Kristin Prentiss Ott, M.D.

10 Things to Know Before Your Next Visit to the Emergency Department

1.  Wait times in most emergency departments are RIDICULOUS! But, if you have a real emergency, you won’t have to wait

If you have abnormal vital signs, a worrisome ECG, or concerning chief complaint, you will be seen long before the person who checked in with a sore throat to get a work excuse.

Check out this snapshot of an emergency department:

26 in the waiting room and “chief complaints” like “gsw abdomen” and “found down/unresponsive.”  Those people don’t wait to be seen.  And if the day ever comes (God forbid) that you have one of those problems, you won’t either.

(Insider tip for non-emergencies:  show up around 6 AM on a Sunday morning and you probably won’t have to wait.)

2.  Your nurse may look like this:

nurse ratched

Or this:

yosh takata

Your doctor may look like this:

Ben-Carson-croip

Or this:

doogie

Or this:

kjpo_1424837661_140

It may blow your mind, but the first man who walks in the room is not necessarily your doctor and the first woman who walks in the room is not necessarily your nurse.

A person who starts kindergarten at age 5, graduates at 18, finishes college at 22 and med school at 26 can finish residency and be a fully licensed/practicing physician at the ripe old age of 29 years old.  So if someone introduces himself/herself as your doctor, please don’t respond with, “you’re too young to be a doctor,” or “you’re too pretty to be my doctor.”

If someone says he/she is your nurse/doctor, he/she is not lying to you.

3.  An MD/DO is not the same as a DDS.

I know this is confusing because both doctors and dentists get called, “Dr.,” but no one in the emergency department went to dental school.  We see patients with “tooth pain” all the time, but we are not the right people for the job.

4.  You may be the most honest person in the world, but a little bit of skepticism is part of doing our job well.

  • We have patients who prick their own fingers to put drops of blood in their urine.
  • We have patients who get discharged from a nearby emergency department and check in at ours an hour later to get more pain medication and another prescription ($10/pill street value can help pay the rent).

These few patients make the waters of trust murky for everyone.  Which is why every person of reproductive age with a uterus is getting a pregnancy test! (See “Medical Idioms & Axioms”)

5.  Please put down your phone while we’re IN the room.

We say things like,

“We’ve got a positive cell phone sign in room 6.”

This is medical lingo for ‘that person doesn’t look very sick!’  If you answer your phone while I’m talking to you, it tells me that although you came to see a healthcare professional you are, in fact, more interested in speaking with someone else (and that makes me want to walk out of the room).

6.  If you’re the patient, don’t expect to eat until your work-up is over.

Nurses spend ridiculous amounts of time trying to track down doctors to ask if the abdominal pain patient in room 18 can eat.  Every shift I hear a patient literally whine about hunger (which is probably a good sign that he/she is not that sick).  If there is any possibility you might need to be sedated for a procedure, you don’t get to eat.  You won’t starve.  I promise.

7.  Pain has never killed anyone and sometimes zero pain is unrealistic.

When you put your hand on the stove, pain tells you to pull it away to avoid deeper, more serious burns.  Pain is a safety-mechanism, a warning.  Acute pain is miserable and all-consuming, but it won’t kill you unless the cause will kill you.

Herniated discs?  Torture.

Killer?  Not likely.

Chronic pain is depressing and debilitating but if the cause is not life-threatening, the pain is not life-threatening (it just feels like it).

If you’ve been a patient in a hospital in the last 10 years you know you repeatedly get asked to, “rate your pain on a scale of 1-10.”  While we like to hear “0,” sometimes the only possible way to take away all your pain is to give you so much medication you stop breathing reliably.  You living on a ventilator until your neck strain gets better just isn’t an option.

8.  Pain can’t kill you, but narcotics can.

Narcotics were instrumental in the early deaths of talents like Philip Seymour Hoffman, Chris Farley, Cory Monteith, River Phoenix, and John Belushi.

Most opiate addictions start with real, painful injuries.  If you’re miserable and you take something that makes you feel better, you will crave it again just for the pure relief of relief.  Add to that the fact that it is truly addictive in the sense that your brain develops a hunger for it and you have a set-up for serious trouble.

  • I once saw a patient who had dried exposed muscle and tendon where she had done her own cut-downs to get to veins for heroin.  She wore “arm warmers” to cover her bandages.
  • I took care of an addict who got pneumonia by snorting liquid heroin when he didn’t have a clean needle.
  • I dare you to google images of “skin popping” (the practice of injecting the drug under the skin (rather than into a vein) so that it diffuses more slowly and prolongs the high).

This is ugly stuff.  Desperate stuff.  The stuff of eye-shielding scenes in movies like Trainspotting and Traffic.  But some addicts look like the person you see in the mirror in the morning.

I wish I could introduce you to these patients.  I wish you could hear them weep and beg so you could understand why narcotic prescriptions are such a big fricking deal.

Pain patients cry real tears and get whip crack angry when faced with not getting what they want – what they came for – what they’ve been given by so many doctors before you.

Give it to them and they love you and are happy, but you continue the cycle and perpetuate a dangerous and destructive pattern.

Try to break the cycle and deny them narcotics and suffer threats and outbursts.

It’s a tough choice every time.  Every shift.

9.  Hospitals are putting a huge emphasis on service and “customer satisfaction.” But we are busy.

If I’m rushing to get back to a patient with a heart rate of 160 and you ask me for a blanket, it puts me in a bad spot.  I have to acknowledge your request, but it’s hard for me to justify going to get it right at that moment.

I can’t tell you the number of times I’ve finished running through a plan with the patient (my priority) when a family member asks me to get him/her some food or coffee.  Administration wants us to serve you, to look out for your comfort, but most of us would really appreciate it if you wouldn’t ask us to wait on you.

If you are a family member, you can ask for a blanket at the desk and ask anyone for directions to a drinking fountain, vending machine, or the cafeteria.  You helping you, helps us (and ultimately our patients).

10.  We don’t want you in the ED any longer than you have to be in the ED (and we really, really want to do our best by you).

We’d love to discharge you!  We’d love to get you a bed upstairs!  But if these things aren’t happening, it’s not because we’ve forgotten about you.

Triage doesn’t end in the waiting room.  You could be ready to roll to CT with abdominal pain and get bumped by a patient with a possible stroke.  If you get labs and an imaging study, no less than 7 people will have been involved in your ED course.  Your care may not be efficient, but it should be thorough and excellent.

Sometimes, your expectations won’t be met.  This may be because your expectations were inconsistent with sound medical guidelines; or it may be because, despite our best efforts, we failed to provide you with ideal care, but I swear everyone is genuinely trying to do right by you.  If you have concerns, please voice them (as calmly and respectfully as you can).  We want to figure everything out, make you feel better, and get glowing follow-up survey responses.

And while my best advice is to avoid the emergency department altogether if you can – if you have a real emergency, there’s no better place to be.

 

Ambulance photo credit:  Alexander Kesselaar, Flikr creative commons license, cropped.

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Kristin Prentiss Ott, M.D.

Author of the viral post: 10 Things to Know Before Your Next Visit to the Emergency Department. Board certified emergency medicine physician, wife, mother, aspiring novelist.
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100 Comments

  1. lisa

    Does being in the ER hall way with major back pain and restless leg syndrome and having to pee badly but can’t walk to toilet constitute getn emergency help? Is it customery to not smile at least or try explaining why no help is giving? And i still can’t figure why they FINALLY gave me meds that didn’t work, took no tests and sent me home. BTW, I came by ambulance.

    1. mrsgpac

      I’m going to be frank here…

      Pain is terrible but is not life threatening. Is it possible that the staff had their hands full with people suffering life threatening emergencies? Like traumas, heart attacks, strokes, surgical emergencies? Emergency medicine providers are trained in helping people who are suffering conditions which are or could quickly become life threatening. That is our specialty.

      In addition to that we are legally bound to see everything that walks in the door regardless of ability to pay, or for that matter, ability to be a reasonable human being. It’s a pretty nice set up all around. If you are dying, we are here to help. If you can’t/won’t/don’t feel like/are above/are too entitled to seek care elsewhere, we are here for you. HOWEVER, if you are the latter, you just might have to wait. Because life threatening emergencies will always always always come first. Always. As it turns out, these things cannot be predicted. So it is not uncommon, as an ER provider, to be interrupted several times per hour with these life threatening emergencies which inconvenience those with non-life threatening emergencies. It is not ideal, but we are still here to see you. No matter what you come in with.

      Restless leg syndrome is not treated in an emergency department because it is a chronic condition, and again not a life threatening emergency. It will never trump a patient with the aforementioned life threatening emergency.

      Having to pee is not a life threatening emergency. Pee on yourself if you have to. We will clean it up and provide you with new clothes. It’s part of our job.

      Being in a hallway is likely better than being in the waiting room. That may be all the space they have.

      Coming by ambulance means very little in an ER. Plenty of people come by ambulance because they think it means providers/nurses immediately rush to their aid with anything they ask for. Every. Single. Day. Does not put you in the front of the line. Your triage number does. That is determined by nurses trained in sussing out what is a true emergency and what can wait a few minutes until we finish doing CPR on a patient without a pulse.

      Imaging does not fix a problem and is rarely (i.e. almost never) warranted in back pain. Like almost never. And the MRI that you think you need, you probably don’t.

      There is no single pill to fix back pain immediately. Period. The average flare of back pain, be it acute or chronic, takes 4-6 weeks to resolve. It resolves faster when you go to PT and work toward getting better, not just take a pill. Also, we are not mandated to resolve all pain forever. That is a ridiculous expectation. We do our best but again, there is no magic pill. There just isn’t. What there is, is a “standard of care”, which does not generally include providing a bucket of your narcotic of choice. That applies whether your threaten me with your lawyer or scream at me or are polite. Doesn’t matter.

