What would you do?

[sk732]

In a different vein, I had someone show up in the ER last night looking to have their TB test read that was planted by their famly doc a couple days previously...because he was told anyone could read it for him, so to go wherever.  I politely unloaded on him, then myself and my ER director sent a shyte-o-gram to the FMD with the F/U letter.  This is the problem in my system - the Canada Health Act prohibits us turning a Canadian citizen away from any emergency dept that walks in the door for any reason, even non-emergencies - we get away with ambulance diversions (ironically), but if you walk in the door, we can't turn you away...even for this complete abuse of the system.  I'd love to have sent the taxpayers' bill to the FMD and have him split it with his patient - this was a pre-employment screening test, not like he'd been exposed to something and actually needed it, so he (the patient) had some part to play in it - since pre-employment vaccinations/PPD screenings aren't covered under Provincial Health Care Coverage, he was hoping to skip the $25.00 or more that people are able to charge for the service.  That cost the tax payers about $1K to walk in for that.  On the other hand, we had a person yesterday that was sick sick sick that came in that was from the US - so he was going to have to pay up front and hope his insurance covered any or all the visit.  We couldn't even get the triage face sheet to go see him until one of the payment clerks saw him first to ensure ability to pay - ultimate irony to me.

 

SK 

[moestown1016]

Working in the ER I get why people tell their patients to go to ER if they can't do anything for them over the phone. I don't necessarily like it and I still won't write for narcotics or benzos but they get an eval and maybe vistaril or something not controlled to help symptoms. "Follow up with your pcp" is always on my discharge instructions.

 

 

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[Reality Check 2]

We live and work in a litigious society. If folks aren't told 100% what to do and why and given Magic 8 Ball information by phone - then they didn't receive good care or advice.

 

Going back to childhood - my military and very common sense parents took care of stuff without calling much of anyone. Pretty much had to have an eye hanging out to get taken to the ER. So, that has shaped my perspective.

 

Now, I have folks who "thought my rx was auto-refilled" even though it is a control and they haven't been seen in 14 months................ Really???

 

Folks think I have omniscient access to every medical record ever on them regardless of year, location or planet and that it autofills my brain every time I come to work - or they wake me up at 3 am to discuss something I have no knowledge of.

 

Many of my folks don't care about side effects or long term issues as long as they feel good right now and keep feeling good for the foreseeable future without having to invest much effort into it - popping a pill is soooo much easier than actually dealing with a dysfunctional job or relationship or a bad habit.

 

And, heaven forbid that a condition NOT have a medical diagnosis or treatment or cure. Deep sigh - sometimes there just isn't an answer.

 

These things wear me out and make me struggle with medicine as a career for the long haul.

 

Then you get the patient who is grateful, kind, loves the education and is happy to know I wouldn't give them a drug I wouldn't let my sister take. 

 

They are too few and too far between these days. 

 

So, when they call me at 7 pm on Friday night and say they are watching the rash spread up their arm as they speak to me and, yes, my lips might feel a little tingly - I am forced to say - go to the ER. Their answers shock me still - "WHAT?? I can't afford that. I'm not going to sit there for hours. That is all you can tell me? Some on-call service you are......."

 

"Well, could be anaphylaxis - I can't see the rash on the phone and NO I WON'T SKYPE WITH YOU. So, what you are telling me sounds bad and needs immediate evaluation and the only places open are Urgent Cares and ERs on a Friday night at 7 pm. Take 2 benadryl RIGHT NOW and have someone drive you or call 911."

 

"What is benadryl? Do I have to BUY that?"

 

"Just be glad it isn't an epi pen - those cost $500 now"

[ventana]

Working in the ER I get why people tell their patients to go to ER if they can't do anything for them over the phone. I don't necessarily like it and I still won't write for narcotics or benzos but they get an eval and maybe vistaril or something not controlled to help symptoms. "Follow up with your pcp" is always on my discharge instructions.

 

 

Sent from my iPhone using Tapatalk

 

perfect answer

[Katera]

I must not of read the post correctly. I thought they were referring to tapping a chronically swollen joint like a knee with djd, etc. That is why I said send to Ortho the next day. If the joint shows any signs of being septic, they are out of my UC ASAP. Straight to the ED. They almost all get admitted.

[Lauren R]

I wouldn't fill them.  Your patient can get a provider in his/her state.  I don't really tolerate people flipping out when they don't get a controlled substance that they wanted.  There are strict laws around this for a reason.  It's your license and your comfort with the medications.  You did the right thing.