In the ED we treat all kinds of people, all walks of life, without prejudice (we strive, but we’re people, too). And, interestingly, people like to tell me what they do when I’m chatting with them. This is different than the medical history, and usually while performing whatever procedures we need to do.
The most reticent to tell me what they do are lawyers (and I’m just guessing here, but if I was a lawyer in an ED I’d worry a little that I’d get over-tested and overdiagnosed due to medmal paranoia; so far as I know not one of my colleagues has ever gotten as much as a phone complaint from a lawyer they took care of, and that’s the sort of thing doctors would talk about). That kind of reticence is not the same in people who work for lawyers.
I was reminded of this by a post from Overlawyered about the couple on a Southwest flight who (allegedly) were attempting to join the Mile High club, in coach. One of the coitus interrupti (allegedly) said, when denied further alcohol service, “I work for a lawyer,” joining a not terribly select club of people who think their bosses’ importance in one field confers special powers to them in the ED. Usually while drunk.
“Do you know who my boss is?” is slurred, at highly indignant volume just often enough for the staff to say, in unison “No, and we don’t care”. It’d be terribly funny were it not for the now emasculated and indignant drunk we still have to take care of.
So far, nobody has tried to join the mile high club in any of my ED’s, but I practice pretty close to sea level. And nobody cares who I work for.
Update: at least one lawyer says I’m right!
I’ve had patients “get their freak on” in the ED (never full-on intercourse, but pretty much everything else).
Some people just cannot restrain themselves.
hello! my career’s not med-related or anything, but i stumbled onto this interesting post anyway… because my job involves talking to complete a-holes, a running gag among me and my co-workers is answering the “do you know who my boss is?” questions with “i know him very well, but not really sure, since he goes by many different names… Satan’s the most popular one though”…
then they go ballistic and well have a good laugh… works every time…
“Do you know who I work for?”
“No, but if you don’t stop waving your fist at me you’re going to end up working for the government. Making license plates.”
I once walked into a room to find the HIV+, Hep C+ patient getting unprotected oral sex from a woman that was not his “girlfriend.” The nurses said he had a rotating cycle of women who would “service” him during his stays.
If you were a patient in another ER, would you tell them that you are an emergency physician? I certainly hope that never has to be the case, but just hypothetically. :)
When I was an intern and working 100 hours a week and not getting any, one of the failry sick patients that I was taking care of on the ward for a couple of weeks had sperm showing up in her urine. Not only was I working 100 hours a week and looking at 200K in school loans, my sick hospitalized patients were getting it more than me.
Yesterday I took care of nice lawyer with chest pain and risk factors. He did not want to be admitted or even stay for a second set of enzymes. I gave my usual spiel on the limitations of testing for ACS/MI in the emergency department. He was competent enough to understand it and a nice enough guy. But now I am thinking what a fool I am for not having him sign AMA. I am sure that this nice informed guy, or his family, would not hesitate to sue my ass.
Carrie,
I don’t tell people what I do unless they ask. I have been a patient and been patient and asked for no special treatment but I would certainly speak up if I saw something unwise about to happen. Docs do have a big advantage in navigating healthcare for themselves and family that other people just would not know, even on such simple things as what hospital to go to. If my kids were real sick I would turn left on the interstate to shildrens hospital. If I were having chest pain I would turn right, bypass the closest hospital and ask for Dr. so-and-so, etc…
That’s funny, I had surgery yesterday for a ruptured achille’s tendon (flag football in my mid-30’s bad idea). I decided not to hand pick my surgeon or anesthesiologist, but to go through the experience just like a normal patient. I figured you could try to control everything and still have something go wrong, and vice versa.
I didn’t tell anyone in the PACU that I was the ER doc who worked downstairs, until it finally came up because of a minor complication. I had spinal anesthesia and developed urinary retention. Since I couldn’t feel anything below my waist, I had no idea why I was bradycardic, hypotensive and diaphoretic, and had a vague sense that something was wrong near my umbilicus. The nurse gave 4mg morphine and I promptly passed out. When I came to, I said I wondered if I had urinary retention. I got cathed and 1100 ccs came out and I immediately felt better. The nurses think it was the morphine that made me bradycardic, but I think I had a vasovagal episode because of bladder distension. Anyway, it was my medical terminology that clued them in. Someone asked, “Why didn’t you tell us before?” and I said, “What does it matter?” All in all, I got good care and I enjoyed being an anonymous patient. I certainly have a lot more empathy for the anxiety that the situation causes. And not being able to feel your legs is very very strange. You almost wish you had some pain so that you’d know it would come back eventually. I tried to imagine what it would be like if I knew that was how it was always going to be, and that thought made me want to jump off a bridge. Just that short experience really made me feel some retroactive compassion for all of the spinal cord injuries I’ve seen in the ER.