      Emergency department DOES NOT EQUAL immediate fix of all that ails you. I’m not sure where this mentality came about. We do not have storage room full of specialists at the ready to see you.

      Emergency medicine is an interesting specialty. We are here for everyone, all the time. We are essentially the only specialty that has NO say in our patient population. At the same time we are constantly ridiculed for being “idiots” and “clueless” because you came in with X and didn’t get Y. We are consistently expected to literally know everything about everything and if we don’t, are expected to immediately produce a specialist who can show up (immediately, mind you) to fix your (likely chronic) problem. If we don’t immediately fix your problems, we are ridiculed for being idiots and useless again. If we are doing chest compressions on a dying patient instead of rushing you your rapid strep results (true story, not long ago), we are slow and lazy. The expectations of ER staff (and medical staff in general) are pretty high. I love my job. I love seeing/talking with patients. But I despise having to justify why you had to wait an hour for your chronic pain treatment (that didn’t work, of course) while I was telling someone that their loved one just died.

      I invite anyone to do our jobs (medicine in general) for one day. One. day. One day of 30+ patients, endless phone calls, no bathroom breaks, no food, and telling loved ones that they will never see their relative again. I have the incredible honor of doing that job. Feel free to show some respect to the next healthcare provider that you cuss out for making you wait. Their families are likely waiting at home for them (again) while they take care of you while you complain incessantly about how mistreated you are. You are welcome. I am sorry about your back pain. Having realistic expectations may be helpful the next time you visit us.

      1. Kristin Prentiss Ott, M.D. (Post author)

        I just want to thank you for this thoughtful and incredibly well written reply. Wishing you some great shifts with good flow, rewarding cases, and grateful patients! PS – Are you in PMG? Or FemInEm?

        1. mrsgpac

          Thanks! Same to you!

          Just joined FemInEM but not aware of PMG.

          1. Kristin Prentiss Ott, M.D. (Post author)

            PMG (Physician Moms Group) is a “secret group” so you can’t search for it. 33,000 strong! Message me on facebook and I’ll be happy to add you.

  2. mrsgpac

    Here is the disconnect:

    As ER providers, we are tasked with taking care of people to the best of our abilities. We are acutely aware of the dangers of opiates and live in the hot zone of exactly what they do to people after years of use. Sometimes the RISK (medically speaking, not patient opinion based) outweighs the BENEFIT. This is a decision providers have to make thousands of times per day. Are we 100% perfect at making that decision every day–definitely not. However, medicine is not a perfect science, so some imperfection is part of the deal. What you don’t necessarily see as a patient is that there IS a lot of though and stress that goes into these decisions.

    I can tell you right now, saying yes to every single patient that comes in requesting narcotics is a heck of a lot easier than saying no. But it is not always the RIGHT decision. We can not write unlimited supplies of narcotics to every person who requests them. Period. And quite honestly, that is the only thing that would make patients in chronic pain happy– doesn’t matter if it is “real” pain, drug seeking, etc. If you get none, we are scum. If you get 5, it’s not enough. If you get a 1 month supply, your doc can’t see you for 1 month and 3 days. I don’t know. There isn’t an easy answer.

    As a provider, the answer for me is that I do not treat chronic pain in the ER. I do not prescribe narcotics for things like dental pain, ankle sprains etc. Is it the right way? I don’t know. Is it the easy way? DEFINITELY not.

    I’m sorry, the fact that some people with chronic pain ultimately commit/complete suicide is not equal to “pain is life threatening” and does not entitle you to unlimited narcotics. You can spin it that way all you want. You can trash the medical community for being heartless and awful–it’s fine, we are used to it. Want and need are 2 different things. Risk and benefit are involved in every decision in medicine. We are not heartless–I assure you I spend more time stressing over confrontations where I said no than when I said yes.

    Remember our oath: FIRST, do no harm… The DOZEN opiate overdoses I have seen in the last 2 weeks are HARM. I have yet to see a twenty something die directly of pain but have seen MULTIPLE die of opiate overdoses. Just this week.

  3. Whitney

    I just want to say that anyone complaining about this article should perhaps reread it. You missed the point. The ER is about life saving immediate care. Yes we can still treat you but you are going to have to wait it out a little longer due to limited resources depending on when you come in. Also as medical professionals we are aware of what toll chronic pain can take on your body both mentally and physically so in a sense it could kill you by making you weaker and unable to cope with other things. Point of this article is that you aren’t going to die right this second. Someone else may actually be dying right this second, actively dying or getting to that point. You should ask yourself where you’d want the staff to be if it were you on such a situation, or your husband, mother/father, or God forbid your baby. You’d want them with your family members and not off treating chronic issues that for all intents and purposes can wait. Also with how over crowded ERs have become and how short staffed they are, it is not always possible to treat a dying or critically I’ll patient simultaneously with treating a chronic pain patient.

  4. Sam

    I think a lot of people commenting have missed a big point of this article. It’s not about whether chronic pain should or should not be treated in the ER. It’s about how and when it should be in comparison to immediate and life threatening injuries or conditions. There has to be a process, it’s called triage, and it’s based on specific scientific standards of acuity. So chronic pain may be an emergency to someone, and the ER will treat it but there needs to be some understanding in how treatment of that chronic pain will fit into the triage system. And the truth is, objectively, most of the time it can wait. I’m not saying it doesn’t need treatment. But it can wait. It has to wait unfortunately. There are only so many people that can attend to so many things and there are a lot of other life threatening injuries or illness that objectively come before chronic pain. I think this is the ultimate dilemma. I think this is why patients are frustrated and healthcare workers get jaded. Both parties feel the effects of this tension. For someone with a chronic pain flare up, it probably doesn’t feel like treatment can come fast enough. The healthcare worker that knows this but still has to take care of the heart attack, stroke, or trauma patient first. The chronic pain patient then gets outwardly frustrated, maybe voices a concern and there is no way for the healthcare worker to fully make the patient understand why they are having to wait given the circumstances. I get it. I see it everyday. But the need to treat the most critical first is not going to change regardless of our society’s use of the ER as primary care.

    This seems to be more of what this article is about–frustration. Frustration that caring for people has gotten so complicated these days. Frustration that you can be in one room trying to save the life of someone’s family member and go next door and have a patient never pay attention to you, look at their phone the whole time and tell you their pain level is a 10/10. Humanly speaking, that stuff is frustrating. Unfortunately wrapped up in that is the non-immediate life threatening chronic pain patient; a patient that is truly asking for help but that objectively may have to wait.

    1. Kassi

      Sam! Intelligent reply! The article spoke to many things, but the chronic pain comments seemed to take on a life of itself .. Beautifully stated.

    2. smitty

      Thank you, Sam. Your response is spot-on and deserving of a blog of your own!

  5. Lola

    You know, I get that you find drug seeking behavior at your job a downer. Sure, its annoying and you have better things to do. You’re not doing any favors, though, to anyone, with the manner that you’re conducting yourself.

    You comment that people who have an opiate addiction are addicted due to their previous doctor; for, according to you, a very real pain related condition. So, basically, these drug seeking junkies are, in fact, caused by the medical profession. One of the biggest reasons that we(USA) have such an intense issue with IV heroin use is due to medical professionals.

    You really watered down what opiate addiction is really like for people who are in that situation and just threw out some quick and easy pop culture references to back your opinions up; but I have no doubt in my mind that you are yet another medical professional who trots out, ‘opiate withdrawal is just flu-like symptoms’.

    People who are abruptly cut off from the opiates their medical care providers hooked them on and then, oftentimes, didn’t bother to wean the off of, are desperate. They have to deal with cold and uncompassionate people, such as yourself, and then turn to the street and develop a heroin addiction.

    The only upshot of this is that if they begin using intravenously they might be able to get on a waiting list for a methadone clinic. Then they can spend the next 10 years to the rest of their life on opiates. The other option is Subutex/Suboxone. Another opiate maintainance option. An expensive option, at that. Monthly care provider visits, running in the low to mid $100 range, followed by the weekly $200+ cost of filling the script. And with both of these options, if the patient in question actually manages to taper or kick, they will forever, for the rest of their life, have their brain hardwired to crave opiates. The(rough) statistics for a methadone maintenance(the gold standard of opiate addiction treatment) patient who manages to wean off the program AND make it through P.A.W.S., is a 10% success rate without relapse. These programs are meant to be lifelong.

    The majority, nowadays, of people who get signed onto these treatment options started as patients with traumtatic spinal injuries or other chronic pain issues. Their doctors placed them in this situation, and you know where the root of this problem lies and you choose to look down your nose and cast blame on them. Not only that, you choose to write this dreck and pass the blame on them so that you can pretend that it isn’t you’re fault or problem when other patients waiting in the ER complain about wait times.

    So, okay, its not *your* fault directly. You aren’t the doctor who put these people in their situation, but you also aren’t doing anything to help or fix the problem either. This is a serious epidemic and your reaction is to throw your hands up in defense shouting, “Its not my fault, its not my problem!”

    Opiate addiction is running rampant and all anybody wants to do is blame and punish the victims of the system.

    On a final note, if you were to ask an IV opiate user about ‘skin popping’, they’d reply with, “What? You mean a missed shot?”

    1. Kassi

      Lola, your first sentence really jumped out at me. “I get that you find drug seeking behavior at your job a downer”…I think the word ‘downer’ and doctors ‘have better things to do’ are expressions familiar to you,
      not Dr. Ott. She came no where close to saying any of these things.
      But yes, Dr. Ott and all Doctors do worry about writing scripts for opiates. Especially if the patient has just logged out of a different hospital 20 minutes earlier because he couldn’t ‘score’.
      Emergency room doctors are not drug dealers. After years and years of education, a small fortune in student loans, residency, etc., they could lose it all over someone thinking exactly that.

      1. smitty

        Kassi, all of us, both in the medical field and in the general public are thankful for people like you –people who “get it”. Thank you!

