A holiday message from your emergency physician

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I truly love my job as an emergency physician.

I think it’s the best job there is in the house of medicine, melding the most ancient of medical traditions (abandoned by many modern practitioners) with the most cutting edge tools of medical technology. And really I never love it more so than at this time of year. I went into this field to be of service to those in need, and Lord knows there is plenty of need, and plenty of service to be provided, in these days around Christmas and New Year’s.

I love it that (to borrow Edwin Leap’s awesome pun) I am among those “working knights” who labor at a dark time of year when everyone else in the medical community has set aside their patients for a brief, forsaking time. And I love it that emergency nurses, in my opinion, combine the best of every element of nursing into one awesome whole.

And although the following might read as a bit of a rant, I don’t want to discourage anyone from seeking emergency care over the holidays. Just the opposite. Also, I don’t begrudge my primary care and clinic-based colleagues the days off, which they have certainly earned. That being said, here are some thoughts about holiday medical care.

My patients. To those who choose to adopt a sarcastic or hostile tone the minute I walk in the room, please reconsider this decision. As physicians, we are constantly reminded to watch our bedside manner. It’s come time to remind patients that there is a corresponding “bed manner.” Emergency staff are stretched to the limit at this time of year providing all the care to our community. Pharmacies, doctor’s offices, and counselor offices are all closed.

Yes, we regularly have 3-hour wait times on Christmas Day and those that follow. It’s a mathematical reality you’d expect too if you think about needs and resources. If you’ve waited the full 3 hours, I’m not saying you shouldn’t have come, but you probably are using us for a non-emergency purpose.

And that’s certainly OK by me, but please don’t snidely say, “I thought you were playing cards,” or “We thought you’d gone home” when I do make it (usually at a run) into your room to learn about your rash of 6 months or your medication refill or cold symptoms.

Please understand, I’m not saying don’t come to me with these concerns, just please consider the context and how your bed manner presents itself. Nothing kills subsequent rapport with your doctor better than snide comments about your dissatisfaction with our perceived holiday speed as the first words out of your mouth. Especially when I may likely have just come from telling a husband he’s lost his wife of 35 years on Christmas morning or cried with expecting parents having told them their child has died in utero.

Your concerns are just as important, but yes, when coupled with sarcastic and nasty manner and when your providers are already emotionally and physically stressed themselves, it’s harder to offer compassionate care for your infected pimple.

My primary care colleagues. Again, I don’t begrudge you time off. And I am forever glad that I can bounce the non-emergencies back to you. I am wired for emergencies and acute/critical care and couldn’t do your job. However, please have some basic considerations for those of us working the emergency pits while you enjoy the holidays with your family.

Please actually supervise those who answer your phones and ensure that, when they advise people to seek medical care, it is appropriate, and have the pride to support that need when the patients do show up. Please in general be aware of a phrase that has become almost throwaway and routine now in medical care: “If that [x, y, z advice] doesn’t work, go the your closest emergency department” and consider if there’s anything we can actually do when they arrive.

I once had a primary care provider who was furious when his patient showed up in my ED. When I pointed out that she had followed his exact printed instructions to her and had come to the ED for precisely the symptoms for which he had told her to seek immediate emergency care, he thundered at me, “Well, God damn, we always write that on the discharge sheets, but I never expect anyone to actually do it!” Ha. Have some pride.

My most common 2014 issue: Please ensure your patients have prescriptions for all the days between their last appointment with you and their next. I can’t tell you how many patients I’ve seen who say their doctor blithely told them, “I’ll see you in 2 to 3 weeks” and write a 3-week prescription. Then the receptionist says, equally blithely, “2 to 3 weeks is the week of Christmas, and there’s no appointments, but we can see you January 7th!”

Guess who shows up on December 26th for their medication refill in the ED? And guess where that patient falls on the triage wait time that can be 1 minute (yes, even during the holidays) for a life-threatening condition to 3+ hours for completely preventable medical needs during this season, the epitome of which might be, oh, I don’t know, maybe medication refill?

And perhaps not surprisingly, just as a coup d’etat, 90 percent of these refill requests are for, yes you guessed it, restricted narcotics. Yes, I get it that pharmacies and patients themselves have some culpability here too, but the more vigilance you spend pre-holiday on your patient’s medication needs being addressed, the last chance they will be languishing in an ED waiting room on New Year’s Eve … likely contracting influenza in the process of refilling their blood pressure medication.

At this season, I am regularly reminded I am in the business of cleaning up after bad choices. Often the best phrase we can come up with after hearing why someone is in the ED is “that might have been a bad decision.” When you make a bad choice that leads to further badness, as a patient or a primary care provider, please let me help.

But also please keep the reminders above in mind, which will help not only your experience, but the overall functioning of the system as a whole. Best wishes to you and yours for a 2015 free of bad choices!

Seth Collings Hawkins is an emergency physician.

Image credit: Shutterstock.com

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