A Budding Emergencist
Monday, August 21, 2006
  Your Safe Place draft
One of the good things about learning so much psychology and psychiatry like I did is when you switch to ER like I'm doing is that I can be a stealth psychiatrist or psychologist. How? Let me count the ways I used psych today:

When I deal with a psych patient, I know what to ask about besides, "uh, do you want to kill yourself? How about other people? Yes, okay. A "special" doctor will see you now. GOODBYE! Don't ever talk to me again. No I'm not giving you any pain medicine, see, cuz you're a PSYCH patient. That means I don't have to talk to you. That means you wait the longest.

I know that psych pts (they wear pink-orange gowns in my ER) get physical diseases. I know how to talk to them. Literal use of metaphor, and sprinkle in the important bits in your creamy conversation monologue like the rice crunches in a Toblerone.

I seem to get more VIPs, lubricated by a PCT or a Pt rep or a pushy relative. No problem, ma'am, I'll see to it immediately. I'm like a soothing salve on the festering wound of modern medical care. I don't care, I'm an intern. And I'm rotating. I'll take the time to extract your history, even the touchy parts like genital complaints or worsening mental status or desperate social situations, like a car service voucher from the ER at 3:00 AM, and I'll make sure they're dealt with.

I get a better history. Hands down.

I alsways get a translator, because most medical errors come from communication breakdown.

I believe you are in pain. I'll treat you for it even though I think you're hysterically maximizing your pain (hispanics, I'm looking at you), because pain is subjective.

There are other methods of pain control besides "ten pounds of mofeen". Today, I talked down a screaming gallbladder with pancreatitis into counting her breaths enough to get an EKG. After I scraped her down from the ceiling.

Pelvic/rectal exams--professional and gentle.

I tell you what I'm thinking if I think you can take it, cuz it motivates you to stay and get proper treatment.

I'll try and rescue you from "00-doctors"--PMD's with HMO contracts.

No problem too small for a complete H & P. I expect "doorknob" phenomenon in these patients--"By the way, about this chest pain I've been having..."

I've got a clinic, cuz my profession (D.O.'s, osteopaths) believe in primary care. I will see you there. I'm conscientious and thorough.

Nurses of my patients know I appreciate their efforts. I encourage patients to get to know their nurses.

Going to the ER is a big deal. I know you wouldn't come unless you think it's serious. Unless it isn't, but I make that decision.

Dx and tx are equal or secondary to patient's understanding of their condition and the gravity they comprehend from my assessment and explanation. If they don't know, they can't tell the next Dr. to see them, right?

smiling is healty. I make you smile during every physical. (to test for facial droop. Fun test, eh?)

I still haven't mastered legitimately irate or frustrated patients, becuase I understand their situation and sympathize with their gnashing outrage at unnecessary delays.

I would choose me for my dr.

do good and be happy!

Signing off,
--the emerencist.
 
Comments:
Yeah, I'm humble, too. I also know that any question beginning with "Why...?" is complaining.
 
It's all psych...
 
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Emergency medicine, from the beginning of a new doctor's career.

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Location: Big City, Metropolis, United States

Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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