A Letter to an Angry Patient
Dear Mrs. D'Ramatica:
I'm sorry you were upset with your experience in our Emergency Department. I try my best to make sure that everyone is satisfied, but inevitably patients with unrealistic expectations are going to be disappointed.
As soon as I walked into the room, I could tell that you were expecting to be admitted to the hospital. I've seen those overnight bags sitting shyly in the corner before, and I know fully well what they represent. When you said that you just couldn't take the pain anymore and that your family had told you to go check yourself into the hospital, of course it should have been clear to me that you expected to be admitted. And it was.
I'm certain that you think much less of me than you do of your personal physician. After all, he gave you a compact disc with your MRI pictures on it and told you to "go see a back doctor." There is something wrong with your back, he told you, and you need to see someone about it. Missing that appointment on Friday was a bad idea, however, and so you ended up in my ER.
When you reflect upon our interaction, remember that your doctor (who you probably still adore) didn't actually tell you what was wrong with your back, or what a "back doctor" could do about it.
Apparently, he didn't even bother to have anyone look at the MRI to interpret the study, because when I hand-carried the disc to personally go over your images with the radiologist on call for the ER (which he interpreted without charge to you, by the way), we found that there was nothing much wrong at all. Particularly nothing that required surgical intervention.
"How can that be?" you wondered. "It hurts so much!"
I doubt that you will remember my detailed explanation of back injuries and their rehabilitation, the rationale of medical treatment and the indications for surgical management. All you will remember is that I didn't admit you to the hospital. You won't appreciate that instead of telling you to go see a "back doctor," I actually spoke with one at midnight and personally arranged an appointment on an urgent basis during a short holiday week.
When you eventually discover that neither the "back doctor" nor your own doctor are going to prescribe you the same quality of powerful narcotics that I did, I hope you send me a Christmas card thanking me for doing everything that I possibly could to make you feel better. You might send one to our patient relations department as well, commending me for taking the extra effort to help you. I know you didn't really mean the awful things you said about me on your way out.
Thanks in advance, and best wishes for a quick recovery,
Your ER doc
I'm sorry you were upset with your experience in our Emergency Department. I try my best to make sure that everyone is satisfied, but inevitably patients with unrealistic expectations are going to be disappointed.
As soon as I walked into the room, I could tell that you were expecting to be admitted to the hospital. I've seen those overnight bags sitting shyly in the corner before, and I know fully well what they represent. When you said that you just couldn't take the pain anymore and that your family had told you to go check yourself into the hospital, of course it should have been clear to me that you expected to be admitted. And it was.I'm certain that you think much less of me than you do of your personal physician. After all, he gave you a compact disc with your MRI pictures on it and told you to "go see a back doctor." There is something wrong with your back, he told you, and you need to see someone about it. Missing that appointment on Friday was a bad idea, however, and so you ended up in my ER.
When you reflect upon our interaction, remember that your doctor (who you probably still adore) didn't actually tell you what was wrong with your back, or what a "back doctor" could do about it.
Apparently, he didn't even bother to have anyone look at the MRI to interpret the study, because when I hand-carried the disc to personally go over your images with the radiologist on call for the ER (which he interpreted without charge to you, by the way), we found that there was nothing much wrong at all. Particularly nothing that required surgical intervention."How can that be?" you wondered. "It hurts so much!"
I doubt that you will remember my detailed explanation of back injuries and their rehabilitation, the rationale of medical treatment and the indications for surgical management. All you will remember is that I didn't admit you to the hospital. You won't appreciate that instead of telling you to go see a "back doctor," I actually spoke with one at midnight and personally arranged an appointment on an urgent basis during a short holiday week.
When you eventually discover that neither the "back doctor" nor your own doctor are going to prescribe you the same quality of powerful narcotics that I did, I hope you send me a Christmas card thanking me for doing everything that I possibly could to make you feel better. You might send one to our patient relations department as well, commending me for taking the extra effort to help you. I know you didn't really mean the awful things you said about me on your way out.Thanks in advance, and best wishes for a quick recovery,
Your ER doc
Labels: patients
posted by scalpel at 9:43 AM
22 Comments:
At least you're able to maintain your sense of humor when people are being unreasonable.
MJ
"My back hurts"
One of the worst three words you can hear in a sentence.
