This crazy lady checked in the other day with chest pain related to her "asthma"- apparently this disease cause you to make squealing whiny noises at the end of every expiration, despite the fact that the lungs are totally clear. Yeah. She told the nurse in triage that she had been there the last 3 days (she failed to mention that she had been escorted out the last two times for acting foolish), but she did tell us that her sister was a nurse on the floor, and that she knew we had all kinds of empty beds upstairs and that we had Press-Ganey so we had to do what she said. Yeeahh. She sure didn't get admitted, but she did get a full cardiac and PE workup. Whatever do you think the results were?
I always make sure to ask the doctors for pain medicine when people request it, but I always word it just like they did and I chart accordingly.. "Yeah, last time they gave me some D medicine and it made me feel so much better"... This no longer gets the "Hell no, they get 325 of Tylenol" and I might hope for, but instead an eye roll and an order for the D medicine they seek. Big bulgarian doc was going off on one of his little rants the other day when a patient of his from the night before came back with the same complaint. "What does she think we will do for her?" he said, "What does she expect to accomplish from this visit?" Uh, I don't know dude. Maybe it's the fact that we give her IV Dilaudid and a prescription for Norco? Why wouldn't she come back?
It's even gone past pain medicines and into treatments. Somehow good medical care has become synonymous with drawing blood. Oh, a hypochondriac, eh? Yeah, lets get a CBC and an FBP for that ear pain so that we'll feel that the complaint was taken seriously. Besides, the nurse has nothing else to do. One of the same doctors who once lectured me about mentioning gastric lavage in a patient who had actually taken the pills in timeframe in which it might have been useful later ordered the same treatment because some lady's hoodrat boyfriend insisted she have it. We never do this anymore, but we sure were ready to did do it for him.
Our former director of medicine, who I absolutely loved, developed this fake form for us to stick up in triage. He said we might as well just start putting them up there since we're apparently supposed to be Starbucks now anyway. He was not cool with us making copies, but from my memory, it read something like this.
Hood Hospital Triage Questionare
check all that apply:
1.Are you interested in the doctor's opinion or knowledge as it applies to your care today?
__ yes __no
(if the answer is yes, please disregard the rest of this form. If no, please continue)
2.What labs do you feel are needed for us to have provided you with good care today?
__ CBC __CMP __PTT/APTT __Complete screen for STDS
__Cardiac enzymes __BNP __Serum Spider Venom Titer
3.What kind of pain medicine would you like? Please circle dosage or indicate of not listed.
__Dilaudid- 2 mg, 4 mg, 8mg, all you've got.
__Morphine-2 mg, 4mg, 8 mg, 10 mg, a bag to go.
__Demerol-25mg, 50mg, 100mg
4.How fast would you like that pushed? Please indicate in seconds or minutes:_____
5. Please check any medications you feel may supplement your medication experience:
__Zofran __Benadryl __Phenergan __ Valium __Ativan __Reglan
6.Would you like to be admitted today?
If so, for how long?
__Just for observation __Until my pain is gone completely __ Until my next check comes in __Indefinitely
7.Please check any medicines you would like to be discharged with:
__Norco __Percocet __Ultram __Phenergan __Dilaudid chewables
__Also, refill everything I normally take __Other (please indicate.)
Toward the end I know I'm making my own stuff up, but it's what we're coming to. I'm serious.