Archives for March 13, 2007

MedBlogs Grand Rounds 3:25

Grand Rounds 3.25 ? ScienceRoll

A day early, and with a Monty Python theme. Be still my heart.

The Clinic

Sometimes it’s a bit bothersome to work in the ED, especially when working a late night shift.  I’m referring, of course, to the ‘clinic visits’.  “Vagnial discharge for 5 months”, “rash for a year”, “back pain for 5 years”, “cough for 9 months” are hard enough to see when the sun’s up*, but when they present after 1AM they’re utterly toxic to the soul of the Emergency Physician. 

Look, we’re all circadian creatures of a sort, and it’s utterly crazy to think that at some point that morning your patient decided ‘you know, that problem I’ve had for months?  I think I’ll take it to the the ED, because it’s an emergency now’.  When these patients introduce their complaint to an ER doc who’s up not because they want to be but because they have to be, the doc might be forgiven for thinking “I’d be in bed were I you”, or occasionally worse.  These same patients who present at 2PM are mildly bothersome, but not really an issue; the same complaint at 2AM will get the doc’s attention, but in entirely the wrong way.

I’m of the opinion there’s not enough of a night-time charge for ED visits, but that’s back to the $5 to be seen, but we’ll give you $5, and by the way, there’s a $5 ice cream machine by the lobby door conversation.

I’m just tired of being an emergency physician who works an expensive after-hours clinic.  The case that set this off was “I have a toothache for three weeks, and I want to be checked for a discharge I’ve had since my miscarriage”.  How long ago was your miscarriage?  “5 months”.



* Like in any ED you can tell if the sun is up.  Every one I’ve been to is like a submarine, it’s the same inside day in and day out.