CP r/o MI, another ER story

I have read this story twice now and I can’t figure out what her whine is?

It sounds like she did get care and did receive the necessary tests, Did she just want someone to sit and visit with her?

I have spent longer than that in an ER. I guess since she thinks she is important (being a dispatcher and all) that the world should have stopped turning until she was safely tucked into bed by the doctor.

Man ya’ll are a tough crowd. Let’s assume tha the patient was given all the right tests, put on the right monitors. It was determined that she wasn’t having a heart attack. Now, let’s imagine that instead of taking up a bed with this stable, non-heart attack patient, that someone could take ten minutes to tell her, you’re not having a heart attack, see your primary care first thing tomorrow and they let her go. Boom! There is a free bed, a relieved patient, and a staff free to do their jobs: help sick people.

Seems that the assumption is that there is something wrong with the patient wanting to be treated or released, but not left in holding for hours on end. I sure don’t see anything wrong with that.

I am reminded of the only time I have been to an ER (exept that time on LifeFlight) as an adult. Vomiting, lots of diarhea, obviously something wrong. Small community hospital, only three other people waiting. I was left to puke and poop all over myself in a waiting chair to what I am sure was the great horror of my fellow three waiting patients for almost an hour. Then I got triaged and sent BACK to the waiting area to spew more bodily fluids in front of and almost on those poor strangers. Hey, at least I had gained a basin to puke in from triage. Didn’t help with the feces all over me and the chair and the floor.

Another hour later I am taken to a bed. I am one of only four patients in beds. There are TWELVE empty beds in the ER. I counted. There are SEVENTEEN staff members sitting around the nurse’s station. Two of them are ACTUALLY reading novels. Within 30 minutes I had used all the toilet paper in my shared bathroom and had started in on the paper towels. I asked for toilet paper. I asked for toilet paper again. Within another 30 minutes I just gave up and wouldn’t even try to get back to bed because I couldn’t begin to clean myself.

When a tech finally came to get my blood she insisted she couldn’t take it in a bathroom while I was puking and pooping because it wasn’t “sanitary”. And SHE wouldn’t get me any toilet paper, either.

Folks, the problem isn’t always the patient.

Some statistics for ya, chucky:

*2-8% of pts presenting to the ED with CP are sent home with AMI.

*H&P and EKG miss 1-4% of all AMIs

*Serial EKG has a sensitivity and specificity (Sn/Sp) of 21-25%/92-99% for Acute coronary ischemia (ACI) and 39%/88% for AMI.

What about enzymes? Here ya go:
*Single Creatine kinase (CK): Sn/Sp of 37%/87% for AMI; Serial values have 66-99%/68-84% Sn/Sp.

*Single CK-MB: Sn/Sp 42%/96% for AMI; serial CK-MB-79%/96% for AMI.

*Myoglobin, single: 49%/91%; serial 89%/87% Sn/Sp for AMI.

*Troponin I single: 39%/93% Sn/Sp; serial 93%/85% Sn/Sp for AMI.

What about Echo? Here ya go:
*Rest Echo Sn/Sp: 70%/87% for ACI, 93/66% for AMI.

*Rest technetium-99 sestamibi: ACI Sn/Sp: 81/73%, 92%/67% for AMI.

*Exercise Stress testing for ACI:
-w/EKG alone: 68%/77% Sn/Sp.
-w/Echo: 85%/77% Sn/Sp
-w/thallium-201 or Technetium-99m sestamibi: 87%/64%.

Ripped from Rosen and Barkin’s 5 minute emergency consult.

Dex,

Thanks for the helpful paranoid reminders and why defensive medicine is the name of the game. Hell, if you are reading this right now and feeling fine you ought to go down to the local ER and get ruled out anyway.

ccdlled,

SOC was met. Sounds like she got the PE work up too. In a rational country you can practice medicine using some clinical judgement. You do the appropriate complaint related H&P and determine that she is low risk. EKG is normal, even lower risk. Depending on index of suspicion may or may not do markers. But not in this lawyer crawling, blame crazy country. Here you admit them all, rule them out with enzymes, rule out PE and every other zebra along the way wasting resources, clogging ED’s and hospitals.

So not only can you guys diagnose malpractice or the lack of it from a newspaper article, but you can do it from a first person account by the patient!

No wonder Frist was so confident in his diagnosis – he actually saw the patient.

“Because of the 1% uncertainty and liability concerns the whole system is clogged up looking for that elusive MI, PE, aortic dissection, etc…..”

Tell me chucky, what are the actual liability risks to the physician in this situation?

“…and it’s better to get 1000 complaints about the big bill or long wait to get a room or inconsiderate staff than one letter from an attorney saying “you have been sued.” “

What’s funny is that you’ve got it exactly opposite here scalpel. Study after study by physicians has shown that if you’ll just talk to your patients, and improve the level of customer service, they are much less likely to consult an attorney regardless of outcome.

I realize this goes against the physicians’ belief that more tests equals less liability risk, but that was always an anecdotal assumption not grounded in any hard facts anyway.

It’s amazing that as scared as all of you seem to be that you haven’t taken more time to learn exactly what you’re so scared of or how to reduce your exposure.