That's hilarious. It used to crack me up when adult patients arrived at the ER in their 'jamies, pitifully holding their favorite "blankie" and stuffed animal while complaining of horrible "nausea and vomiting"---but then having no GI problems at all consuming potato chips, Snicker Bars and Coca Cola while waiting for all the lab results to return....
Sometime when one goes Doctor shopping, there just aren't any good deals.
Ahh, the old "positive suitcase sign." I think it should be included in the triage note, so you know what you're getting into.
Great site, by the way.
I do feel really sorry for doctors people expect miracles when they are sick and when they aren't they blame to doc cos they aren't dying. catch 22
Scalp,
Are your Press-Ganey scores as low as mine?
Cherigrace,
That would be the Double Samsonite Sign
"Are your Press-Ganey scores as low as mine?"
I have never gone over my reviews, so I have no idea how my scores compare to my own colleagues, let alone physicians at other facilities.
I work at a facility where the pencil-pushers place a huge emphasis on those scores, so I'm surprised it hasn't been addressed on the individual level. Probably because I don't go to any meetings and hardly ever see my bosses. Avoiding most of that political stuff is one of the best things about going to nights-only.
As a facility, I think our scores are probably above average, but we don't get much trauma either. Personally, I have no idea. Most of my patients seem to be very complimentary, and the rest of them wouldn't be happy no matter what I did.
The satisfied customers don't seem to fill out those forms as often as the angry back-painers do, so I don't worry about scores much.
Dude. You capture that kind of patient exactly.
The worst thing is that when they talk to their friends, they only know their point of view. My mother-in-law is that kind of patient. She loves doctors who kiss her ass but hates those who tell her what she needs to hear (exercise, lose weight, there's nothing we can do about your back pain). I hear about how she is mistreated by doctors on a regular basis.
*snicker*
You have good eyes & ears for people.
In rehab, we get the chronic back pain people who, in addition to having positive Samsonite sign, request specific doses of Dilaudid as well. And become deeply irate when our docs prescribe something so cruel as say, Vicodin.
/jo
"a compact disc with your MRI pictures on it"
I just had a nerdgasm. I wish I could get all my old x-rays onto a CD... dammit. Do the patients get copies of them?
i so enjoyed this entry. it captures exactly what has happened countless times to so many of us. the sarcasm was wonderful. i'm reminged of the acronym in the brilliant book, house of god by samuel shem, GOMER, or get Out Of My Emergency Room
Brilliant. Sheer genius. Never has back pain seemed quite so funny.
Perhaps before you do another one of these postings, you may want to familiarize yourself with HIPAA. I have attached the penalties for you
Wrongful disclosure of individually identifiable health information:
Wrongful disclosure offense: $50,000 penalty, imprisonment of not more than one year, or both.
Offense under false pretenses: $100,000 penalty, imprisonment of not more than five years or both.
Offense with intent to sell information: $250,000 penalty, imprisonment of not more than 10 years or both.
Is it possible to be so clueless to think that "Mrs. D'Ramatica" is a real name?
I guess so....
Ummmm, yeah. I made up the name.
The cases I present are not related to or identifiable as any specific patient, my name and hospital are not identified, the significant details are changed for the purposes of anonymity, and all cases can be considered composites of several hypothetical patients. Any similarity to actual patients is purely accidental.
Feel better, HIPAA Nazi? Sheesh.
I'm late getting into this one but great post and comments! :)
I always find a medical professionals POV interesting.
As a life long patient, I have type 1 & 2 brittle, the treatments have produced further 'complications/diseases', and all throughout this I have spent innumerable hours in doc offices and ER's'.
As the many years have passed I have witnessed and experienced first hand the steady DECLINE in patient care.
In your blog, you present yourself as an exception to this, which in my opinion, is becoming all to rare now-a-days.
I do take offense to being mistreated by these persons I am FORCED to see to stay alive, and to see the wisecracks made here about patients just validates what I already know - A good Doctor, medical provider is becoming one of the rarest commodities, and poor patient care is epidemic.
It is sad that this lady seemed to need help for her pain, was the pain imagined or real? either way this lady needs help even if it is phycriatric...
Sadder still is some of the comments on this subject! where is the compassion? physical or mental the pain is real to them!
