An ER doc gets pissed when PCPs tell patients to go to the ER. I agree, this isn’t an ideal situation, since many problems can be handled in the office.
“Just go to the ER” is the PCP’s way of practicing defensive medicine. When a patient calls outside of office hours, there is no way to examine the patient – short of doing a house call. Telling them to go to the ER is the equivalent of an ER doc admitting a soft chest pain for a rule out. Defense all around.
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Shadowfax makes some good points.
What may be underemphasized in after-hours care, though, is the patients ability to self-report accurately.
When someone presents to the ER with a complaint, the tendency is to accentuate the symptoms, and maximize their value in determining a diagnosis.
On the phone, after-hours, however, there is a tendency for patients to minimize symptoms, in the hopes that they can be told to “come in in the morning.”
Case-in-point: A patient called me last night because, after being seen in the ER for abdominal pain, deemed to be due to ovarian cysts, she was prescribed Tylenol with Codeine. In the past she had an adverse reaction to percocet characterized by difficulty breathing. On that prior episode she went to the ER c/o difficulty breathing and was treated. Last night, after taking codeine and developing shortness of breath, similar to the prior episode, she called because she wanted me to prescribe something for the acute episode so that she would not have to go back to the ER. She actually didn’t ask. Her boyfriend did because she was too short of breath to come to the phone. Nevertheless, they called asking for something to be called in. This episode was “just like the last one” and he felt that “she’ll probably be ok.”
I told them to go to the ER.
ER docs should note that telephone triage can be difficult, and most of us treat several patients (or several hunderd) for each one that is told to “just go to the ER.”
Call it defensive if you like, but in a situation like the one I describe above, I prefer to have a physician (which might be me) examine the patient.
I am an ER doc. All of this go to the ER really used to piss me off. Now I don’t really care and there is no use fighting it. I know the shift is going to busy, the waiting room is going to be full of stupid stuff. The patients with stupid stuff are going to be angriest. So what, they didn’t have to come.
Next.
Next.
Next.
Can I have another?
It is job security. Those that are told to go to the ER by their primary care doc are more likely to actually have insurance versus the 30% I treat for free.
The OB’s in my community are especially lame. They will send very stable first trimester bleeding FROM THEIR OFFICE. I know they have an Ultrasound machine in the office. Why not use it. The patient is totally pissed they are sent to the ER. I can usually do an ultrasound, bill for it, then tell them to follow up with the OB that they now hate.
I agree with the previous poster. I think there are bigger problems if you are an ER doc than these. Typically these are paying customers with simple problems. You want to get rid of this and have revenues go down, they should be glad these guys come in.
We don’t care if the patients hate us…we have enough jackasses coming in for uri, diabetes, and what not that we will never run out of patients, we are trying to shift the liability onto you…keep laughing it up…one of these times you’ll be sued for discharging the patienet we sent you…then we’ll be the ones laughing…
Anonymous 10:27
Why would you call a patient with a URI or diabetes seeking medical care in an office setting, a “jackass”?
Some of you guys are a disgrace to your profession. Its hard to imagine that some of you are really physicians. You act like children!
Does Kevin know, or even care, that his blog has turned more people against the medical profession than any news source on the market today?
Is “defense” a code word for “failing to do your job” now?
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