    2. Whitney

      This article has nothing to do with not caring about a patients pain and need for help. It’s about how the system works. I completely infestation many drug seekers have deep demons that they wished didn’t exist. Point being is that if “your” mother or “your” baby were in the hospital and needed life saving interventions, I bet you would want me to take care of them first before sitting down and making a plan on how to help an addicted crawl from the depths of despair. Also you talk about how this is all the fault of Dr’s and how they prescribe pain meds for very painful injuries. Studies show that when pain meds are taken for pain and taken correctly your body reacts differently than if you take them without any pain. Interstingly enough you are less like to have addiction when you take them correctly as prescribed for PAIN. Also I read a lot of finger pointing myself from you and how its all these Doctors faults. Funnily enough you give no suggestions on what should be done instead of medications. I’m 100% for alternative therapies. When that is not enough however, I hope you keep your stance strong and refuse any pain medications from your traumatic spinal cord injury as you might get addicted. I wouldn’t want you to be faced with that dilemma and then blame the staff when you start taking your meds incorrectly.

  6. Katie

    I’m a nurse. I’m also, unfortunately a person that must frequent the local ER. Count your lucky stars if you have to wait in the ER waiting room because if, like me, you’re taken back immediately and rushed into a trauma bay with more than 1 doctor and more than 3 nurses flying around trying to stabilize you… you’re a lucky person. I have an (obviously) very severe anaphylactic allergy to latex. And yes, latex is in everything, including the air and residue left behind on something previously touched. I’ve had good ER care and bad ER care. Jaded ER staff and truly, genuine, life saving care from ER staff. However, through it all, I realize, they’ve got my back when I truly need them and I’m ever so grateful.

    Chronic pain is tough and it’s a hot button topic in our country. However, the ER physician writing this article is correct. Pain sucks. It’s awful. No one is telling you otherwise. However, it won’t kill you. When I stop breathing, if I don’t have anyone to treat me at my local ER because a chronic pain person has decided enough is enough and they want their pain meds NOW and security has to be called or an argument ensues or whatever sceneries you come up with, it will kill me. And that, I have a problem with.

    1. Brian Del Bono

      Katie you’re creating a false dilemma. You’re assuming either you get care for your “severe anaphylactic allergy” or the chronic pain patient does. In the real world, both of you can and do get care in the ER concurrently. Obviously a pain patient getting meds hasn’t “killed” you yet.

      And where do you get pain won’t kill you? What evidence do you have to support that statement. Which part of your nursing training did you learn that? Pain has been shown to affect every body system, worsen medical conditions, and is a major contributing factor to suicide in chronic pain patients. Pain is just as important as abnormal vital signs.

      And do you realize to a person with chronic pain, your statement that pain “won’t kill you” emotionally is the “equivalent” of somebody telling you during your anaphylactic reaction to get an epi-pen and some Benadryl and quite being so dramatic?

      1. Anita Lambert

        Yes. Pain that is unrelenting is one of the cardinal reasons for ER treatment.

        However, in a priority scale, as an ER nurse, ABC (Airway, Breathing and Circulation) come way before pain in my agenda of taking care of my patients. Any allergic reaction threatens to put the A and the B of that trio in jeopardy. And if you wipe out the first two, it won’t be long (think: 3 to 5 minutes) until you wipe out the third and suddenly I’m doing CPR and praying that we can still get an artificial airway into this persons trachea before we start to lose vital brain function.

        So, respectfully, if both patients are mine, guess where my attention goes first?

      2. smitty

        Brian, you have great debate skills, therefore I know you can ‘see’ the big picture of Dr.Ott’s blog and the positive feedback of the readers. If you “see” myopic…..perhaps that’s because you have become myopic!

  7. Freda

    I am a retired nurse and have chronic pain after repeated herniated discs and a fusion which required me to retire on disability at 51. I was devastated since I dearly loved my job, and cried daily for a year. I was offered any pain med I wanted by the surgeon, who diagnosed me with “failed back syndrome”. I told her I would rather be in pain than become addicted as I had seen so many dependent patients needing more, and coming to the hospital demanding a pain shot before getting into a gown, and watching the clock and calling out for another 1/2 hour before the next one was ordered. I tried acupuncture after that with little relief. I found that the upper-cervical chiropractor I still see, massages, ice packs to my ever present sciatica, water aerobics and lots of distraction methods (breathing, concentrating on reading, helping others) help a lot. My family Dr put me on Zoloft for my fibromyalgia, and it has helped me greatly (I tried going off of it, but that made things revert back to the great pain. When I feel great, my pain is down to a “2”, which is rare. I have chronic neuropathy in my feet too – I use ice packs for all types of pain. I hope this helps someone else with chronic pain. I also have a great comfort on my faith, and rely on God to get me through the rough days.

    1. Kat

      Zoloft IS NOT for pain. It is antidepressant medication.

      1. Kassi

        Kat, although Zoloft is not specifically used to treat pain, one of the benefits is to treat the stress of every day pain, and it has also been used to treat symptoms of IBS, severe stomach issues. The mind and the body walk hand in hand, and what sometimes quells the mind, helps the body.

        1. smitty

          Absolutely SPOT-ON!

      2. Ros

        Kat – SSRI antidepressants are widely used in chronic pain management. Although SNRI antidepressants are preferable. They help not only the depression brought about by being in severe pain all the time, but they help block some of the misfiring nerve signals that cause chronic pain, the same way some anticonvulsant drugs do, like gabapentin and pregabalin.

    2. smitty

      Dear Freda. I’m so sorry for the pain you suffer, but I can tell that you are a living testimony to the grace of God….and that is a grand purpose for living!

  8. Sugrin

    Pain can kill and it doesn’t even matter what your definition of pain is. The first person that claims to know something is the last to discover the truth about it.

  9. med109

    Sadly I suffer from chronic pain. I see a lot of people say if you have chronic pain you should have a pain specialist. I wish such a thing existed for me, and I am sure my story is similar for many people.

    First, a little history on me. I have scoliosis, when they operated at age 12 it was an emergency surgery. They wanted to wait until I was older and closer to being done growing. My curve progressed so rapidly and so bad that I had to have emergency surgery. My curve is “s” shaped and when they first found it it was 20 degrees on top by 15 degrees on bottom, I was fitted for a brace and wore It faithfully. When they checked me 6 months latter my curve was 75 degrees on top and 60 on bottom. Surgery was scheduled for a year latter.

    2 months latter I was rushed to the ER, for a collapsed lung! My curve had progressed so bad it punctured my lung. I was scheduled for surgery a month latter. When I arrived for surgery my curve was 115 degrees on top and 90+ on bottom! Worse curve on record at the time (and maybe still) They said surgery would take about 10 hrs, and I would be in the hospital for 1 week ( I would be home for my 13th bday!) When they put the first rod in, I lost my evoke potentials and if they continued I would be paralyzed. So 19 hrs latter the surgery was stopped and I was placed in a full body cast with a turn buckle. 2 months latter (2 months spent away from my family, in the hospital) the surgery was tried again and both rods were placed, as well as a rib removed. I spent 3 months in the hospital.

    I suffer pain daily, terrible pain than makes me wish I was dead some days. After many years of trying every possible thing for pain relieve (therapy, TENS unit, chiropractors, various meds etc I can’t do injections because of the rods, and I am allergic to vicodin and gabapentin) I finally found a Dr who prescribed me 5mg Percocet 4 times a day. I FINALLY could function and work a job. After 6 yrs on that dose, the pain was getting uncontrollable so I was put on 7.5mg 4 times a day. 4 years latter he asked me to see a ortho specialist to see what he recommended. We both knew I couldn’t do injections because of the rods and the cost ($3000 a month, with NO insurance). The ortho said I have numerous disc and vertebra issues and the only thing that could be done is pain control, he suggested 10mg percoset, with Lyrica (at $350 a month, again no insurance). So that is what my Dr did. A month latter my Dr retired! The “replacement Dr” who was a PA and not a Dr. wrote me a months worth of Rx and the next month dropped me as a pt!

    They refered me to a “pain specialist” who wanted to start me on tramadol (which NEVER worked for me) and refused to do anything else. I called EVERY Dr in 3 towns close to me and NONE of them would take me as a pt because I have pain issues! So at this point what choice do I have when the pain is so bad I can’t stand it, it makes me vomit, it makes me suicidal? After being off ALL pain meds for 2 yrs (so no I wasn’t in withdrawls) I began having a new type of pain. It was far worse than any pain I have ever had, and it actually felt like I had a broken rod or something. I went to the ER.

    I am otherwise very healthy (I am an EMT and check my blood pressure regularly, between my checking it, and all the times the Dr’s checked it as appointments it was never above 130/80, unless I was in pain then it would be 140’s over high 80’s). When I arrived at the ER this weekend, because of the intense, new pain my blood pressure was 240/160, with a pulse of 140+! Those readings were because I was in pain, I am sure you realize that with vital signs like that, I very well could have a DEADLY situation (so please don’t tell me pain can’t kill you). The ER Dr gave me an IM injection of .5mg dilaudid and told me they wouldn’t do anything else cause it was “chronic pain” and they can’t do anything for it! They sent me home with one 5mg Percocet pill and told me to follow up with my Dr. I explained I don’t have a Dr. He shrugged his shoulders and said “Don’t know what to tell you” Oh and they never checked my vitals again. Pain, chronic or otherwise CAN be very serious, and the medical community in general treat people in pain like SCUM!!!

    1. Jen Doug

      Would you go to a beauty parlor and ask for pain relief? How about, a locksmith? No? Because they can’t help you, and neither can we. As an EMT, you should know our hands are pretty much tied as to what we can offer you in an ED. Chronic pain isn’t going to kill you, and although I understand you have a hard time finding an MD for primary care, coming to our place looking for us to fix it helps about as much as going to the beauty parlor or locksmiths. ANd we understand you are upset, You!!! Don’t!!! Need!!! To!!! End!!! Every!!! Sentence!!!Like!!!! This!!!!!

