From R. Lyles Blog - The Things I Ponder 16 things to avoid saying in the ER I hear these things a lot. The people I work with hear them a lot. We hear them so often we just grind our teeth and wonder to ourselves and each other, “Why do people say things like that?” Maybe it’s miscommunication. What you say and what we hear are two different things. Maybe its unrealistic expectations on your part or on mine. Maybe its a fundamental difference in the understanding of what we are there to accomplish. Maybe its human nature. I know the miscommunication works both ways. I have heard stories from friends about how simple phrases we in healthcare use everyday can be terrifying. Take, unremarkable brain scan for example. So, from a providers standpoint, I want to make a few suggestions of phrases patients should avoid saying or things to avoid doing while receiving emergency care: 1. If you call the Emergency room ahead of time to see how long the wait is….you probably don’t have an emergency. We have no control over how many people decide to come in and what they decide to come in for. We do use a system called “triage” very shortly after you arrive to sort out people who are likely dying from those who are seriously ill, from everyone else. If you are in the first two categories and there is a legitimate chance of your life ending in less than 24 hours, it doesn’t matter what the wait time is… you are going back. If you are not in life-threatening condition, which we determine using years of education and experience, you should be thankful you didn’t have to be taken back immediately. The ER is not the place to gripe about wait time. If you want to have an appointment, try calling your primary care provider in the morning or going to an Urgent Care. If you don’t have a primary care provider, take this as a wake-up call that you need one. 2. Never use the phrase, “I have a high pain tolerance”. ER translation: I want pain medicine and lots of it. If this is not the message you are trying to communicate, don’t say those words. Technically a “high pain tolerance” means that you should be able to tolerate a lot of pain and shouldn’t need as much medication as someone else with your condition. Trust me, this is the worst thing you can say to get your pain addressed. 3. “It’s in my chart”. Seriously, this is your life and your health. You should know this information. What if the chart is wrong? What if it’s out of date? What if you’ve said that so many times that is no longer accurate at all? This phrase communicates that you want me to care more about your health than you do and that you expect me to go dig through your chart to find out information you are too lazy to remember yourself. If you have a complicated medical history or are on several medications, bring a list. It’s a simple thing that sends a positive message to the people taking care of you. 4. “My lawyer told me to come in”. Really? If you think you have a medical emergency, you should be consulting a doctor, not a lawyer. I might have already suspected that you were here for that reason, but now that you went ahead and told me to my face, I will be very careful to accurately chart the extent of your non-injuries. And as a tangent: a car accident does not automatically mean that you need to go to the ER. If your airbag didn’t go off, your vehicle is still drivable, there wasn’t an ambulance called to the scene and the worst of your injuries is that you are “sore”- take some ibuprofen and make an appointment with your primary care provider. 5. Rating your pain above a 10. The pain scale is practically useless nowadays because you think that telling me that your pain is worse than humanly imaginable will make me believe you… it doesn’t. Be honest. Do you feel like someone is sawing off your leg with a chainsaw? Sure, say that your pain is a 10. But I’m going to be looking at objective signs of pain like your heart rate, breathing, posture, movements, and the fact that you are still texting, and treat you according to the objective pain scale and not just the fact that you told me you are an “11”. Secondly, please, remember what you told me your pain was the first time. Because even if you don’t remember what number you said, we do, because we had to chart it. 6. Allergies: If a family member is allergic to Penicillin, this does not mean that you are. If your mother told you that you were allergic to penicillin as a child, ask her what happened. Did you get a rash, did you have a seizure, did you swell up and stop breathing? It makes a difference. And a pill making your nauseous is not an allergy. It’s a side effect. 7. “I didn’t take anything because I wanted you to see how bad my pain is.” If you are in pain, take something for it. That’s what over the counter medications are for. It’s good stuff and it does work. And please take the recommended dose on the label. We will be much more likely to believe you if you actually tried to take something for your pain before you showed up and want narcotics. Often, an anti-inflammatory actually helps with the source of your pain as opposed to stronger medications which just block pain-receptors. If you want us to believe you are in pain- take something for it before it gets bad enough you think you are dying. 8. “I knew you wanted to put your hands on me”. In general, flirting, making a move, or any sort of comment about you and I as anything other than caretaker and patient is repulsive. You are supposed to be dying remember? Please know that after I finish vomiting in the back of my mouth, I will limit the time I spend in your room to the absolute minimum necessary and no, I will not laugh it off when you tell me you are just kidding. It’s not flattering, it’s insulting. 