ER Etiquette

[kareng57]

(note - something to help them sleep is not an answer, I need drug/dosage and have myriad forms filled out that state I have the right to know)

It was a great post, but can I ask you one favour?

Please forgive the nurses for saying 'something to help them sleep' the first time and ask for more details politely.

We're under a fair amount of pressure to get the balance right between not patronising the knowledgeable patients/relatives and not upsetting/confusing the less knowledgeable ones by using technical terms and jargon.

I have to agree.  While I do have a medical background, it's pretty dated, and I don't automatically recognise the names/purposes of current drugs.

I see nothing wrong with firstly giving the purpose of the drug, and then the name, if the family member wants it.  Otherwise:  "what's the name of that drug you are giving Dad?"  "Promoxucillin" (I'm making it up).  "What's that?"  "It's an antibiotic, Dad has a mild pneumonia and we want to be sure that it does not progress".

The same with "something to help him sleep" - just because a nurse/doctor says this doesn't meant that he/she is being terribly patronising.  The relative who is asking could even be a retired pharmacist and not know the name of a new drug.

[Garden Goblin]

Garden, 

I have to ask, because I'm going to be moving to a rural part of a state with a reputation of having notoriously bad hospitals,  how do you reccomend people advocate for others and themselves when they don't know anything about medical conditions?  I'm trying to prepare myself in advance. 

Get things in writing and have a witness.  If you don't think that will be possible, invest in a digital tape recorder and keep records that way.  (Do make sure the doctor knows that conversations are recorded).  Make the doctor put all diagnoses and instructions in writing and if at all possible, have them signed. 

Keep asking questions until you feel you understand the answer to your satisfaction.  Get copies of all your records (preferably electronically) and keep them in case you need a second opinion without delay.  Insist test results be explained to you.  Be a nuisance if necessary, abet a polite one.  Don't get shrill (you'll be dismissed as hysterical no matter the situation or how reasonable your concerns  ) but keep your tone firm.  If you want something done, phrase it as an instruction rather than a request.  "Excuse me, I need X" rather than "Please can I have some X". 

Go to the computer.  WebMD and the like can be a real asset.  It might not give you all the answers, but it can tell you what questions you should be asking.  Print things out and take them with you.  Get yourself a notebook if necessary to keep everything together, with some scratch paper for taking notes.  Keep in mind though, you can easily shoot yourself in the foot here.  Remember the adage 'If you hear hoofbeats, think of horses, not zebras'.  It's more likely you have the flu presenting in an uncommon way than it is for you to be suffering whatever you saw on House last week.

Be polite to nurses and admins.  In some ways, they know more than the doctors.

I have to agree.  While I do have a medical background, it's pretty dated, and I don't automatically recognise the names/purposes of current drugs.

I don't have a medical background, but I do know the commonly given drugs that members of my family have reactions to and enough to know what to ask in addition to ensure they are being given the right dosage.  If it doesn't sound familiar, I can then make the quick comment, 'will that react with the ____ the patient is on or with the _____ condition the patient suffers from?'  Then my concerns can either be quickly alleviated or the nurse can do a check, which at least 1 in 10 times results in the nurse either giving something else or having a discussion with the doctor.

Or I can give the nurse the quick warning of, 'you can give her Demerol if you like, but she won't be able to respond coherently at that point' and let the nurse determine if it's a good idea or if it's better to give Tylenol and wait an hour until the rest of the tests get performed.

They gave her Demerol in the hospital on Black Friday.  Yesterday she called me from the rehab center to ask how she'd got there, as she didn't remember anything between Thanksgiving dinner and waking up that morning.

[kherbert05]

Garden, 

I have to ask, because I'm going to be moving to a rural part of a state with a reputation of having notoriously bad hospitals,  how do you reccomend people advocate for others and themselves when they don't know anything about medical conditions?  I'm trying to prepare myself in advance. 

I have a basic medical history that I keep in my wallet, and another one is attached to my emergency contact card at work. My sister knows my history (was taught to recite it at a young age and I know her's)

A few years back they actually admitted me for an allergy/asthma attack because of chest pain and an irregular heart beat. They gave me something that nauseated me. Then they were going to give me something for the nausea that "would help me sleep". I told them no it would probably have me tap dancing on the ceiling. Sis showed up about that time. She confirmed to the nurse that I react badly to sedatives. She told them they needed to be prepared to restrain me if they gave it to me because I have tried to deck people and escape before surgery. I've also tried to fly off a third story balcony after taking something that is usually a sedative. They called the doctor and got orders for something that would stop the nausea but keep me up - I slept for 6 hours straight. 