For the most part, I was treated the same before and after it became known that I was the doc downstairs, which was reassuring.
What’s odd is that I’ve been a patient in the hospital where I work before I was ever a nurse. And I’ve worked in the hospital in other roles besides nursing. For instance, most everybody knows me in the ER – first because I was a patient registrar and then because I was a nursing student there. However, the ER has changed a lot over the past few years, and sometimes I can go and nobody knows who I am.
I don’t really say that I’m a nurse or that I used to work there in order to get special treatment, but I usually do say that I’m a nurse and they know I work in the hospital, etc. I guess part of the reason I say it is so that when I explain what is wrong (I have had the strangest things happen to me!), they won’t think that I’m somebody who’s trying to sound like I know what I’m talking about when I don’t. For example, the very few times I had to go to the ER for headache, I clarified that I used to work in headache research and am a trainee member of the American Headache Society. In other words, “If you treat me like I am a drug seeker after I tell you all this, then I’m totally gonna cry.” (Note that I did not say I will get angry or punch somebody or walk out….because it doesn’t make me angry so much anymore when I get inadvertantly treated as a drug seeker – just depressed.) I also ended up in the ER with anticholinergic toxicity and didn’t even know who I was for about 8 hours, with memory and vision loss + bad vertigo from basilar migraine, went 1.5 months after sinus surgery with a massive bleed that required emergency surgery, and some other pretty freak things. (All of those were separate occasions, by the way!)
So I know a lot of times I’ll still wait a long time – just like everybody else. (Although I do get to sit behind the registration desk in the office at least some of the time, which makes me feel better because it’s quieter back there and the people aren’t as scary as those I run into in the waiting room!) One time when I was in the waiting room, a charge nurse that I knew saw me sitting there and told me he was going to get me back there immediately. I didn’t ask him to do it, but he did it anyway! And yet when I went in with the anticholinergic thing and abnormal EKGs plus a heart rate that was racing away, I actually waited 3 hours…I personally wanted to leave because I thought I was just wasting resources and time, but very shortly after I finally got taken to a room and put on a monitor, I went into the worst part of it – didn’t know who I was and was wide awake but couldn’t see and I still don’t remember most of it except for what people tell me happened.
I do it because if you saw me in person, you would not believe it to be possible that I have so many health problems…I’m 25, healthy looking, but inside this body lies 3 different headache types, including 1 that has never gone away in nearly 6 years now, avascular necrosis of bilateral femoral condyles, history of a benign tumor at age 16, suspected rheumatoid arthritis, hypertension, history of DVTs, and a few other random things. Saying that I am a nurse and have worked in hospitals since I was a fetus kinda helps…people tend to believe me more.
I have a huge amount of insecurity about this entire issue. I’ve never felt so torn in my entire life than when I was a patient, a student, and an employee all at the same institution. I dont’ like when I’m walking in to work and somebody who took care of me is asking me how my headaches are. I hated when I was stuck on the telemetry unit for 12 days and the tech doing my daily EKG was a guy who I worked with in clinicals who is my age. I hate when I can share stories from the inside about aspects of these issues and people don’t want to hear it and treat me badly and say mean things…just because they think that’s an acceptable way to behave. I have never really been able to feel at ease with it, so I guess I mention that I’m a nurse so that it’ll help smooth it all over! I dunno… I’d rather have never known these things, never ran into these problems – that’s for sure!
If I ever find a better way to handle it, I will certainly do that! :O) Sorry to ramble on – a very hot topic for me and one that I have extremely mixed feelings over. I go back and forth about a lot of things relating to this very issue during times when I’m a patient but at my hospital. I don’t even feel comfortable going to the neuro’s office in scrubs – and because I used to work there, they all know me. If I get called in by the NP because she’s on time while other patients are waiting 2 hours for a doc, it looks like I got called back because I know people there. I don’t like that! Some people would probably take full advantage, but it makes me feel very self conscious and I’d prefer to just be more anonymous at times! But that kinda went out the window a long time ago!
Take care,
Carrie :)