*We’ve all heard ’em, the blaring sound of ambulance sirens rushing through the streets. At one time or another we have probably been the driver caught in the middle of an oncoming brigade of fire trucks, police cars and ambulances rushing towards us and we are momentarily consumed with fear as we frantically try to get out of the way. So once they reach their destination, the emergency room, and the worried families sit outside in the waiting room with baited breath wondering what will become of their loved one, those white swinging doors close and a series of medical professionals take over. What’s happening in there…really? One ER doctor decides to open up and let us know 5 Terrifying Secretsabout hospital emergency rooms. Hold on. #5 Doctors train on your body “Just stay out of the comments; not everyone is here to learn.” Well, though this topic alone can be frightening, it’s not really surprising. There is only so much practicing on a dummy is going to teach you. Once, I was showing a new family-medicine doctor how to do his very first spinal tap — a procedure in which a long, thin needle is jammed in between two vertebrae in the lower back. I started by having him watch a video of someone else doing it. On YouTube. So, he watches the YouTube video outside the room, and I remind him that if he felt resistance as he was pushing the needle in, that was probably bone, and he’d need to withdraw and try again. So, he starts on the patient (who is awake, but out of it) and pushes in hard. He keeps pushing, and finally says, “I don’t think I got it in the right place.” So I go to pull the needle out of the patient’s spine, and I can’t. The needle’s stuck in there. When we finally got it twisted out of the patient’s spinal column, we saw the damn needle was bent at a 45-degree angle because he’d slammed it into the bone so hard. The patient never knew (drugs erase all mistakes and bleach every sin). Read more here. “OK, that didn’t go so well, but now you get to learn how to properly issue a code blue.” It might be a nurse doing an IV, a physical therapist getting you out of bed, or it might be your doctor. In the good old days, medical students got more of this hands-on training before they graduated, but due to changes in medical education, brand-new doctors often have to learn on the job. As a senior resident, I’ve walked interns through everything from a pelvic exam to a lumbar puncture to a central line placement (that last one might not sound too bad, until you realize a “central line” is a large IV usually inserted directly into your jugular). #4 What am I doing…I’m Googling your illness It seems TV shows like “House” and “Grey’s Anatomy” have only contributed to the major misconceptions we have about how much doctors automatically know about our illnesses. We go to school for years more than most people, we seem to make a ton of money, and a lot of us have nerdy-looking glasses. So it would make sense that we are bottomless wells of knowledge, and these TV shows don’t do anything to dispel that notion. In the real world, if a patient shows up to the ER with a somewhat rare disease, instead of immediately knowing the nuances of the pathophysiology, epidemiology, and treatment, I’m struggling to remember the basic details of a disease that I learned about back in medical school. Read more here. #3 Yes, other people are dying, but we must still find time to relax No matter how it looks, do you really want a tired doctor working on you? But yes, doctors confirm that we don’t like to see them relaxing or taking a break while our loved one is suffering in the ER. if your husband is having a heart attack, you don’t want to see me laughing with my colleagues about the crazy ending of The Walking Dead the other night (“I cheered when Daryl smashed that zombie’s head in the car door!”). Or if I just put a breathing tube down your mother’s throat because she had a massive stroke, you really don’t want to see me sitting at my computer a minute later, eating gummy bears and texting my boyfriend about what’s for dinner. On an intellectual level, you know doctors lead normal lives outside of the ER. But on an emotional level your loved one is sick and I’m blithely popping candy in the next room like some sort of sociopath. #2 We Notice Some Weird (Cynical) Trends Mondays are the worst. About 5 percent of what I see in the Emergency Room are actual emergencies, 10 percent are urgent cases, and the rest of the people who come into an ER could probably have waited for a normal doctor. And a huge number of those non-emergency, non-urgent cases flood us on Monday. Why? Well, if someone pulls their back on a Friday, they're not going to waste weekend time in the hospital. They're going to come in Monday -- to get their minor injury seen to and a doctor's excuse for their work absence. There are a lot of things like that we start to notice over time. Another one: the patients most likely to pass out while getting stitches are young guys with tattoos -- women and old people do so much better. I make the young guys lie down before we even start. They're going to pass out anyway, and anticipating that makes less work for me. And then there are the drug-seeking people; they're not usually hard to spot. They'll claim, "I'm allergic to everything but one drug ... it starts with a D?" That's the narcotic painkiller Dilaudid, and they damn well know the real name. But every drug-seeker seems to follow the same script: they'll come in claiming some legitimate, recurring problem, and then act as if the name of the only pain drug that works for them (which just happens to be a narcotic, every time) is some half-remembered riddle. #1 Yes, I'm Judging You I said above that only a small percentage of what I see are actually urgent cases. Well, everything about the whole ER experience -- from the long wait to the annoyed look on a nurse's face -- makes more sense if you keep that in mind. As for me, it takes only a few minutes to know if I like you or not. It's not going to affect your standard of care, because I'm a professional. But it might affect if I remember to tell your nurse you asked for a blanket, or if I go out of my way to offer you a written work excuse. Petty? Maybe. But this is what you're going to get until they finally staff hospitals with robots: ER doctors are human beings and compassion fatigue is an actual thing. Once you see enough gunshot wounds and car wreck victims, it gets difficult to care about someone who declares their chronic back pain to be an emergency. "Sir, despite what the cereal mascot told you, you are not suffering an emergency deficiency of vitamin D-Licious." If you think it's callous to be annoyed by someone who is truly in pain, you have to keep the context in mind. Everyone who walks in thinks their situation is an emergency -- it's right there on the sign -- but only some of those people are right. And there is no correlation between how much people complain/make demands and how urgently they need help. The person screaming for pain pills for their pulled muscle is going to have to wait behind the guy who is quietly hemorrhaging. And the person who has to wait is not going to like it. "I'm behind him?! If I'd known a wound from a .22 would get you to the front of the line I'd have shot myself on the way here." Things that will earn my wrath: boasting that you have a "high pain tolerance" (if you've had that thought, it's almost certainly not true), not having any idea what medications you take, not having tried anything for your pain at home (you are young and healthy, it's OK to take a Tylenol for your toothache before coming into the ER), being above the age of 10 and bringing a stuffed animal in with you, the list goes on. Doctors are human, and we definitely do not have an endless amount of patience. And nothing in medical school taught me how to be forgiving of someone who, for instance, claims they couldn't afford the antibiotics that were prescribed for their child, but show up with cigarettes in hand. If you're worried about pissing off your ER doc, remember: it's not hard to avoid. Just be honest about your symptoms, and don't be offended if we aren't always as sympathetic as you'd like. You have no idea what we saw 10 minutes before walking into your exam room. Source
