Now that I’m here, when can I leave?

There’s a certain group of patients that come to emergency, mostly vague historians with vague complaints, who don’t want to wait around to see any kind of resolution to their presenting complaint.

Many of these people don’t have problems that can be diagnosed, solved and cured within a reasonable time frame, they have chronic multi-dimensional problems that need comprehensive work ups and follow up. But that still doesn’t explain why they want to go before seeing their results, hearing some kind of definitive opinion or at least having a plan for follow up.

Tonight for instance, I looked after a lady who came in complaining of 3 days of facial/jaw pain after some sinus surgery a week ago. While she was there she mentioned that she had experienced some mild chest discomfort that had resolved on its own within the last hour or two. She had some significant risk factors, such as age group, ex-smoker and obesity, so it may well have been cardiac in origin. While waiting for her facial CT’s to be reported on, we started a cardiac work up (ECG showed a right bundle branch block -?new ?old, no history), and got on top of her facial pain. Not long after this, she became really difficult to deal with. She kept asking when she could leave, and seemed to be irritated in general at being there.

Why do I see these kinds of people all the time? I’ve actually had people come to me at the triage window and state in an irate voice, “just letting you know I have to be gone by 3pm ‘cos I have an appointment.” What the??! It must not be that much of an EMERGENCY then, is it!!

Is it that the perception of hospitals sometimes doesn’t match up with reality? Maybe it’s because people want a quick fix – get rid of my pain, and I’m out of here thanks! Do people not know that vague complaints like abdo pain take time to investigate? Physical examinations, blood tests, chest and abdo xrays, CT and ultrasound, specialist referrals, medical or surgical opinions, pain relief, IV therapy – if you present to emergency with a complaint that is potentially serious and needs investigating, these things will take time.

Still ringing in my ears is a patient from last week, a guy who presented with abdo pain and didn’t want to wait for any of his tests to come back (because we’d improved on his pain with short acting IV analgesia, none the less!), so he yells, “I’ve had enough of all this crap!” and storms out – total time in the department, around 1 hour.