The Forty-Nine(rs)

In the last three days of my ED rotation, I’ve seen 50 patients. One of whom had an actual emergency (new onset seizure). The other 49 were just chillin’.

The worst part of the medical bureaucracy is the feeling that it’s never going to change. Example: three of those 49 patients called their PCP or clinic and were told to come to the ED just in case, because everyone is afraid of being sued. One of the 49 was at a local health center, actually being seen for her non-emergent problem, the health center nurse called some ENT to try to get her an appointment, the ENT told her to come to the ED. Was my only order on that patient “ED Consult to Otolaryngology”? You betcha. Did I feel bad about calling that consult? Well…. maybe just a smidge.

I try to be very clear in my discharge instructions what constitutes an emergent condition. A good rule of thumb is, if you think you might need to come into the hospital overnight, the ED is a good place to be.

I would love to see more Urgent Care Centers, but I’m told over and over that they won’t solve the problem because you can’t ask people to triage themselves. To which I say “Why not?” We ask people to vote for president and contribute to the infrastructure of their country through taxes. We allow them to drive 2 ton vehicles, consume mind-altering substances, and purchase assault rifles. If they can behave like responsible adults with all of the above, why do we infantilize them medically by insisting that they can’t possibly know if they are sick or not sick. And if someone triages themselves to Urgent Care when they should have gone to the ED, the physician or nurse practitioner there should send them over straight away. 

Internship is making me cynical, and kind of a horrible person. Battle-weary. I am not tired or fatigued per se, but I do need a vacation, a change of scene. Really I just want to go hiking, which I can easily do here, but I suspect there is still snow on the mountains. So in two weeks, I’m turning off my pager and going to Sedona, AZ. I may not come back.


One thought on “The Forty-Nine(rs)

  1. I think more urgent care is a perfect response. I’ve been to urgent care a couple of times when I couldn’t get seen by primary care in anything less than 2 weeks and had conditions that couldn’t wait that long. Granted, I’m a PA, but I don’t really think I was using any kind of extraordinary knowledge and my primary care referred me over. My insurance also recently sent out some information about after-hours and urgent care options. Another factor: urgent care visits have lower co-pays than ED, for me at least, which could encourage non-emergent patients over to the urgent are.

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