Emergency?

Based on the two words that clearly describe what goes on in a hospital emergency department, you would be quite surprised on who walks into the ER. There are a number of people in their 30s with back pain. Back pain, by definition, is not an emergency. I go in and do some BS exam where I touch their back.

Me: Does it hurt when I press here?
Patient: Oh yes, lots.

We do an x-ray which shows nothing. Unless you have actually fractured your back, which is unlikely unless you are in a high speed accident or fall from a roof or something, an x-ray rarely shows any back pathology. What they need is an MRI, but unfortunately for them there is no such thing as an emergent MRI. The next question:

Me: Do you have a family doctor or someone you go to on a regular basis?
Patient: No. I need to get one.

Yes, yes you do. Because they need someone who will order a non-emergent MRI, and who will then help them with pain management and/or surgical referral if they actually do have something wrong with their back. Most of these people who come in are in their 30s, not much older than me. Seriously, how much back pain could you possibly have? I don't know if these people want their Vicodin or an excuse to miss work or what. And it wouldn't be so bad if we didn't see about 8 of these patients a day.

Then you have these people who come in who obviously aren't sick at all. You can tell just by looking at them they aren't sick, and it doesn't take a medical degree to come to that conclusion.

Me: How many times have you thrown up?
Patient: I don't know, maybe two?

News flash - people throw up from time to time.

There are some people who come in who are legitimately sick or could possibly be sick. And lacerations are always fun to take care of and suture. But sometimes even the sick people can be frustrating. It amazes me how difficult it is for some people to stay on task and answer simple questions.

Me: Did you get dizzy before you fell? (Simple Yes/No question.)
Patient: Well, you know... (long pause) ... it just gets so confusing sometimes...

Confusing indeed. Ten minutes later, the patient is still rambling on and I still don't have an answer. With some people I feel like I could talk to them for an hour and not have any idea what the hell is going on with them.

Me: Have you ever had a heart attack before?
Patient: Well you know, there was this one time 15 years ago when I was in the hospital...

It's yes or no! It doesn't take a 30 minute story to answer that question.

Again, not everyone is like this but a majority of the patients can be on some days. And after 12 hours of dealing with this, you are ready to literally pull your hair out. The fun thing about ER is that you can pretty much blow off most of these people once you've ruled out anything serious and the procedures are a lot of fun.