      1. Brian Del Bono

        @ Jen Your beauty parlor analogy is a false comparison. Of course this person wouldn’t because it’s a beauty parlor. An ER is a medical center. Your comparison begs the question: if ERs can’t treat pain, should we be letting them treat anything else then?

        And where is your evidence that chronic pain doesn’t kill? Chronic pain kills people every year. More people then the good doctor probably realizes. Suicide is a cause of death for chronic pain patients because of poor pain control or causing subsequent depression. See: http://europepmc.org/abstract/med/10498789; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380602/pdf/amjph00520-0138.pdf. In fact, the evidence is relatively strong that chronic pain patients are at greater risk for “completed” suicide than the mean. Chronic pain can and is a biological and mental health emergency. And let’s not forget that suicide prevention is also one of the Joint Commission’s number one patient safety goals for emergency departments in America.

        And by your argument that chronic pain can’t be helped in the ER, we shouldn’t be treating terminal cancer patients or patients that we know will die either. Triage, right? Let the ER focus on those that are salvageable. A thought that, to me, is disgusting!

        The fact that the good doctor ignores this to get to her “pain doesn’t kill” position speaks more to her priorities as a physician and treating mental health, chronic pain, and as a person that doesn’t want to see people in pain. Just because you copy and pasted the header from the good doctor’s article to fabricate the semblance of an arguement doesn’t make your statement true!

        1. Kristin (Post author)

          Hi Brian – Clearly you have a lot of passion for this issue. Some of your comments keep going to spam and I keep approving them, but I encourage you to read this: http://www.kristinprentissott.com/in-my-opinion/ .

          I want to commend most of the commentors for “speaking from experience” which gives us all a frame of reference and an opportunity to do what the brilliant Harper Lee writes about in “To Kill a Mockingbird”: “First of all,” [Atticus] said, “if you can learn a simple trick, Scout, you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view […] until you climb into his skin and walk around in it.”
          Hearing some of your personal stories/experiences will help us. If you’re unwilling to speak from experience, please stop arguing with posts of people who are.

          And, as someone who fills out death pronouncements – I assure you “pain” has never been listed as a cause of death. I 100%, wholeheartedly agree with your arguments about pain and suicide – – I believe I state IN the article that chronic pain is depressing and depression is certainly a risk factor for suicide. But even suicide is not technically a cause of death. The cause of death would be “asphyxiation” or “transtentorial GSW.” So while you’re point is well taken that chronic pain increases one’s risk of suicide and thereby is “life-threatening” – – I stand by my statement that pain is not the cause of death.
          All the best,
          Kristin
          PS – I can tell you have suffered, and for that I am sorry. I appreciate you calling me “the good doctor” and hope for healing for you.

          1. Brian Del Bono

            “I can tell you have suffered, and for that I am sorry”

            Kristin, I’ve seen several of the these projections about me and I can assure you I have not suffered. I see the problem with health care, and the comments on this board and article, being with its health care providers, not the type of patients or the patient expectations. So I feel compelled to explain a little bit about my background since its being focused on.

            I was a former healthcare worker. I’ve worked as an EMT and medic for several ambulance companies and moved into a variety of provider positions at quite a few emergency rooms, hospital floors, and an intensive care unit over several counties in the SF Bay Area (I use to work a lot). I was an ACLS instructor for 4 years, and a BCLS instructor for 8 years. I’ve seen a lot of emergencies, and an unacceptable amount of bad care by doctors and nursing staff. In between night shifts at an ER that saw 55,000 patients a year and filling out my application for Davis Medical school, the amount of bad care, and outcomes, being giving by my former colleagues discouraged me. I left healthcare entirely and swiftly took the LSAT. I’ve been in litigation for several years and law school for the last 2. I could share what I do in litigation as well, but that would upset quite a few people here. I only found out about your blog because I have several Facebook friends still in healthcare that tagged this article.

            And to be fair, those friends have gotten the riot act from me as well.

            As a former provider, there wasn’t a patient that I couldn’t make time for or a concern that I was too busy to handle. I loved when patients asked me for a blanket because it was the easiest thing to do to make a person happy and feel cared for. It baffles me why anybody that works in the ER complains about some of the easiest tasks to accomplish. And interfacing with a viable human is more rewarding over the 95 year old full code being brought in by medics doing CPR for 30 minutes. I didn’t see saving brain stems of the chronically ill a productive use of ER Staff times, but I did it anyway and STFU. That was my job and the service I provided. I didn’t like doing foley caths or NG tubes, but what I liked doing didn’t matter. It’s about the patient.

            In my experience, the doctor or the nurse complaining about how busy they were usually are the ones at the nursing station the most talking about their home/significant other/pet. The pain patients not getting medication in the ER also seemed to be directly proportional to the number of nurses going on break. Let’s not forget the number of times I’ve seen doctors order a saline bolus, instead of pain medication, to patients they though were drug seekers. When I see comments like Jim’s or Katie’s, I laugh. I laugh because not only have I been there, but also because I know their arguments come from staff I hated working with the most.

            The last ER I worked at, which was a teaching hospital, we had to elect the scribe nurse as the sergeant at arms to kick out staff from codes because too many staff wanted to get involved. So I’m not drinking the ER Kool-Aid, even for a busy urban ER, that non-urgent patients can’t be accommodated.

            Bottom line, I don’t share the frustrations expressed in this article or the people supporting it. Most ER staffer want to be in the code because they fun and exciting. The truth is most of the work in ERs is doing mundane tasks and generally being a decent human being with customer service skills.

            That being said, you may not list “pain” as a cause of death. You probably also don’t list “atherosclerosis” as the cause of death of an AMI patients, even though it’s the actual root cause of the AMI. What you’re really listing is their mechanism of injury or illness. Rest assured, if a patient completes suicide by intention overdose because of chronic pain, pain was the root cause of them dying. Your just playing games with language being used regarding the mechanism of injury or illness. So I respectfully disagree with your statement because your use of language deceptively takes the focus off the root and underlying cause of death.

      2. med109m

        I ended one sentence with “!!!”. I hope you are more observant than this with your pt. care. I said I haven’t had pain medicine in 2 yrs. I had a NEW pain that feels like one on my rods had broke. It was far more intense than my normal back pain, and it is a totally different type of pain. Both the Dr. and nurse admitted my back was swollen, and bruised. Yet he didn’t do anything. No, your hands aren’t tied, he should have managed my pain and done some x-rays. Instead I was treated like a drug seeker and immediately dismissed in his mind.

        1. Whitney

          Not every doctor and nurse are like this. Sorry for your poor care and awful experience but it does not represent or encompass all medical professionals

    2. Robert Bernstein

      Ive had Harrington rods placed in my spine when I was 14 for severe, debilitating scoliosis. My back hurts 24/7. Im 39 years old now. Im and ER doctor as well. My back hurts even more because of my toddler Im constantly carrying. The only thing I have ever taken for my severe pain has been ibuprofen 800mg and if its REALLY bad, a lidoderm patch accompanied by my heating pad. They work. Its been shown in studies that NSAIDs are just as good as opioids for pain. The ER is not for chronic pain. Dont expect us to manage it. Try Advil, it’s OTC and works just as well. Try a heating pad. If it doesnt work for you, then your pain is in your mind and you are just in denial. You sound like every other addict in the ER. Sorry but your blood pressure of 240/160 is BS. 13 years in the ED as an MD and ive never seen a diastolic that high. You are either lying/exaggerating or misread it. Your 40 hours of EMT training does not give you ANY right or background to comment on this stuff.

      1. med109

        So because your pain is managed fine by Advil and heat, everybody’s must be that way? Advil does not work for my pain, so my pain is in my mind? Not only does advil not work, I can’t take it because I am allergic to it. But it works for you so my allergic reaction to it must also be in my mind? Pain is different for everyone! I have had patients with an amputation that refuse morphine when I offer it, and then I have pts with a stubbed toe begging me for pain meds. My EMT training is far more than 40 hours (almost 3 years actually) I am ACLS, PALS, and ATLS certified (to name a few) as well as an ACLS instructor. I don’t have any right or background to comment on the importance of pain management? When my pts are in pain I do my job and treat their pain. My little dose of IV Morphine or Fentanyl can do wonders for my patients, it isn’t my job to judge my patients, if they say they are in pain and they have supporting signs and symptoms, then they are getting something for pain from me. Once again, just because you have never seen a pressure that high does NOT mean it doesn’t exist. I have never seen torsades, does that mean it’s not real? I have seen pressures that high many times (checked by manual cuffs, automated cuffs, switching arms, and verified by staff in the ER.) Here is a link (one of MANY I found), that shows numerous medical professionals getting readings that high. http://allnurses.com/general-nursing-discussion/what-is-the-353223.html. My corrected curve is over 70 degrees by over 50 degrees, and numerous herniated disks, my pain is very real. Thank God you are not a Dr. in my area, because I would not be a very good patient advocate if I brought my patients to a Dr. as rude as you. You make is painfully obvious that compassion and bedside manner is not taught in medical school!

  10. David Benoit

    Brian Del Bono,
    Perhaps you should explain your past experience in the ED. The reason I say this is that you are so far off base with some of your comments I am almost about to ask you what article you are responding to. Because what I see in this article and what your comments are addressing do not match.

    1. Kristin (Post author)

      Very perceptive.

