Saturday, February 12, 2011

Emergency Medicine

I have just finished a rotation in the emergency departement. As a child I never went to the emergency room, due in part to the fact that I never broke any bones or had any major accidents, but also because in my mind the emergency room was for people in extremis, those having heart attacks, strokes, car wrecks, etc.. St Louisans do not, however, harbor any such notions regarding emergency care. Here are some vignettes to illustrate the abuse and waste found in the medical system.

44 year old african american male presenting to the ED complaining of chest pain. Upon further questioning he actually has heartburn. He asks for Maalox. When asked why he came to the ER instead of buying a $4 bottle of Maalox at Walgreen's, he replies "the ER is cheaper".

21 year old African American female who was in the ED 2 days ago for heavy vaginal bleeding. She was given a script for medroxyprogesterone and an appointment today with an OB. When asked why she came to the ER instead of the OB, she said "I'm still bleeding, they told me to come to the ER". When the OB is queried, she replied "that's ridiculous, she can come to clinic, we never told her that". I love being lied to.

59 yo caucasian female with history of coronary artery dz, diabetes, hypertension, and depression comes in with "high blood sugar". Apparently she ate a bag of cookies, checked her glucose which was 486 (pretty high, but not astronomically so). Took 5 units of insulin, didn't re-check her sugar, and then called EMS. Came to the ED. Sugar in ED: 187. Patient unable to understand instructions regarding sliding scale insulin, and discharged home. This patient visits the ER weekly.

34 year old lady with heartburn, came to hospital via EMS.
Multiple drunk folks admitted to ED to sleep off their booze.

21 year old with severe asthma who snorted cocaine. Cardiac arrest, died.
45 year old cardiac arrest after doing cocaine. Died. (well, technically came to ER dead, we just coded her for a while. Same with the cocaine-asthma guy).

24 year old with history of 22 (!) intubations in past 2 (!) years for asthma exacerbations. Comes in after smoking (!!!!!) a cigarette and now wheezing like an accordian. Statistically speaking, this person will die within another 2 years from asthma. The only people in our day who die of asthma are those who insist on smoking.

21 who is "constipated" and hasn't moved her bowels in 1 day. Explained normal bowel movements to an adult.

33 year old man with heartburn. Describes classic timing after meals, positional nature, sour taste in mouth, relief with antacids. Not exacerbated by activity, no history of coronary disease or angina, no hyperlipidemia. Yup, another dude with GERD coming to the ER.

21 year old male whose girlfriend told him she had chlamydia, so he wanted antibiotics. When asked why he didn't go to any one of the numerous free clinics in town, he replied that it was cheaper and more convenient to come to the ER. This was after a 9 hour wait in the waiting room.

44 year old who was bumped in the knee by a motorized wheelchair who was upset when I ran out of his room when the cocaine-cardiac arrest lady coded. Sir, your utterly non-emergent mild knee pain is going to have to wait while we try to resuscitate this woman.

UTI count: 7.
Pyelonephritis: 2
Viral upper respiratory illnesses (colds): 5. Folks, the sniffles ain't emergent. No fever, no chills, no vomiting, no diarrhea,no abdominal pain, no chest pain, no shortness of breath = NO COME TO THE ER! See, a cold is a virus, so berating me for antibiotics is not going to work.

I'll post more stories of waste and abuse later when I can recall them all. Some of these are obviously not abuse of the system, but rather failings of the system as a whole. Why the diabetic lady who probably has an IQ of about 70 is giving herself insulin is beyond me.


Chris and Linzi said...

This was highly entertaining to read during my night shift so thank you. I think my favorite was the asthmatic with 22 intubations because all the kids we see with asthma have parents who freak out that you have to give them an IV, but smoke 5 packs a day sitting by their asthmatic child....

Lauren said...

Amen, Amen, AMEN. We see this all the time in our ER as well. The best is Sunday morning. There are usually about five beds lined up with college age males totally passed out drunk.

Mhana said...

I'm kind of hungry, but only a little. Should I come to the ER? Or have a snack? Which is quicker and cheaper? Our hospital looks like a ritzy ski lodge -- a good vacation destination?