9. “I need an antibiotic.” Actually, most likely you don’t. You can be sure that I have assessed you and your symptoms and that if you need one or are likely to need one, I will prescribe you one. If I didn’t, I most likely just had a long conversation with you about why an antibiotic is not going to help you. If you don’t believe me, follow up with your primary care provider tomorrow. If you don’t listen to me and my explanation, why should I listen to yours? 10. “That’s not what they usually give me.” This is an emergency room. Hardworking people spend a lot of time and effort trying not to end up here. If you have a job and health insurance, it’s expensive. Saying things like that just tell us you are here way too much and you are most likely not footing the bill. Although the bill shouldn’t change how we treat you, it has changed how you treat the emergency department. I tell you what, when you establish with a primary care provider and whatever specialist you need and you make and keep regular appointments with them and you only come to the emergency room when it is a true emergency, then I will treat you like the bill doesn’t matter. But for now, since I will be paying for your visit, why shouldn’t I get to decide what you get while you are here? 11. Name dropping. I don’t care who you are or who you know. The only reason to name drop is to try and use influence to get better or faster service than everyone else who is waiting. It implies that I and everyone I work with are not already doing our best and I don’t appreciate your implication. If you want faster service, all you need to do is come in the back door as a CPR in progress. 12. “I want you to write me a prescription for that over the counter medication.” I think this one is pretty self-explanatory, but it’s amazing how often we hear it. You just came to the ER for a condition that you can treat with a medication that doesn’t require a prescription. Maybe you truly thought you might be dying. Now you know better. Most likely I am going to be paying for your ER visit and now you want me to pay for your medicine too? 13. “I’ve been here like 17 times for this same thing”. Translation: there is nothing emergent going on and I haven’t followed up like I was told to or taken the medication that I was told to or stopped whatever activity I was told to stop. I want you to reinvent the wheel and find what everyone else missed or I want to you to give me a magic pill that makes me better without me having to change anything about how I live my life. 14. “Can I get something to eat?” You are dying remember? If you are less than 5, older than 80, or have a blood sugar less than 70, this doesn’t apply to you, otherwise; take a chill pill. Hunger is a good sign that something bad probably isn’t happening to you. And don’t you dare send someone out to bring you McDonald’s…. if you do end up needing surgery and your just downed a #5, you are going to make a lot of people unhappy. 15. “You didn’t do anything for me”. This is simply never true. From the time I lay eyes on you, I am using my education and experience to evaluate your appearance and posture. Whether you made eye contact, what your breath smells like, the words you use and how you speak them is noticed. Your general state of health and how much time you spend on hygiene is noticed. The rate at which you speak and how many words between breaths. The way you move to from the chair to the bed and the unconscious movements you make as we talk. Your gait as you made your way to the exam room was likely assessed. The words you use to answer my questions and the way you describe what is happening to you. You have undergone quite an evaluation before I even lay a hand on you. Then I physically examine you. To you it may not seem like much, but everything I’m doing is giving me information about what is and what is not likely happening. Often, I can make a fairly good call after using my questions, eyes, ears, and hands. Just because we didn’t send you through a fancy machine, or poke you with a needle, or put you in the hospital overnight, doesn’t mean we didn’t do anything for you. The truth is that you don’t understand what I have done for you, not that I haven’t done anything. Saying, “I don’t understand how you came to that conclusion”, might actually encourage your provider to explain their reasoning. 16. Complaining. You can let me know you are unhappy with your care. The fact that you are able to complain about it is a point against you however. You are healthy enough to let me know how unhappy you are and that is a pretty good sign you are going to be okay until you follow up as instructed. You might not be perfectly healthy, you might be in pain, but you are alive. An emergency room is there to keep you from dying and to admit you if you are really sick. When you come to us we ask, “Is this person dying or at risk of dying without intervention?” “Do they need admission to the hospital?” if those two questions are no, we instruct you to follow up. That’s what we are here for. You may think you are dying, but we have actually seen enough people die to know the difference. If its not life and death you are upset about, maybe you came to the wrong place. Finally: most of us chose to do this job because we want to help people. If we seem to have lost sight of that fact, maybe you could say a prayer for us? A wise man once said: A gentle answer turns away wrath, but a harsh word stirs it up (Prvbs 15:1). The ER can be a pretty harsh place for those who work there and not just those who come to visit. A kind word can make a big difference. Most of us actually would like you to have the best experience possible. Just keep in mind that we consider “best experience” from the perspective of life and death and not “how pleasant was your stay”.
Posted on: Mon, 01 Dec 2014 04:32:57 +0000
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