  11. Katie

    Great piece, Kristin. Chronic pain patients are best served by chronic pain specialists. And to those with chronic pain who are critical, your frustrations are misplaced. Your doctors don’t take call, don’t respond to our calls, and don’t give you a good plan for exacerbations. Our job is to make sure there’s nothing going on to explain your worsening symptoms. We can’t help everyone, just because we have magic prescriptive authority. But we try. We’re not all jaded (including Dr. Ott), but we definitely must be cautious. This problem did not exist in it’s current form before long-acting opiates/opioids. First, do no harm…

  12. Karen

    I understand where this article comes from and I appreciate the effort of the author. What I do notice is a lack of understanding of the situation in which some patients are. People with chronic pain have underlying health problems, often a complex combination of different issues. Though this is not life threatening, some of the complications that can derive from them can be. When the pain gets worse this is a serious warning sign. The patient cannot be expected to go through a period of weeks, even months to get an appointment with their own specialized doctor. And when they contact their GP he or she probably don’t want to take a risk and say go to the ER. The ER doctor is not a specialist in the area of those issues and this is how chronic pain patients end on ER getting the attitude as described above. I have chronic pain and other issues due to paralysis and have been to ER’s for many times and sent home with no treatment or – worse – medicine I was not allowed to take due to the lack of medical knowledge. A couple of times there was serious misjudgment with a life threatening situation become worse. From my patient organisation contacts I learned many other patients had similar experiences. After this I learned to push the right buttons by telling the stuff that made the situation look more severe in their eyes but that should not be necessary. I do not blame ER nor their doctors. I just want to point that ER doctors like Kristin must realize there is probably a lot more they do not know about medicine than they do know and that the most important rule is to take the patient serious and understand where they are coming from. Though I appreciate the article I find the tone towards these patient not doing their situation right.

  13. frankie

    Wow, you don’t really get it do you…. I’m someone with chronic pain. Do you have any idea how debilitating it is to be in agonising pain day after day? And then one day it goes up a notch so that you truly cannot take it any more, so you would head to the ED. But then you get some smug arsehole of a doctor telling you to suck it up and that “pain won’t kill you”. Fuck you.

    1. Kristin (Post author)

      I’m sorry you struggle with pain. “Acute pain is miserable and all-consuming…chronic pain is depressing and debilitating…” I can’t imagine how hard it would be to live in pain all the time.

    2. Kassi

      Frankie, do you have a pain management specialist. I am familiar with this chronic debilitating condition. My sister suffers from it. She does have a pain management specialist, where there is always an on call Doc for emergencies. She would never go to the ER for pain management, because frankly, the sitting and the wait are too painful.

    3. Seesquared

      Spoken like a true drug seeker.
      And as Kristin nicely put, NO, pain itself will not kill you.

      But I am not as nice as Kristin. Let me tell you something: “Agonizing pain” to an MD is equivalent to an open fracture dangling in the wind. Hell, even a kidney stone!

      Not your chronic back pain from a bulging disc that 90% of America also has. And no, your fibromyalgia should not require Dilaudid. Neither should your foot fracture from a car accident 7 years ago.

      Everybody deals with pain differently, and it’s completely based on their psychiatric makeup. If I had a dollar for every b.s. Chronic pain patient that had a “victim of the world” mentality I could pay off my house. I have witnessed doctors discuss alternative, useful options to help control pain and 99% of patients are too lazy to try anything aside from a pill.

      True chronic pain patients are recognized by the ED doc and treated appropriately. Cancer eating your bones? Have anything you want in your IV. Destructive arthritis that has crippled you over decades? Here’s a Percocet.

      I always love reading articles about chronic pain and then the comments blow up with people bitching about their own problems and how no one takes them seriously… Or how “druggies are ruining it for everyone”. No one ever mentions the diagnosis or cause of their “debilitating pain”, but always seem to say how severe and excruciating it is. other people have been diagnosed with the same problem you have, yet don’t require MS Contin daily.

      The bottom line is that an ED doc will spot your bullshit. And they will not heal your mental anguish with a controlled substance. You don’t think there’s a personality pattern or common psych pathway to chronic pain? I challenge to prove me otherwise. All chronic pain patients should undergo psych counseling as part of their pain management. The ER is the last place you should come for drug addiction, simply due to almost zero resources.

      And before any of you attack my comment since getting into internet arguments with strangers is so popular these days, I live with pain everyday from a broken back and multiple extremities from an accident 2 years ago that has now set into nasty arthritis. Strangely, I’ve also been impaled with a javelin (not elaborating). AND I DEAL WITH IT AND DONT LET IT CONTROL ME. *sits on heating pad and pops an Aleve*

      1. Kristin (Post author)

        You were impaled with a javelin?! That is one mighty cool scar story!

  14. Heather Tipsword

    May I use #8? I am a VA physician and this puts in words exactly what so many of my veterans need to hear. I’m not sure if I can post it somewhere, or hand it out, but I would love to have this with me at times.

  15. stacypandya

    In the words of Taylor Swift: And the haters gonna hate, hate, hate, hate, hate and the players gonna play, play, play, play, play and the breakers gonna break, break, break, break, break, I’m just gonna shake, shake, shake, shake, shake, shake, SHAKE IT OFF! SHAKE IT OFF! Dr. Ott, is an amazing, brilliant, distinguished, insightful human being who loves cats and all people! Before we harshly judge anyone, especially our doctors, remember that your life might lay in their capable hands some day and Dr. Ott is someone I would only hope to find rushing in to the room (in all her glory) to help me on my worst day.

    This article is incredible and so are you

    1. Brian Del Bono

      “Before we harshly judge anyone, especially our doctors, remember that your life might lay in their capable hands some day”

      So because doctors are in a position of power over a patient, they are immune from criticism or critique? Or was that pretext for criticism may yield substandard care?

    2. Kristin (Post author)

      Thanks, friend. Cats are actually not on my list of favorites, but Brian’s cat is not bad looking.

  16. Brian Del Bono

    Your “article” is everything I expect of a jaded ER physician who thinks their time is too valuable to treat pain, patients in disadvantaged positions, and/or short on resources. Your job is to treat everybody, emergent and non-emergent. If you don’t like your job, please leave medicine.

    Through thinly veiled complaints about your patients and analogizing pain patients to skin poppers, you’ve clearly outlive any utility as a physician.

    Dear ER staff, get over yourself. You are there to serve the patient, not your ego. It is not the mother with a non-acute child fault that your job is hard or overwhelming. Even if they are not worthy of an emergency room. Some are paying 10k, 20k, 30k to get assurance and leave, at least, a little better than when they came in. Break that bond at your peril.

    1. Kristin (Post author)

      Hi Brian – Cute cat. I very much appreciate you taking the time to share your thoughts. I actually agree with much of what you’ve said.
      We do treat the emergent and non-emergent. I’m actually happy to see a strep throat – I can’t handle coding patients all shift long.
      I LOVE my job. Every job has pros/cons, but everyone who goes into EM knows what they’re signing up for.
      I think after drawing a word picture of hard-core drug use I wrapped up with, “but some addicts look like the person you see in the mirror in the morning.” It was meant to be an unexpected turn, but my point was to try to make it clear how it can happen to ANYONE – – you, me – – we are all one painful injury away from a tough time giving up opiates.
      I wish I could introduce you to these patients. I wish you could hear their stories (maybe you do – I’m not sure what you do), but it is my compassion for their pain and desperation that makes my job hard sometimes. I want to make them happy in the short term, but not harm them in the long run. I want to please people so that as you say – they can leave a little better than when they came in – but I never, ever want my prescription to be the one they overdose on… It’s something I struggle with BECAUSE I want to do right by people.

      Skin popping is a phenomenon most of the lay public is not familiar with and I thought it would be an interesting educational point. Sorry if it seemed a bit heavy handed.

      I feel sorry for the people with non-emergent complaints that wait 6 hours to be seen. They’re not happy about it and I feel bad about it. I am happy to see them, but wish there was some way a visit to the ED didn’t have to be a day-long venture for them involving hours of boredom in a hard chair in the waiting room. I think perhaps you mistook my frustrations for something that they are not – – they are all motivated by my concern for my patients – the patients I am delaying by getting someone who’s not sick coffee – – the patients who wait and wait and don’t understand why… I care about all of them. More than you realize. And quite honestly your words were hurtful.

      I genuinely do appreciate your feedback and willingness to engage. This post has been viewed 85,000 times and you are the first person to publicly respond negatively (but I’m guessing there have been more (perhaps that felt the same as you), that didn’t take the time to write – not here at least). Anyway – for that I thank you.
      All the best to you,
      Kristin

      1. Kristin (Post author)

        Oh – and as a shout out to my fellow EM workers – – you are such an incredible group of people – – passionate, dedicated, compassionate (sometimes a little jaded), but I believe what I wrote that we all want to do right by people. Carry on, warriors!

      2. Brian Del Bono

        I sympathize with your position as a physician, but disagree in the manner in which you express your frustration. Specifically addressing pain patients, since that is the overall target of your post, you do no favors judging those that “should” get opiates and those that “should not.” Maybe you prevent a drug seeker from getting an IV fix of morphine and 20 tablets of Vicodin. Or maybe your refusal to provide needed pain medication is just the push that pain patient needs to commit suicide because they could not stand the pain any longer. Who knows, would you ever actually find out what the result was? If you want to take credit for saving lives as a doctor, you have to take credit for when you lose lives as well.

        There is no way for a doctor to know the whole story, which is why you should always error on the side of the patient. The minute you question the motives, interests, and incentives of your patient, you become adverse to them. That’s not what they pay you for. And the patient doesn’t have to understand how hard your job is while doing this either.

        If your motivation was to express concern for your patients, it was expressed very poorly. I took in an article piece that seemed resentful and myopic. I’m sure you treat your patients just fine overall, but your article leaves me the impression that you expect something in return from patients. Maybe that wasn’t your intention, but it is in your literary tone.

        Your piece caters to a very specific audience , the ER staff audience. That’s fine, and its probably why you haven’t gotten any negative feedback. I can assure you the people that would really take issue with this article are too busy trying to get care from their doctor to respond.

        1. jc

          the ER is not the place for chronic pain patients to routinely seek pain medications.
          the end.

