than later: words like chest pain, shortness of breath, chest pain and shortness of breath, substernal chest pain that radiates to my neck and arm. Really, sometimes it's like listening to a case from one of our medical textbooks. The patients get very savvy about using some medical terminology that will assure that they will be seen expediently. Then, once they're in a room, they start saying, "Oh, yeah, by the way, can you check my...." AND, "how about some pain meds and a box lunch?" Yes, they know we have a supply of sandwiches and milk kept in the E.D. refrigerator. They even know what kind of juices or sodas we keep.
So, we run lots of expensive (and sometimes unnecessary tests) because legally we can get sued if it's noticed that a patient came in complaining of something that wasn't addressed on their chart. Yes, folks, your tax dollars at work.
Officially, I have a day off tomorrow. I have a 1/2 hour meeting in the morning that will eat up about 2 hours of my time, but I am off, finally... now where did I put that six pack...?
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