Thursday, December 28, 2006
Change of Shift, and "Minor Complaints"
This week's Change of Shift, the nursing blog carnival, is up over at NeoNurseChic. Thanks for including me, Carrie!
And, while we're on the subject of medicine, here's a subject that's been nagging at me for a while: the issue of people showing up in the ED with "minor complaints." DisappearingJohn wrote this post a while back kvetching about the problem, and during a recent volunteer shift, I heard a doctor venting about the same thing. "These people come in with nothing, nothing! They don't need to be here!"
A few notes: Everybody who talks about this acknowledges that people who don't have insurance have to use the ED for primary care; in addition, DisappearingJohn informs me, laws designed to protect the uninsured mandate that EDs have to evaluate anyone who walks in, even if the triage nurse considers the problem minor. There's also a trend where primary-care providers tell patients, "Just go to the ER," even for problems that might be better handled with an office visit. And some nurse hotlines, cautious about liability, seem to use "go to the ER" as a default (although the one I use has always been good about saying, "No, that's not that serious; you can see your primary tomorrow," or, "This doesn't sound serious now, but if XYZ happens, go to Urgent Care").
However, all these factors aside, I hear in many such complaints an exasperated expectation that patients should be able to figure out for themselves which problems are minor and which aren't.
Dear doctors and nurses:
Newsflash: We can't do that. In most cases, we don't know how to evaluate our own medical conditions. We aren't the doctors and nurses: you are. You're the ones who are trained to figure out if something's minor or if it isn't. That's why you get the big bucks. (Ed. note: Since this line has deeply offended certain readers, I feel obliged to point out that it's ironic; I've never heard it used any other way, but I guess some people have. See comments.) That's why you wear the scrubs and white coats and we wear the oh-so-fashionable gowns gaping in the back, okay?
Also, there are entirely too many people who go to the opposite extreme, who consider their own problems minor and won't seek medical treatment unless other people tell them to. Consider:
* My classmate in graduate school who had a huge red boil on her arm but wanted to wait until after our three-hour seminar to go to the university health service. My cousin had once had a boil like that, and it developed scary red streaks and he had to be in the hospital for a week, so I told her to skip class and go to the doctor. She said no. I said yes. I convinced her. She went to the health service and received very prompt treatment from ashen healthcare providers; about a week later, she told me, "My doctor's only now telling me how serious that was."
* Another friend who had an annoyingly painful paper cut, one she couldn't even see but that hurt like blazes, and who finally went to the doctor for it, feeling really foolish, and who then discovered that she had an antibiotic-resistant staph infection, and who spent quite a while in the hospital and had to take several months off work.
* The time I thought I had a stomach virus and was really embarrassed about going to the ED, even though my aunt the nurse told me to very firmly; the ED staff thought it was gastroenteritis, until the bloodwork came back with a white count of 29,000 (I know I've told that story here before, but it was pretty traumatic, believe me). A friend of mine told this story to a friend of hers who's a nurse, who evidently turned pale and said, "She could have died."
And then there's the sort-of-funny story an urgent care nurse told me once when I went in, feeling very embarrassed, to have a very small and painful splinter removed. (She took it out, and told me that I'd been right to come in.) She'd been working in an ED once when a call came in from a guy who said, "I have a splinter in my hand. Are you busy? Would it be okay if I came in now?" She told him to come in, but she and her colleagues were rolling their eyes about the wuss with the splinter -- until he came in with a 2x4 driven through his palm.
You see, doctors and nurses, if you ask us to decide what's minor and what isn't, sometimes we're going to err on the wrong side. We aren't the best judges of this. You are.
And yes, we all know that you have to deal with too many hypochondriacs, too many people who come to the ED for the wrong reasons (drug-seeking, social contact), too many people whose sore throats and coughs would respond very nicely to over-the-counter medication, and whose germs aren't doing the ED staff and the other patients in the waiting room any good, either.
But think about the other side: the times you have to tell a patient that he's having a heart attack, that she's had a stroke; the times when you have to tell patients and their families that a suspicious mass has showed up on the scan, that it looks a whole lot like cancer, that emergency surgery has been scheduled.
You hate those moments. I know you do. I've seen you steel yourself to deliver bad news. I've heard you say, "Oh, man, we just had a guy come in with an inoperable brain tumor."
I know that the patients with the coughs and sore throats take up valuable time, time you'd rather spend with the patient who's just been diagnosed with cancer. I know that your frustration with "minor complaints" is really a larger frustration at having too many patients and not enough staff. I know you wish you had the resources to give everyone your fullest attention.
But think about it: wouldn't you give anything to be able to tell your cancer patient, "It's nothing, really. You just need a bandaid and some aspirin. You can get dressed now and go home."