          1. Kassi

            JC, your comment is the most concise and enlightened I have read on this page. Severe Chronic Pain patients need specialists, and those specialists should be able to be reached around the clock, or at least the ‘on call’ doctor.
            The ER is widely known as ‘the place to go’ for addicts of all kinds. Chronic pain patients do not fall into this category, but they do need specific specialized care that the emergency room is not able to give them. Think of a patient who begs for oxy, and a Physician writes a script, and it ends up in the wrong hands. Physicians, as Dr. Ott clearly states, are taught, above all, to do no harm. Demanding narcotic pain medications is a very slippery slope for any doctor, especially one who specializes in emergency room trauma. Your comments bring sensibility to all.

          2. Kassi

            JC, concise and perfect response re: pain management patients. I assume most of them have specialists and because of the trauma involved w/any chronic pain patient, I would hope there would always be an on call doc to help. This is not about shaming chronic pain patients at all. It’s about the differences in what doctors are able to do. Dr. Ott is the epitome of Do No Harm. We should be praising her for her stance on pain meds.

          3. Ssj

            Absolutely!!! All these chronic pain patients that are complaining can’t recognize that they should be seeing their PCP!!! One says she can’t wait for weeks to see them. Have regular follow up scheduled! If you are constantly needing higher doses of your narcotics, you are showing signs of addiction!!

          4. Danielle

            I agree…and most patients don’t realize that we can access their history of being prescribed controlled substances….if you have been prescribed 120 Percocet 2 weeks ago from one doctor and 90 Percocet a week ago from another doctor then I have a hard time believing that you don’t have anything to take for pain. Regardless of a person’s tolerance for narcotics…..narcotics can kill you.

        2. Haley

          Brian, I’m just wondering…but do you work in the medical field?

        3. Sam

          Brian, I think one big element you may have overlooked in your assessment is role of a physician. I agree it is to serve but it’s to serve by providing the best and safest treatment for a patient. It’s something doctors go to school for a long time for. They take an oath to “first, do no harm”. They spend years learning how the body works all the way down to the molecular level. This is so when a patient is presented to them they can attempt to best serve that patient.

          Serving the patient does not necessarily mean attending to their pain, even though it does most times in the process of treatment. In the same way, a highly skilled mechanic obtains his skills to serve the public but are we to think that he serves others by fulfilling their demands for potentially unsafe practices. If somebody asked the mechanic to remove the brakes because they thought it would make the car go faster, should the mechanic “serve” the customer? The value of his service is in his knowledge and skill to carry out safe practice.

          In your assessment, patients don’t need doctors to make informed and educated decisions. It seems you’re suggesting it would be more efficient if doctors didn’t bother with using all that education and just gave patients whatever they wanted, even if it’s unsafe, since according to you that’s what they signed up for. Serving the public in emergency medicine cannot so easily be equated to service say at a restaurant. Sure healthcare workers should smile and serve and be nice. These just make a better overall healing environment. I strive to do that every shift I work. But the physician serves most effectively by using their training and knowledge of the body to make the safest decisions for patients. And sometimes the doctors educated decision is not compatible with patient expectation. But that doesn’t mean they’re not serving. It doesn’t mean they need to get out of medicine. They didn’t sign up to serve the public by carrying out unsafe practices. They educated themselves so that they could be the gatekeepers of health.

          1. Brian Del Bono

            Sam, the statement is “do no harm through action or inaction.” A doctor that is impotent is just as dangerous as an overzealous doctor. People leave out that part because qouting Hippocrates (a physician that promoted bloodletting) seems more dignified when the part about not ignoring the patient is left out.

            We are are not talking about doctors using their judgment, in fact it’s not even in the conversation. To be honest, this argument isn’t even about providing narcotics to pain patients; which only gets brought up because it’s an ER staff’s favorite punching bag.The scope of my argument is the about the attitude of ER personnel, and specifically doctors and nurses. In that regard, it is exactly like a restruarant. You are their to serve everybody, in fact we had to make a law saying you can’t turn people away to mandate the attitude. And the determination of emergency is a lay person standard, not what an average emergency room doctor would be impressed with.

            A doctor can use that professional judgment all they want. They don’t have to provide narcotics to a pain patient. They can do trigger point injections, marshal a pain specialist referral, or admit for example. There is other things they can do, the fact they default to narcotics is their defect and not the patients.

            Maybe this tactic works for some patients, or maybe it doesn’t. But this post isn’t about the specific exemplar of a difficult patient you have in mind. It’s about the overall attitude of the ER being very poor and patient adverse.

            The ER staffs need to get over themselves because the ER is now a primary care center. Otherwise don’t be surprised or upset when patients sue, leave bad reviews, and/or complain to licensing boards and hospital administrators for, what is essentially, an attitude problem displayed with the staff not accepting their new role in American Healthcare.

          2. Jim

            Brian, I will say it again. The ED is not a primary care facilty. We simply are not set up for that. We specialize in stabilizing patients. Not treating chronic health problems. Because WE ARE NOT SET UP FOR THAT. Did you here me that time. Even if you pitch a tantrum, that will never make it so. Related news, stop going to McDonald’s and ordering a whopper. Although they are similar, it’s not what they do. But I am sure you will still come in for non emergent reasons because it easier for you and get mad at me when I just can’t get you that drink and blanket stat. Forget about the fact I am giving TPA in the next room. No excuses right. It’s a service industry. Except, it’s not.

      3. Misty

        Brian, I do not trust physicians. Period. My father died from a medical error because one particular team decided a roof leak was more fun to talk about than his care. However, I still have common sense. What if it was your loved one in the ER having a heart attack and the staff did not get to them in time because they were tending to the patients families needs in the next room or they were patiently waiting for a patient to get off of a cell phone to go over test results, or they were too busy being screamed at by some drug addict who simply wants a bottle of Vicodin when it’s truly your loved one who needs help. I see no difference here than on the road when I see an ambulance trying to get through traffic yet there is some idiot talking on his cell phone blocking that ambulance from getting to a real emergency. I see where Kristin is coming from and anyone with common sense can see what it is she is trying to say.

        1. Brian Del Bono

          Misty,

          I think your faith in trying to create fictious link between my family, common sense, and a hypothetical situation is misplaced. If a doctor giving test results to a patient is going to be the demise of my hypothetical family member dying of a heart attack, they were going to die anyway. Common sense dictates that ERs staff nurses that are ACLS certified, techs that are paramedics or BCLS certified, and enough people to assure every thing that needs to be done during a heart attack is done…even in the absence of a doctor. So if, despite having all those resources, that 2 minutes that one hypothetical person doing their job is away leads to my family members death, either the staff is poorly trained and my family member was going to die; or their heart attack was that bad and they are going to die. The missing doctor/nurse doing patient care with a drug seeker is just a redding herring to the inevitable.

          And I don’t buy the ER is so busy that one person extending courtesy to a patient creates havoc, or a staff member is too busy to address a patients needs. I do see and hear a lot of judging, especially on here, based on what people subjective think merits the good doctors time, and it disgusts me.

          How about this: my family member and I go to the ER for whatever we feel like, and if the ER staff doesn’t like it….it too bad.

          Getting medical staff to acknowledge their deficits with patients is like addressing climate change deniers. There is always something. The comments here humerously show that through every ad hom attack and straw man argument that gets presented in each and every subsequent response here.

    2. Jim

      Brian, you seem to have missed the point. There is a reason it is called the EMERGENCY department. Not the I want it now department or the I need a work excuse department. We are not there to treat non emergent patients that don’t take the time to find a primary care dr. I can’t speak for all across the country but in my area there are plenty of free clinics that you can see. It is just as not convient as the ED. But I am sure you will miss the point again. So I am sure I will see you again tonight with your chronic toe pain arriving by EMS and expecting me to call you a taxi for I ride home.

      1. Brian Del Bono

        Jim, I really think you’ve missed that point. Contrary to what impression you’ve conjured up by watching Nurse Jackie and ER, the ER is a primary care center in the United States now. The “Emergency” is in name only; you, if you’re an ER staffer or physician, are there to serve. Do your job and be grateful to have such job security.

        If you’re there judging me for what I’m being seen or for what I judge an emergency, you should find employment that suits your temperament better.

        1. Kassi

          Brian, Brian, Brian…oh dear. Where to start. First, you seen angry so I’m thinking you may have had a bad experience with a doctor or an ER.
          Actually, as you are totally entitled to your opinion, I’d just like to correct one point that you may not be correct on. Because of the Affordable Care Act, the non-life threatening emergencies, especially with children, have dropped dramatically in all ER’s because people who previously were uninsured and were forced to take their child to the ER for, say, an ear infection, now have health insurance and can take their children to a regular doctor. Obviously, this benefits everyone–starting with a sick child and an exhausted parent who no longer need to go through a six hour wai.
          I came away from this post with the exact opposite reaction you did. My impression that this us a very smart and caring Doctor who is trying to enlighten us ‘civilians’ to what to expect. And I loved it.
          Take care.

          1. Brian Del Bono

            “Because of the Affordable Care Act, the non-life threatening emergencies, especially with children, have dropped dramatically in all ER’s because people who previously were uninsured and were forced to take their child to the ER for, say, an ear infection, now have health insurance and can take their children to a regular doctor.”

            Cite? Show your work!

          2. Kassi

            Brian : one source for tonight. But lots of info.
            Http:/www.medicaldaily.com/emergency-room-crowding-decreases-after-formerly-uninsured-get-insurance-uclastudy-finds-3O7137#.VY14R0iZ1jU.mailto

          3. Brian Del Bono

            Kassi, I can’t open your link, but here is an article recently published on USA Today that contradicts your claim: http://www.usatoday.com/story/news/nation/2015/05/04/emergency-room-visits-rise-under-affordable-care-act/26625571/

            I’m assuming we can agree as reasonable people that USA Today is a sufficiently reliable source of statistical information on ER Visits.

