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Comments on: Expectations, or Letting People Down



Ramblings of an Emergency Physician in Texas



Last Build Date: Sat, 02 Dec 2017 13:18:31 +0000

 



By: jamie

Fri, 09 Oct 2009 04:32:35 +0000

Bravo, Mandar. I wish there were more docs like you in the world. Sometimes (as a patient with chronic pain), flareups send even the best coping mechanisms out the window, and a few days of pain meds literally will make the difference between feeling absolutely miserable/potential SI without a serious plan, but a desire to end it all, and being able to ride out the flare in more comfort until you can get to your specialist- especially if the specialist is hundreds of miles away. I've had docs who cut to the chase, didn't think I was drug seeking as an addict, and treated me like a person with a SERIOUS emergency- and yes, Migraines that go over 72 hrs without a 4 hr break in pain while awake IS a medical emergency... especially for those with other potential stroke risks... But, even the regular Migraineur in Status Migrainousus is at risk of a TIA.... and needs it broken, either via Mag Sulfate, a drug cocktail, or whatever has a hx of working for the patient previously. When a doctor asks me what has worked previously, and doesn't dope me up on narcs when I don't want them- just Mag Sulfate and Dexamethasone and Zofran- I feel like I've hit the lottery. For my neck, however, sometimes I DO need the narcs for a few days with muscle relaxants to get me through and to keep my head from getting involved in the pain cycle. And then- the 2 times I've HAD to go the the ER, it was even worse than being a Migraine Patient- which I thought was the "low of the low" on the totem pole of ER physicians' emnity... I was wrong, apparently. Chronic pain patients in crisis really need more doctors like you, who treat them like human beings, and ask what brought the patient there today. Sometimes, it's 'cause you can't take it anymore and can't get to your specialist immediately, or your PCP won't prescribe Narcs 'cause of FDA scares, and it's literally the last hope you have. And other times, it's for the flares that last longer than you have rescue meds for, and can't get them called in over a weekend... We, the patients, are totally in your hands. It hurts even more than the physical pain when I'm mistreated by someone who swore to "due no harm" and makes the patient even more desperate, and SI may increase. Thank you for caring, and treating us like any other patient that you may see during your day. You are a gem, and I just wanted to let you know how much people like me appreciate people like you. Best, J



By: Searching for hidden agendas when patients with chronic disease present to the Emergency Department | EMEDology.com

Thu, 08 May 2008 02:15:26 +0000

[...] post about dealing with patients presenting to the ED with their chronic illnesses highlights the challenges Emergency Physicians face when caring for patients with chronic [...]



By: Mandar

Thu, 08 May 2008 01:37:12 +0000

Sometimes I start the consultation by summarising their entire previous medical history in front of the patient. This shows that I am aware of their case, and really builds a trust and rapport. Patients appreciate the impression that you have already taken the time, care and effort to find out everything about them. Then I cut to the chase by directly asking what exactly they want from me today. Often with these patients, what they want is not purely "medical" (i.e. a diagnosis or cure). There is a hidden agenda - fear, isolation, stress, strained coping mechanisms, breakthrough pain, grief, being at the end of one's tether, etc. Sometimes the patients themselves haven't thought about exactly what led them to present to the ED that day! This sort of direct questionning certainly helps to crystalise in their minds what their expectations for the consultation are. By identifying this hidden agenda early in the consultation the Emergency Physician can focus the consultation on delivering precisely what the patient needs at that crisis point in their chronic illness, rather than offering what he assumes is needed.



By: Jony Menasches : Expectation Management

Wed, 29 Aug 2007 23:40:18 +0000

[...] http://gruntdoc.com/2007/06/expectations-or-letting-people-down.html [...]



By: [redacted]

Thu, 05 Jul 2007 03:40:16 +0000

I couldnt agree more with your sentiment as you wrote 'maybe some of the letdown is for me'. I believe the practice of medicine is largely about people-pleasing. In the end, however, patients appreciate humility over arrogance. Furthermore, admitting to a patient that you dont have all the answers garners far more respect than disingenuity.




By: MLO

Thu, 21 Jun 2007 14:07:26 +0000

Maybe I'm weird, but I thought ER physicians were for emergencies. I do not want an ER physician diagnosing anything more than the presenting emergency - that isn't their specialty. I want them to be well-versed in all the varieties of emergency medicine and how it presents. I do know that in my neck of the woods there is a dearth of walk-in clinics for those who are without regular doctors and become sick. Now in certain circumstances, taking a complete history makes sense. But, it seems to me this is a contributing to the costs of the ER. Pax, MLO



By: Amanda

Wed, 20 Jun 2007 23:26:54 +0000

From the patient POV, sometimes at least telling us what it isn't (like 911 doc said) can be helpful. I ended up in the ER a couple of months ago (I'll spare you the details -- see my April archive if you're super-curious) and at least the ER doc was able to tell me that I wasn't about to croak from prolonged blood loss, which was my concern at the time. My tests were so perfect it was disgusting. When I saw my regular docs the tests continued to be impressively normal, which makes putting up with my personal health situation a bit of a PITA, but at least the ER was able to tell me, when I was scared nerveless, that not only was I not going to die but that I was revoltingly healthy. Eh, it can be a double-edged sword. Plus side? I get to nag my family for a long, LONG time ;)



By: Prudence

Tue, 19 Jun 2007 14:55:25 +0000

It's also the same here in the country I'm practicing. Actually, there are even some who continually go to the emergency room for chronic problems. Somehow, some of my fellowmen still cannot distinguish between an emergency room and an outpatient clinic. Most would tell me that they get tired having to lineup for outpatient consult that's why they go to the emergency room. It's kind of frustrating for me that I've to explain to them that they shouldn't be doing it that way, for their own sake. Follow-up consultations are not done in the ER. But, well, still people are stubborn. About those who are chronically ill but the doctors can't seem to find out what's wrong with them, it's hard having to explain to these patients that there's nothing that I can do for them in the ER. But in situations like that, I try to tell them that all the tests have been done for them as ordered by the specialists they have seen, but the problem is, although modern medicine has improved very significantly in the last few decades, still it has limitations.



By: 911doc

Sun, 17 Jun 2007 04:49:32 +0000

great post doc. here's my generic pre let-down statement, "often the best we can do here in the emergency department is to tell you what you don't have. sometimes we can't tell you what is causing your problem, but we can make sure it's not an emergency." super, huh?



By: Mike

Sat, 16 Jun 2007 20:58:36 +0000

House whisperer, I'm not talking about the ones with the white count of 20K or the fever of 103. I mean the ones where its a social admit or a case where they could have observed for another hour or just taken a diagnostic stand and sent them home. I always give the ER the benefit of the doubt on the ones who look well now, cause I wasnt there when they came in. But when I've worked with ER prelims who are rotating through medicine, they groan as much as I do, so its not just me.