One last tale — years ago an EMS crew brought a dude to my ED. My boss met them. The crew said “yeah, he’s super anxious…” and blew him off.
My boss saw a guy propping himself up rigidly on his elbows, eyes wide as dinner plates. She ordered testing. He had an aortic dissection and was trying to die.
It is NEVER anxiety in emergency medicine even if it is.
6/7
@mcnado I appreciate your take so much. The stories I’ve heard over my years working with people with chronic illness…and you’re 1000% spot on regarding charting and having that shit follow you forever. Thank you.
@tayfonay
Back in the days of dead tree medical files a friend had the misfortune of having her peculiar response to a class of painkillers first being recorded by the hospital system during a set of interviews triggered by her mother being a less than ideal parent. Paper files meant that dentistry notes were completely air gapped from hospital ones. Unfortunately so were the different hospital departments, so she eventually discovered that this analgesic tid-bit first appearing in an odd place resulted in the file they used in ED having an orange sticker on the cover saying "this patient has a psych file that should also be consulted"
As you can imagine, it wasn't. So instead of realizing that this woman had been an incredibly resilient and sane kid in spite of difficult circumstances, who just happened to have problems with painkillers commonly used in dentistry; assumptions were made
Endometriosis was anxiety induced abdominal pain
Epilepsy was panic attacks.
For over a decade, until she left the country and escaped that file.
@mcnado
So please my EM friends, stop seeking for the easy out. SIT down. Take a good history. Do a decent exam. Obtain appropriate testing. Finally, if you have a picture of anxiety, having ruled out lethal processes, present your decision making to the patient in a way that makes it crystal clear that you don’t know for sure what’s happening. Leave space for error, change, and re-evaluation. Validate the visit. Damn near all ER visits are appropriate — it is the system that is not.
7/7