          4. Kassi

            Sorry about the link. I can’t figure out to post an actual link on here & of course there are a million articles re: affordable care act from 1000 different views.
            This particular one is from a highly regarded study from UCLA … I would try http://www.medicaldaily.com and go to the Emergency Room Crowding Decrease.
            This is still a very hot buttoned law, so you will find pro’s and con’s all over the place.
            One of the main goals of ACA is both to save hospital’s millions of dollars yearly (that will show up in lower over all insurance rates for us) because the uninsured will finally have insurance, can go to a doctor office and not tie up the ER with non-life threatening illnesses, etc.
            This is the goal, it’s a beginning, and as time goes by, hopefully are ER departments will go back to the emergencies they were meant to handle.
            My comment and attempted link are meant to compliment Dr. Ott’s words. There is a crisis in the ER’s across the country and the dedicated doctors are working diligently to get to everyone. She did an outstanding job of explaining why you may have to wait 6 hours, which she doesn’t want anyone to experience.
            OK. Peace and Good Health to you.

        2. Jim

          You are sadly mistaken my friend. The emergency department is properly named. We are an acute care facility. We are not a primary care facility. When did this magic wand wave and change the word emergency to mean whatever and whenever. We do see people with non life threatening issues because self entitled people like you are to lazy to seek out the appropriate place like a clinic if you cannot afford a primary care physician.
          Here is a hint. If you have to wait in the ED for 4 plus hours, than you should have never come to the ED in the first place. People who have “true” emergencies will always be taken back first. In my ED, we will only see those non emergent patients after the emergencies have been cleared out. And we will always leave a couple of rooms open so that we can immediately see the emergent patients because that is our purpose.
          And I am grateful for the security in my job. I feel very lucky in that regard. Oh wait a minute, it might have something to do with the fact that when choosing a career, I chose one with high job security. So I guess I am grateful to myself for caring about that.

        3. Ryan

          No one is judging you for what your complaint is; if you come in the door, you will be evaluated and treated accordingly. And yes, there are plenty of primary care complaints that show up on a daily basis (although no, nobody pays 20-30k for an ER visit, no matter what kind of testing gets done — the collection rate for an average emergency department is ~30%; most people pay absolutely nothing). What you don’t seem to understand when you say things like “do your job” is that it is *not* the job of the staff to give you everything you ask for. They are there to triage, stabilize, and treat medical conditions. They are called on to be stewards of scant medical resources–and yes, time and personnel are resources as much as antibiotics, ventilators, and available ICU beds. They are there to exercise their knowledge and expertise to treat medical conditions using best practices as studied and documented in peer-reviewed literature, NOT as demanded by patients. And when it takes five hours for you to be evaluated for your sore throat because the ambulances keep dropping off trauma patients and the helicopters are flying in stroke victims, it means that they *are* doing their jobs. So no, they are not “there to serve”, as you so boldly assert.

          As to your pain control gripes, have you ever dealt with a patient who had a spinal pump continuously infusing Dilaudid throughout his central nervous system, who also takes 150mg of oxycodone on a daily basis and is asking you to control his pain? What about someone who has logged 10 visits in a month for 10 different complaints and is ringing the call bell for more fentanyl every fifteen minutes despite being up and walking around the department? The point I’m trying to make is that dispensing narcotics requires a degree of discretion, and there are a lot of people who would not consider their pain to be at an acceptable level if given all the narcotics in the world. Most patients are given some quantity of pain medicine; from there, it’s all about expectations. If you walk into the emergency department expecting them to abolish every bit of pain that you’re experiencing, then the problem is with your expectations, not their practices.

          Your posts smack of a certain naivety that paints you as an aggrieved party, with little inside perspective, looking to get the last word. Your statements aren’t wrong, but without any grasp of context, they aren’t exactly meaningful either.

          1. Kristin (Post author)

            Thank you for this rational, balanced, honest response!

          2. Dina

            Sorry, Ryan, I have to disagree with you regarding out of pocket ER costs. Sadly, I have to pay $28,800 a year for the privilege of being to own healthcare in this country. I hardly ever see the Dr. and I only use an emergency inhaler maybe 2-3 times a year. Should I get sick over the weekend or have an accident (God forbid) technically, I am paying almost $30,000 for an ER visit.

        4. Something that sounds like dilawyer

          Ha, this is the common misconception of the public. They are not there to serve they are there to find out what is wrong with you. They aren’t a pharmacy and the patient doesn’t tell the doctor what to do. The doctor is actually paid for their knowledge on medicine so if you think you need antibiotics for your virus sorry you’re not getting them and if you think you need morphine for asthma, sorry that doesn’t make sense and you’re lying to get narcotics. I’m glad you think so highly of yourself that you think you know what ER docs and RNs should be doing

        5. Wormwoodbush

          I’m in Australia and we have free universal healthcare, however we suffer the same fate as EDs in the US, too many people turning up who could have been treated by a GP! Yet our doctors are generally free, or minimal cost, so there’s no real excuse to use the ED as a free clinic! Many seem to think it’s cool to say they spent the day or night in “hospital”. Many turn up with varied types of pain yet haven’t even taken basic analgesia! They often get given paracetamol (acetaminophen) and are better, yet expect to be given a free box to go home with, despite it being available in supermarkets for around a few dollars or less! Or when asked if they’ve taken any pain killers they state no as they couldn afford to buy any, yet in the next breath ask to go outside for a smoke! Priorities of many people amaze me. I do not work in emergency medicine, I just have the misfortune of having to use their services too often! I also have a mate who works in emergency medicine, and I’m a retired nurse, so I know exactly what it’s like from both sides of the fence. I also suffer chronic pain, not why I go to the ED, just adding that so you can see I understand chronic pain. When in the ED with conditions unrelated to my chronic pain, I’m always treated exceptionally well with regards to my chronic pain, I’m offered extra or appropriate doses of analgesia to control my pain related to why I’m there as well as to control my chronic pain. However i don’t make stupid requests of the busy staff, like cups of coffee. I just do what they ask me to and am usually feeling too crap to want any food or fluids, or I’m fasting for possible surgery. If you just sit or lie quietly and only ask staff questions etc when they are in spending dedicated time with you, you find you get better service than when you call the staff away from other jobs for minor requests or questions. Obviously if you have a serious problem like sudden extreme pain or bleeding or vomiting, press your call bell and the staff will come, or if you have to, call them on their way past. But don’t just call or for silly reasons like coffee. Use your call bell and someone will attend to you when they can. Maybe US EDs don’t have call bells, as no one has yet mentioned them. We have them in Australia and we are encouraged to use them as patients. The main point here is really don’t use the ED as a free doctors clinic as that just increases the wait times for everyone! One day, Brian, you may be the seriously ill person and your wait may be extended unnecessarily by everyone else going to the ED because they can and think they are entitled to, like your comments seems to suggest this is how you feel.

      2. Brian Del Bono

        Jim, I’ll respond here since it’s the most appropriate place to deal with your gripes. Especially since your comments are a special kind of absurd and the fact you offer a lot of conjecture that the Emergency Room serves some noble purpose beyond non-urgent patients.

        The ER is a primary care center. (See: http://www.usatoday.com/story/news/nation/2015/05/04/emergency-room-visits-rise-under-affordable-care-act/26625571/; http://www.rwjf.org/en/library/research/2013/07/understanding-why-patients-of-low-socioeconomic-status-prefer-ho.html) The ability to provide expedited care, diagnostic testing, and physician evaluations has replaced the traditional model of primary care. In fact, the American College of Emergency Physicians states the lack of primary care doctors is one of the leading causes of increased emergency room visits to obtain primary care. (See: http://newsroom.acep.org/2015-05-04-ER-Visits-Continue-to-Rise-Since-Implementation-of-Affordable-Care-Act). A review of all three sources cited above supports a shortage of primary cares doctors, the primary care system being too inefficient to match higher quality ER care, and a patient preference to deal with ER staff as some of the leading causes for this trend. So despite your that an ER “is not set up for that,” the evidence does not support that and patients, the government, and health plans are treating the ER like a primary health center.

        Otherwise, can you please show USA Today and the American College of Emergency Physicians the secret stash of primary care doctors you’ve been referring your chronic pain patients too?

        Make no mistake, the “emergency” in emergency room is in name only. In practice and reality, it is an on demand primary care center serving to facilitate care amongst a diverse population group. Take out the back pain and sore throat patients, you might actually be out of a job. In fact, some hospitals had to downsize and layoff emergency room staff in 2008 because the lack of “non-emergent” patients not utilize the ER lead to staffing glut during the first 16 months of the recession. It seems we don’t need staff that serves TPA (which doesn’t work according to some studies), we need people that do rapid Streep screens and booster shots.

        You’ve now been given 3 sources of reliable information, one being the primary professional organization for ER physicians and another being USA today, proving my assertion. What evidence do you have besides the mumblings of a jaded healthcare professional?

        1. Jim

          Did you even read those articles. They do show a rise in ER visits after the affordable care act which is true. There is a nation wide shortage of primary care doctors but there is not a shortage of clinics which should be used in the short term until a primary care dr can be found. Every time I discharge a patient that does not have a PCP, I give them a resource guide. People like you don’t want to go to a clinic because it means you have to be responsible. You have to make your own appointment instead of just show up by private car or probably EMS. You will have to wait two days for blood results instead of 45 minutes which greatly increases costs to taxpayers. And you might have to go to an outpatient facility for your scans instead of just being pushed in a stretcher from place to place while demanding a warm blanket.
          Here is my point, I have thought about quitting my job several times because it becomes dangerous when I have to juggle to many patients at once. I know you want to sit back and say I should just work harder. The ED has high and low points to everyday when it comes to patient census. The lows are horribly boring. But the busy times are insane. My license is on the line every time I treat a patient. I have to be perfect, or people die. And due to the patient load, Almost every shift I have to decide who to see first based on who would die first. Only someone who works in the medical field can truly understand how hard and scary that is for both the medical professional and the patient. But dont you worry your little head. TPA is highly overrated. I will not do any more training on real emergencies because I need to increase my speed on strep test and treating fibromyalgia pain. Basically, what people like you have done is create a dangerous environment because your lazy and self entitled.
          And no, I will not quit my job even if people like you keep coming in. The worst part about your entire argument is you don’t have a clue of what your actions are doing to health care. But you still have your head buried in the sand blowing your hot aired ignorant opinions out your. You really need to go volunteer in a busy ED for one week. Get to know the people and there responsibilities. Your opinion will change.