[kitty_ev]

Garden, 

I have to ask, because I'm going to be moving to a rural part of a state with a reputation of having notoriously bad hospitals,  how do you reccomend people advocate for others and themselves when they don't know anything about medical conditions?  I'm trying to prepare myself in advance. 

Also, don't forget that bad hospitals does not equate to bad clinicians. Hospitals are a lot about protocols and procedures- if these are bad even an excellent clinician will seem like a quack.


A current bugbear of mine- if you're going to A&E/ the ER I know it's a stressful and difficult time and you often are hanging around a while waiting to be seen. Staff know it's boring and that you need to keep people updated. We get that. However, our lives are made more difficult and your care gets delayed if you wander away from the department frequently or for long periods (or both). It delays your care and everyone else's care if clinicians have to spend half their time hunting for patients who've gone out "for a quick cigarette" and are gone for 30 mins or more. Popping out for 5 mins is fine, just don't make it much longer. Actually, this rule applies when you're admitted as well. Staff can't treat patients who aren't present.

[RooRoo]

Re: all those questions they ask

My memory is unreliable, so I keep an emergency medical information sheet with me at all times. It lists my emergency contacts, my allergies, my medications (including OTC), my doctors' phone numbers, my chronic conditions, and history (a list of my surgeries & childhood diseases). In other words, the answers to the questions they always ask!

It has "Emergency medical information" in big letters, and a red cross. I keep one copy in my cell phone case, which dangles off my purse. (Some EMTs are not allowed to look in your purse.) It has a clear window, and I fold the sheet so the "Emergency medical information" and red cross show. I also keep a couple of spare copies in my purse, to hand to the nurses who interrogate me.

I just made 4 extra copies, because I'm having minor surgery on Thursday. It saves both them and me time. And I have been thanked many times for handing it over, and even complimented for being foresighted.

[rashea]

Re: all those questions they ask

My memory is unreliable, so I keep an emergency medical information sheet with me at all times.

I love having one of those. I hate that it isn't big enough for all my surgeries.

[Jules1980]

As a hospital worker, I love those lists.  It save so much time when I can just write 'see list' and attach it to the file rather than having to write it all down time after time.

[JeseC]

Be sensitive to patients with mental health problems.  This includes people presenting with self-inflicted damage resulting from mental illness.  A good referral to a mental health practitioner will do a lot more than fussing over how much of a bad idea that was.

My particular incident was a regular doctor rather than an ER, but I've heard many similar stories about problems in the ER, people being accused of "wasting time" or "being stupid," and the like.  Judging a mentally ill person for their symptoms does little more than encourage them to not seek help next time.

[Garden Goblin]

Re: mental conditions (along with a few other things)

Quick note to certain members of a particular hospital's staff - depressed does not equal stupid or deaf.  Bipolar does not equal hard of hearing or come with an inability to understand words larger than two syllables.  Hard of hearing does not mean blind.  Blind does not mean deaf and/or stupid.  Mildly retarded does not automatically equate to unable to dress or feed oneself, nor does it mean diapers.  Schizophrenic does not automatically equate to violent or suicidal.  And for the love of little green frogs, anxiety disorders DO mean don't keep a person in suspense or keep reminding them that whatever problem they had could be/get a lot worse.

[PurpleFrog]

Please don't shout at me when I tell you that it's only been 20 minutes since your last dose of pain meds and I can't give you more yet. I'm legally not allowed to kill you.

Please don't tell me you have a pain score of 9 or 10 while lieing serenely and reading a magazine, I will have to note that you are showing no signs of serious pain and query drug seeking behaviour.

Do not enter other patients rooms/cubicles

Please, if a frail older patient is in a room alone and staff have left the door open so we can see her at all times, do not take it upon yourself to close the door becuse 'you don't like seeing sick people'.

Finally: when there has been a widley publicised major incident, with mulitiple injurys and casualties think twice about calling an ambulance for somthing minor. If  you do call an abulance and are sent to a peripheral hospital as the major hospital is closed due to said incident do not shout at staff because you are a long way from home. Once you have been discharged and you have to wait for an ambulance home (due to mobility issues) it will take a while, you going out of area and most of the ambulances are still tied up with said major incident. Asking every 15 minutes will not make it come quicker.