As a chronic pain sufferer the last place I would go is to an emergency room!! sitting for hours ! and then what are they going to do?
I am blessed to have several wonderful Drs (some who I have gone to for over 20years )who are available to me and are as anxioux as I am to find something that works for my pain,
Unless you experience it first hand you have no idea the hell CP patients go through, trying different drugs and treatment in hope of relief from pain!explaining when you look great! and are dying inside!
When I first started having back problems the Dr put me through so many tests and procedures! it was humiliating because I knew with the FMS/MP, Osteoarthritis I have, he was convinced nothing was wrong, he did surgery and it took him 6hrs to pick out broken bone chips, I had a spinal fusion, He wasn't there for my recovery and had a collegue look in on me! as soon as I could I got another Dr
When I needed shoulder surgery I went to same practice and got another Dr, no beddside manner but good DR..again I came up against the FMS predjudice ..and more tests thsn needed.But after talking to my Rheumatologist he called and apologised and said he would do surgery, I have since gone back to him and refer him to everyone...He knows I don't waste his time...this is rambling but I want you to know there are people who have chronic pain which medication seems to barely take the edge off! we mightlook healthy enough but inside we are struggling to get through each day!
and most medical personel and Drs are at a loss as to what to do with us! and some don't even try to hide their scorn over what they cannot see in an x-ray or stitch closed!
Adding to that any other health problems and you just barely get by some days!
Yes my back hurts! but I know it is futile to go to ER
Though recently my family Dr sent me when they thought I was having a heart attack! and everyone was wonderful!
Wish I could say the same for busy Nursing staff on floor I ended up on
I wish I had time to relate all the horrible experiences I have gone through in different hospital stays, for genuine surgical proceedures no less! Nursing staff being the biggest culprits!and I am a nice respectful patient. of course it is well known the local hospital is a disgrace! under staffed and under paid! and the way they talk about their coworkers on other floors or in the ER...disgraceful!!
Makes me terrified to go into a hospital!
But as patients we have no choice we are always at the mercy and whims of the staff!!
I am rather astounded that anyone would want (and prepack) to stay in a hospital.I find this extremely sad
and incredible, all I ever want to do is get out!!
You have a difficult job,I admire you all for your skils and the difference you are able to make but please continue to have compassion for those you treat!
I came here to read this because of uproar about the posts I read on a website,
Maybe you have to suffer pain before you can sympathise...
My thanks to Scalpel, he does seem like he cares but shame on some of you for your scorn! these people are to be pittied not laughed at!
it is sad they have to go ER to seek out treatments!
To the last 2 posters: the reason why you get this reaction is because (as you said) there's nothing that can be done for you in the ER, and that goes for any chronic problem.
If you forget, ER stands for EMERGENCY room. Yes, you have pain. Yes, I feel bad for you. But NO, that is not an emergency. And NO, it does not warrant admission to the hospital. You will not die or loose a limb from your chronic pain. On the other hand, if you have a new development in your chronic problem (eg you fell) then I'm sure you will not be treated the same way. But again, that means, you have an acute condition which is appropriate for the ER.
There's a reason why doctors are trained in different specialties. People need to go to the right one. Chronic pain needs an anesthesiologist specialized in pain management and back pain requires either a orthopaedic spine specialist or neurosurgical spine specialist, NOT the ER. Would you go to an roofer to fix your leaking plumbing? No, because they specialize is different parts of the house, even though they are both in Home Repair.
And to the HIPPA nazi .... just go away!
Sorry for the rant...
I agree that there are a lot of people using the ER's for pain medications. However, I have seen the very unfortunate cases where someone is realistically in pain and is not treated with the appropriate level of pain medications by ER doctors!! I am seeing this more and more!! I know that docs are afraid because of the DEAs new laws but I DO NOT agree that someone who is genuinely in pain should suffer due to 1) past experiences with true "drug seekers" 2) doctors have become bitter towards any patient claiming pain 3) The DEA. I worked as a nurse for 30 years in the ER and now I am just PRN but I can tell you that more often than not recently, I have seen my patients being under treated for pain!! I don't agree with it and even approached a doctor about it a few times and was blown off!! I think its very sad that we have let these select few patients that doctor shop govern how we treat the rest of our patients. Im very disappointed in where medicine has gone in the last decade!! :(
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