The traditional way of thinking is disassembled in the ER. Here you focus on the most acute problem - whether it be back pain, urinary retention, diarrhea, or migraine headache. Nevertheless, some people assume the ER to be their primary physician and start firing a list of complains when I ask if there's anything else of concern.
"I have this pain in my elbow that's been bothering me since I'm 18."
"What made you come here today, Mister F?"
"I can't breathe."
As much as I'd like to lecture them on sustainable medical habits, they are still our 'customers'. As dictated by professional medical ethics we must treat every patient with respect and dignity. Hence I always respectfully ask them to go back to their primary physician for the elbow pain that's been bothering him since he's 18 but fails to mention it on every follow-up visits for the past 60 years.
Life on the ER is punctuated by short bursts of incoming patients, as listed below:
8 to 9am: after breakfast but before outpatient clinics start
1 to 2pm: lunch hour and before afternoon outpatient clinics
7 to 9pm: after dinner and 8pm prime time soap
Of course there are those requiring the very best of emergency care. For the past week we had a few acute myocardial infarctions, stroke, a beefy man wedged in heavy machinery (who we performed CPR on), and an interesting diver with decompression sickness. These grade one calls we have to drop all our tasks at hand and rush into the CPR area.
There is no predicting when a grade one will come in. That's why our plans is fragmented into tiny little pieces we label "appropriate", "passable", and "absolute contraindication". For example, having a quick lunch at the staff lounge 2 minutes away - appropriate; go buy coffee across the street - passable; have a quick flirt with the gorgeous PGY in the observation room - passable; pay your bills at the post office during lunch hour rush - absolute contraindication.
As with society all walks of life come and go in the ER - the demanding and hysterical daughter in the US who come back to her father who is ill for the past 30 years; the naive grandma believing her cough is nothing but flu; the underage teen who denied any sexual history in front of her parents complaining of active vaginal bleeding, abdominal pain, and 3 missed periods. It is hectic as it is, but these people are a major challenge to manage, especially when they are hiding something.
One more week, and I think I'm going to miss it.