Monday, May 4, 2009

Today's "Reason For Your Visit"

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list.  Some are funny, some embarrassing, and some just tickle my warped sense of humor.  I try to give the benefit of the doubt.  I know that these people are hurting and just want to be seen, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit."  Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.

So let's get to today's Reason For Your Visit:

<Doctor> Said Come here NOW.  Turning Blue.

Normally when I see something like "turning blue" on a sign-in form, I can laugh a little and take my time confident in the knowledge that people walking in the front door aren't turning blue, and that when a doc sends someone to the ER POV, it is generally just something that the doctor doesn't feel like dealing with.

Not this time.

Well, actually I suppose he wasn't turning blue so much as he was turning grey.  He was gasping for breath and spitting out mono-syllabic words.  The color was completely gone from his hands and fingers and lips.  In fact, Nancy Pelosi probably had more signs of life than this guy.  I hooked him up to the sat monitor and got low 80s down into the 70s.  This is where my triage ended as I scrambled to get him back to a room and on some oxygen and a heart monitor.  Unfortunately, we were slammed and I never did find out what ended up happening to the guy, though I fear that he may not have made it.

I was left wondering what on earth would possess a doctor to send someone with known respiratory and cardiac issues over to the Emergency Department in a private vehicle.  It boggles my mind to think that you can complete your training to become a doctor and not recognize the need for an ambulance when it is staring you in the face.  Okay, so you said go NOW.  It is important to let the family know how important it is to go the ER immediately and not stop for a latte on the way, but don't you want this guy accompanied by some ACLS-trained medics who can do the 12-lead and put him on oxygen and ausculate for lung sounds and intubate if needed?  All the family can do is panic, which is precisely what they did - and rightly so in this case.

For the sake of this Doctor's patients, I hope that there is something more to the story that I'm not aware of, because otherwise I wonder how he is allowed to practice medicine.


Linda Wyatt said...

I was on a call once, to a woman in a car by the side of the road, who had had a seizure and stopped breathing. She had been sent to the ER by POV, from her doctor's office. This was less than a block away from his office.

I was livid.

She made it that day, but died a few days later.

I hope your patient fared better.

ShrinkingDoc said...

Who knows what the heck the dr. told them. I can't even count the number of times our nurse line has told a patient to call an ambulance, I can see it documented in the EMR, and they show up by car in the clinic with their chest pain, etc. People frequently don't listen. So then they get a charge from me, one from the ambulance, AND one from the ER. I've had people do it who were sent by ambulance to the ER from the clinic the last time they had an MI. I do not understand.

Unknown said...

Someone who is gasping and blue and calls their doctor's office to see what they should do, probably isn't going to listen when the doctor tells them to hang up the phone and dial 911.

These folks are the flip-side of the system abusers we see. They don't want to bother anyone. I don't think my folks would use an ambulance even if they had a bone poking out. Some people are just like that.