One of the things that many emergency physicians enjoy is the variety of patients. You never know what’s coming through the door next, but you can handle it.
The variety of patients also brings a variety of attitudes and demeanors. Which can be exemplified by two messages that two different patients recently left in their rooms after being discharged from our emergency department.
One patient was having gastrointestinal issues – abdominal pain, bloating, diarrhea. She had numerous normal CT scans and had been to her primary care physician several times for the same problem. The primary care physician would refer her to the emergency department every time she had pain and the emergency department would “lab her up,” do a CT and send her back to the primary care physician.
We sat down, figured out that the symptoms tended to coincide with meals and made some suggestions to try to find out what was causing the pain. Perhaps it was a reaction to food she was eating. Couldn’t be a gall bladder problem because she had already had it removed several years prior. Maybe it was bacterial overgrowth syndrome. Possibly gastritis. She got Bentyl for her pain and felt better. We suggested that she keep a food diary. Told her to come back in a couple of weeks and we’d recheck her. I gave her the times I’d be in the ED. Even though we didn’t do any labs or x-rays, she was happy to have some direction on how to fix the problem.
The other patient was having back issues. Chronic pain. Multiple pain meds. Happened to take his last three Norco pills earlier in the day and needed a refill on Friday night because the pain was worse.
We sat down and tried to figure out what was causing his pain. He wasn’t interested in discussing it. He had MRIs that showed bulging discs. So we looked through his old records and found an MRI from a few years ago showing mild disc bulging at two levels. Then we looked through the state database and discovered that the patient had received multiple prescriptions for pain medications from multiple different physicians over the past month – far more than should be prescribed to one person.
“I don’t want your Toradol. That stuff doesn’t work. I’m not taking steroids, either. I just need more of my pain medications.
“Sorry, I’m not comfortable refilling your prescription.”
The note was placed on the pillow of the bed in the room.
The glove was taped to the wall behind the door so that when the door was closed, the glove was visible.
See if you can match the patients with the messages they left behind.