Thursday, June 14, 2012

Pretty Pretty Please

Please.

Pretty please.

Pretty, pretty please.

Don't just go to the emergency room.  Try me first.  OK, if death is imminent, call an ambulance.  But otherwise, I'm just a dial tone away.  And I am acquainted with the dizziness, chest pain, and swelling in your abdomen.  I read the results of your latest stress test.  I was there that day when the edema in your leg was a blood cot.

The doctor in the ER is kind and patient, but she doesn't know you.  She didn't stand by your side when your husband died or when you broke your leg.  She doesn't recognize that your eyes glaze over when your anxious or the wince you make when you're in pain.  But I do.

And things happen in emergency rooms.  Demented people get IV benadryl.  Renal patients gets NSAIDS.  Admission to a medical floor is a given if you are over the age of seventy.

Trust me, you want to avoid the hospital if possible.  Although you imagine yourself entombed in the warm bosom of safety, reality is much more frightening.  Resistant infections, medication errors, and hospital acquired delirium await you in every corner.

I want to protect you from these mishaps.  But once you hit the ER, I become superhero without a cape.  I lose my special powers.  My opinions and influence have no meaning there.  I have to wait till you arrive on the medical floor before I can declare your admission a waste of time, your arm pain muscular and not cardiac, and send you home.

Emergency rooms are good for emergencies.  Emergency doctors save lives.  But if your are dizzy, have a sinus infection, or swelling in the legs.  Call me first.

And we'll work through it together.

9 comments:

Lynda Halliger-Otvos said...

Dr G, you made me tear up with this post; if only there were a way to get to my PCP when I am in pain and vomiting with a rising BP at four in the morning... Perhaps you have a different way of dealing with your patients but my doctor doesn't pass out her phone number to us patients. We are unable to communicate with her by email. When we call the office number the phone tree is long, the waits can be interminable and even if we can get to a human, we are speaking with a young woman or man who has NO medical training and cannot connect us to our doctor even if they wanted to... "Let me get your number and I'll have a nurse call you back sometime today" isn't always a sufficient response to our inquiries.

You have some very lucky patients; can you be cloned, please? Then scattered about in communities world-wide?

I wish you were my primary care doctor, with all my heart i wish you were... what is your advice to those of us who cannot reach our doctor, have either some, a little or no medical training and are unusually sick and frightened in the middle of the night?

AM said...

I second Lynda's comment. I got chewed out by my PCP when I called to get a setative because my boyfriend killed himself, because her two year old was sick. Her question? "Really, what do you want me to do about it" I did change doctors but I find him just as inaccessible. I had a raging infections my bloos sugars were running in the 300's and I couldn't get into see him. So I went to the ugent care. I suspect I'll change again but what a freaking hassle! I hope you do treat your patients like that. They are lucky lucky people.

Alaina said...

I couldn't agree more with this post. Working in the ER, we see a wide range of non-emergent complaints that could have easily been resolved out patient. One of the first question the ER doc asks is, "Have you called your PCP about this issue?" Emergency rooms don't have every test in their repertoire, and we don't have the luxury of following-up to see if their complaint has resolved. IMHO, primary care is sadly underutilized in this country.

Anonymous said...

As an ER doc, thank you. I wish there were more folks like you out there for the people that need you.

tbd88 said...

I have had doctors of both types. I first met my psychiatrist (Dr. X) in 1991 when I was placed in a psych ward (against my will) and diagnosed with major depression and panic disorder. He is creative, compassionate, and keeps up with research and current thought better than almost anybody I've ever met. I would have seen him out of the hospital as well, but he didn't start seeing anybody outpatient until 1997, so the six years in between were various types of hell. I had side effects on the old tricyclic antidepressants and this essentially drove Dr. Y nuts to the point that he took me off of them entirely, I expect to shut me up. I was unstable for a few months and then completely crashed; without timely intervention I could well have been shut up for good!

When I got a call from Dr. X saying that he could see me again, I went immediately. It hasn't been an easy road, and I haven't always been happy with him. When you've had to take time off from college because your medication has failed and the summer is half gone and nothing is working, it's natural to feel like somebody has dropped the ball. But during this period of time, he did things like give me his home telephone number and his personal cell phone number. He knew that I wouldn't use them unless I had no other choice, and fortunately, I never did. But having them definitely made me feel better.

I went back to college, graduated, and ten years later I'm still here. I've been in full remission for the past seven years apart from the occasional panic attack. I live with my partner, not my parents anymore. I can get on an airplane (and do!) and take a real vacation. If I'd only had Dr. Y, I have little doubt that I'd either be gone or in long-term institutional care. But twenty-one years after meeting Dr. X we're still going strong.

Anonymous said...

Your patients are very, very lucky.

Jody said...

Yep, lucky patients indeed. My PCP isn't available after hours, the bariatric surgeon is a jerk and will tell me and other patients abdominal pain is in our heads. One needed emergent gall bladder surgery, I had an obstruction. Where do we go then?

Jen said...

I agree with you. In an ideal world, it should be like this. HOWEVER, we are not living in it. You seem like an amazing PCP and your patients are lucky to have you as their physician

The vast majority of your colleagues, however does not work the same way.
Getting in touch with your PCP? If it is not office hours, impossible. During office hours, extremely difficult. It already takes a ton of time to get through to the receptionist who then, if she is in good mood and considers your concerns important (thus making judgement calls without ANY medical background) will pass on a note to a nurse who MIGHT call you back some time later that day if she finds the time.

Same day appointments are pretty much impossible to get; the doctors have a too busy schedule. If lucky, they can squeeze you in two or three days from when you call.

Oh, and did I mention that in this area many physicians only work 3 days a week?

So yes, as much as I agree with your post, that the ER should be for true emergencies only and that it might be a ways better way to see your PCP as only he knows all the facts of your medical background and has a more 'holistic' view on your symptoms, it is unfortunately not very feasible most of the time.

Anonymous said...

I have been lucky enough to end up, purely by luck, with a PCP like you. I hope others do not give up. There are family doctors out there who care and keep up. The formerly ill-run office has become a phone-answering, nurse-available well run machine and I, and my health, is all the better for it.