          1. Brian Del Bono

            Jim, I’ve provided evidence for my position. There is also not one assertion that isn’t supported by my evidence from the cited articles above. You have offered nothing to support yours. The burden of proof is on you.

        2. megan

          Brian, you seem to think that simply because some people use the emergency room as a primary care office the ER should now function as a PCP. Inappropriate use does not change the intended function of anything. I can use a butter knife to tighten a screw, but it doesn’t become a screwdriver, a homeless person sleeping in a bus station doesn’t make it a hotel or a homeless shelter and my kid jumping on the bed doesn’t turn it into a trampoline. Emergency rooms are still intended to treat emergencies, things that can’t wait for a primary care appointment. People using the ER for non-emergent situations does slow down the flow through the ER and can cause delays to the care of critical patients. I can’t put a patient who needs immediate care into a bed that is being taken by someone who should have gone to their PCP.

          There are somethings that I think are missing from the discussion. First, EMTALA requires that all people who wish to see a doctor in the ER get a medical screening exam, no one can be turned away, regardless of chief complaint or ability to pay. Second, many chronic pain patients who see pain specialists also have pain contracts that limit their ability to get pain meds from anyone but their pain specialist. This is done to stop the patient from doctor shopping to get additional pain meds, which includes going to the ER for narcotics. Patients who don’t follow their pain contract can lose their ability to get their prescriptions. These pain contracts often state that ER doctors should not prescribe narcotics for subjective pain. Third, ER physicians are limited in the amount of narcotics they can prescribe per patient, often in a small quantity that should be enough to get them through to a follow up appointment. Many people wait to get a PCP until they need an appointment on an urgent basis, and most clinics don’t offer new patient appointments on short notice. Once established those patients can get a same or next day appointment. Many ERs have signs posted that they cannot refill chronic pain medications.

          I agree that pain is debilitating, especially chronic pain. I think that most ER staff are very sympathetic to people who have chronic pain issues and need to utilize the ER for their chronic pain on a very limited basis. Frequent fliers, those patients who use the ER frequently as a PCP for their pain and other complaints that should be managed by a PCP, are going to be referred back to their PCP for treatment because that is the appropriate place for chronic medical conditions to be treated and followed up on.

    3. Frank

      Ummm, actually the Emergency Department is not for non-emergent. Hence the name, Emergency. You’ve got an Emergency? Great, come on in. You dont? Thats what primary care is for.

    4. Chance

      It’s not their job to treat the” non emergent”. That job belongs to their primary Dr. The er Dr is to screen you for an emergency then treat appropriately. As far as chronic pain, yes they really do care. Only one md can prescribe that person. chronic pain management includes many more methods of treatment besides prescribing narcotics. which are addicting tolerance building debilitating drugs if not used carefully. The US consumes 80%of the world’s opiates so I think the Dr’s here are being generous not “jaded” as a whole. They have to be a detective as well as a Dr for all the dishonest ones who will show up later ODed or sell the pills to someone who may do the same. Pts in the US despite lacking insurance or $ have access to the best care in the world by just walking through a door. The rest of the world wishes they had this. Citizens are so filled with entitlement this day age and it’s very sad. We should feel thankful for what we have and esp those who do nothing to deserve it but live here.

      1. Wormwoodbush

        Chance -. “Pts in the US despite lacking insurance or $ have access to the best care in the world by just walking through a door. The rest of the world wishes they had this.” Really? You honestly believe this?? I’m Australian and we have free universal healthcare, much like Canada and the UK. I wouldn’t wish for the US healthcare system in my worst nightmare. We have the same or better hospitals that treat anyone and everyone for free, that includes multiple days stays and surgery for absolutely anything, such as cardian bypass, organ transplants, brain surgery, anything and it’s FREE!! so why do you believe the US system is so good? Without insurance, your citizens can access basic medical care at best. I’d hate to need major surgery in your country! As I can’t afford insurance. The only advantage insurance gives you in Australia is choice of doctor and gets you into hospital quicker for less or non urgent operations. If you need life saving surgery you get seen pretty much straight away in the public system. So I’m damned happy with our healthcare system.

  17. Julie

    This is an amazing article and spot on!! I have been an ER nurse for 8 years all over the country and this is so true!! I wish we could hand this out to the patients when they walk into the door. I have learned NEVER to give times when it comes to the most popular question, “How long is this going to take?” It is incredibly frustrating when patients become angry with you because of the prolonged wait times. And then there’s the ones who do not understand the meaning of traumas, codes, stroke and STEMI and how that impacts their wait times. I love the comment about getting coffee for the family!! Classic! And “pain can’t kill you”…absolutely true! I recently had a patient rate their pain “15” on the scale 1-10…meanwhile they are texting on their phone as I am trying to perform a physical assessment. Thank you again!! I definitely will share!!

  18. Hank

    So, essentially, no matter how sick you are, how much pain you’re feeling, or how much blood is pouring from that gaping wound, remain mindful of how you address ER staff. They may have sensitivities related to gender or professional status. And don’t expect sympathy. Remember that pain is good for you. These folks have seen thousands of hypochondriacs and junkies, so it is only natural to assume that you’re one, too. Remember: you are basically a sausage traveling down a conveyor belt. Expect to be treated as such.

    1. Kristin (Post author)

      Pt’s “in extremis” are excused from all social graces. I LOVE to treat pain – – it’s one of the one effective treatments I have at my fingertips. I write Dilaudid q1h PRN on almost all pts with pain in the ED – – I don’t want nurses to have to waste time tracking me down and delay additional pain management for patients – – what I don’t want to do is create or perpetuate crippling dependence/craving – – tough call. Pain isn’t good for anyone, but it’s true, it won’t kill you.

  19. iwillnotliveinvain

    Clicked on this article because of the St John Ambulance pic – Holla for St John!! 😉 (I volunteer for them in Australia 😉 )

    1. Kristin (Post author)

      It’s a great picture! Photo credit at the bottom. I wonder if this is why so many people have read it in Australia! Over 15,000 people in Australia have read this article which is super cool. I didn’t realize how similar our medical systems (and patients) must be!

      1. iwillnotliveinvain

        Lol, it might be! But I did get directed to it from a link on a US friend’s FB page 🙂

  20. mike johnson

    an er rn: james belushi is alive. john is dead, otherwise, spot on

    1. Kristin (Post author)

      Ah!! thanks for catching this!! Fixing it NOW!

    2. Kristin (Post author)

      and, of course, my apologies to Jim

  21. Mitch

    great article – just one tiny error – it was John Belushi who died (not his younger brother James, who is still very much alive) from from drug usage OD…

    1. Kristin (Post author)

      Thanks for letting me know – your comment initially went to spam for some reason, but someone else caught it too and it’s fixed!

  22. Kassi

    Kristin, you provide such valuable information for all us ‘civilians’. A look at the ER from the inside, and from the most valuable asset the ER has, is very powerful.
    Thank you. Very powerful.

  23. Kassi

    In my lifetime, maybe because I’m up North, nobody would ever ask a doctor for even a peep more than necessary. That seems so non-productive. I’ll take a meeting with your supervisor!!

  24. Kassi

    I can’t believe a doctor has to get a blanket, or food for anyone. You are stretched too thin as it is. Wouldn’t it be a better world if every ER could hire ‘case workers’ or ‘care takers’ to keep the patients comfortable so the doctors & nurses can do their job.
    My pet peeve in every corporate place of business…Hospital Head Honcho, Insurance Co. CEO’s, Big Pharma Execs: just how much more money do you really need?
    I do love your work stories. They provide valuable info we really can’t get anywhere else. More money for more E.R. Staff would solve so many problems.
    BTW, Jon spent a few years as the Psych. Eval ER guy in a hospital in Jackson– he called the addicts ‘frequent flyers’. It’s a tough job you have. I’d love to start a movement (without naming you or the hospital) that would shame zillionaire’s while laying off nursing staff or Doctor support staff…

    1. Kristin (Post author)

      Some hospitals actually do have those people (“patient care techs”). I think patients encounter so many people in the ED (from registration people to techs to transporters) that they lose track of who is who and just always ask the next person to walk in the room. Women doctors DEFINITELY get asked to do these things more than male doctors, but that’s just the way it is!!

      1. Natalie Britt

        You are so right about the
        Male/female thing. Kris works as a PCT in the memorial ED while he’s finishing nursing school. We have had multiple instances while walking down the hall together, me in my (short) white coat and business casual and he in his blue tech scrubs, wherein I have been stopped and asked for directions, food, blankets, etc. One time, a polite gentleman looked at kris and said, “I’m sorry for interrupting, doc” after asking me for coffe creamer!! Of course, at memorial, the hallway ED beds have a lot to do with the flagging down of random hospital personnel for any and every little need.

        1. Bob

          “Chronic” pain is not an emergency. Call your “chronic pain” doctor if you have problems. Just because we didn’t give you dilaudid doesn’t mean we didn’t treat your pain. There’s not a menu at the door when you walk in. You get what the Dr. orders based on his assessment.

          1. sonia

            seems to me that people get hooked on pain pills and there are other options the ER is not a place for chronic pain do you need to go to a regular doctor

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