A story that is shared in ERs across the country:
If you present to the ER with chief complaints of headache AND chest pain, then you are most likely suffering from an anxiety disorder . . .. . . Don’t worry, I’m still going to do the CT scans, ECG, cardiac monitoring, and blood tests anyway. I’ll probably even admit you. Maybe you’ve got Lyme Disease. Probably not. Expect a humongous bill when you are discharged with nothing. It costs a lot to make sure your anxiety disorder isn’t something worse, and either of your complaints MIGHT be something serious. However, in my experience, the presence of chest pain and headache together is almost diagnostic of anxiety disorder without any tests at all. Unfortunately the lawyers have trained us to order a gazillion tests and overadmit to cover our butts.
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{ 11 comments }
Brilliant ER observation.
Also the more “numb and tingly” you feel the less I am concerned.
Face it: If you present to the ER with ANY complaint and Chest pain you’ll get admitted and at least a $10,000 workup. I’ve noticed that even the few ER Docs who claim not to don’t worry about lawsuits admit all chest pains, or even epigastric pains, shoulder pains, any pains geographically close to the heart. It is drilled into us that the Lawyers make a killing on missed MI’S. Last night I admitted a 31 year old with chest pain for “R.O. MI”. It was her 3rd admission in one month! Definitely an anxiety disorder. But what the Fuck do I care if she gets admitted, the last 2 docs admitted her, until she has a Cardiac cath she’ll get admitted every time. It’ s our revenge that the politicians could care less about tort reform. Why do you think the healthcare system is so clogged up?
I admitted a 26 year old female with chest pain. Her ECG, cardiac enzymes, other blood tests, chest X-ray, and CT scan of the chest were entirely normal.
But she was an attorney, so…….
I’ll bet she also had a headache and felt “numbness” but emphatically was in denial that anxiety could be playing any role.
Hopefully she gets a nuclear perfusion scan during admission with equivical results leading to a cardiac catheterization. In addition to the CT, those will greatly increase her odds of getting a radiation induced cancer in 20 years.
No. Hopefully she’ll get a CT scan with contrast to rule out PE, will have an allergic reaction to the IV Dye. The radiologist, freaking out because she is an Attorney, Will give her IV Epinephrine by mistake, causing her to go into V-Tach. He will then do an awake defillibration out of VTACH (After all, it was years ago he took ACLS), giving her the 360 Joules every Lawyer deserves, and thus “saving her life”.
Y’all are harsh. I would think her karma debt would be met after all the expensive extra studies we could have ordered: venous dopplers of both legs, protein C, protein S, V/Q scan followed by pulmonary angiogram, echocardiogram, Cardiology consult, pulmonary function tests, Pulmonary consult, multiple respiratory therapy treatments, Rheumatology consult, lyme titer, ASO test, ESR, c3, c4, anti-dsDNA, ESR, heavy metal screen……
She’s only 26 after all.
Patients expect and want expensive work up’s for chest pain today. If a patient presents to the ER with chest pain, you pretty much have to admit them:
http://rebeldoctor.blogspot.com/2006/10/usa-today-raises-healthcare-costs.html
“If a patient presents to the ER with chest pain, you pretty much have to admit them:”
I agree. I’ll bet if you survey the ER physicians who blog here, 100% admit all chest pains they see. A large percentage have probably also been sued for a missed MI, even though half the time thre’s no way to prove the patient actually had an MI. The truth is not necessary in the lawsuit business.
No doubt, many of my psychiatric consults requested on our telemetry floors are to r/o anxiety or depression.
Unfortunately, while thallium scans and enzymes and CTs may be near universal, how many get a psych consult? Or are referred for treatment?
This is great advice. Many people must have already been “scammed” like this. The reality is that today’s health system is filled with bills, bills which not everybody can afford. It is a disaster. A disaster which will plague us until the next great health reform which we all await so anxiously. Maybe the only good thing in all this mess are the mail order pharmacies. But perhaps that’s because we never interact with them except on virtual level.
You know I really wish that some of you doctors would get REALLY SICK and REALLY SCARED with no result being found just 1 time in your life. So what if it is anxiety disorder, in alot of cases anxiety is a symptom of an underlying disorder. I am an anxiety sufferer but also have mitral valve prolapse ith regurgitation so many times I didnt know if I should go to the hospital or if somethingwas really wrong and was told I was crazy even went to counseling the docs did not take me seriously until I started having 2-3 periods in a month and discovered I had a bad case of hypothyroidism. My doctor apologized for taking my anxiety lightly when his own son started having anxiety. He was even committed untill the next night when his dad took him out AMA and took him to another hospital where they found serious problems with his gallbladder and as they were remocing it from his body it burst. His son is fine and anxiety free now. come to find out anxiety is a symptom of gallbladder disease. No case should be taken lightly ever, if you can’t be compassionate or let your job get to the point that you are that annoyed with people then you need to find another profession….Maybe if you cut in half the time you spend with the drug reps you would have more time to be compassionate
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