During a major incident all hospitals in the area will be busier, we can't help it.

Finally: when the poilce & other emergency responders who have completed their shifts, despite their own injurys and distress at this major incident, drag themselves 20 miles to us so as not to put extra strain on the already streached major hospital, you can bet we're jumping them to the front of the Que, before the earache/fell over drunk/random non urgent illness, yes its favoritism, but you know what tough.

[snowdragon]

Just because you can't see the problem does not mean it's not more serious than your problem - they will be jumped to the top of the list,  be thankful you are not that bad.

Just because you are X age does not mean you  go first, old or young.  again be thankful you are not at the head of the line.

[ladyknight1]

This applies to hospitals as well as the ER.

The vast majority of hospitals are now no-smoking for the entire property. My uncle had a tantrum over that rule when he was visiting my great-uncle.

[mmswm]

Please don't tell me you have a pain score of 9 or 10 while lieing serenely and reading a magazine, I will have to note that you are showing no signs of serious pain and query drug seeking behaviour.

On the other hand, a person with major, chronic pain issues can quite legitimately be quietly reading a magazine and still have a pain level of 9 or 10.  When you're 10 or 13 years old and quite literally have never known a  pain free moment in your entire life, you learn to deal with even major pain in ways that make no sense to "normal" people.  Please believe the parent or other person accompanying the patient when they tell you this. 

This is a bit of a bad spot with me.  My youngest son suffered unimaginable pain for months because I couldn't find a doctor that would believe him.  When I finally drove him 4 hours to the nearest major city's children's ER, I finally met a doctor who did the appropriate diagnostics and figured out what the critical problem was. This is the same child that did two weeks of PT after major hip surgery, relearning how to walk, on an undiagnosed broken foot, and never complained about foot pain.  This kid is one tough cookie.  I firmly believe that his "6 or 7" on the 1-10 pain scale would probably kill us puny mortals.

[blue2000]

Please don't tell me you have a pain score of 9 or 10 while lieing serenely and reading a magazine, I will have to note that you are showing no signs of serious pain and query drug seeking behaviour.

On the other hand, a person with major, chronic pain issues can quite legitimately be quietly reading a magazine and still have a pain level of 9 or 10.  When you're 10 or 13 years old and quite literally have never known a  pain free moment in your entire life, you learn to deal with even major pain in ways that make no sense to "normal" people.  Please believe the parent or other person accompanying the patient when they tell you this. 

This is a bit of a bad spot with me.  My youngest son suffered unimaginable pain for months because I couldn't find a doctor that would believe him.  When I finally drove him 4 hours to the nearest major city's children's ER, I finally met a doctor who did the appropriate diagnostics and figured out what the critical problem was. This is the same child that did two weeks of PT after major hip surgery, relearning how to walk, on an undiagnosed broken foot, and never complained about foot pain.  This kid is one tough cookie.  I firmly believe that his "6 or 7" on the 1-10 pain scale would probably kill us puny mortals.

I can believe it. I have dealt with pain that I half-jokingly qualified as '85' on a scale of 1 to 10. My default response to pain is to kind of curl up and shut down. A magazine would have been nice to take my mind off things.

However, I wasn't asking for painkillers at the time, so drug-seeking wouldn't be an issue.

[PurpleFrog]

Please don't tell me you have a pain score of 9 or 10 while lieing serenely and reading a magazine, I will have to note that you are showing no signs of serious pain and query drug seeking behaviour.

On the other hand, a person with major, chronic pain issues can quite legitimately be quietly reading a magazine and still have a pain level of 9 or 10.  When you're 10 or 13 years old and quite literally have never known a  pain free moment in your entire life, you learn to deal with even major pain in ways that make no sense to "normal" people.  Please believe the parent or other person accompanying the patient when they tell you this. 

This is a bit of a bad spot with me.  My youngest son suffered unimaginable pain for months because I couldn't find a doctor that would believe him.  When I finally drove him 4 hours to the nearest major city's children's ER, I finally met a doctor who did the appropriate diagnostics and figured out what the critical problem was. This is the same child that did two weeks of PT after major hip surgery, relearning how to walk, on an undiagnosed broken foot, and never complained about foot pain.  This kid is one tough cookie.  I firmly believe that his "6 or 7" on the 1-10 pain scale would probably kill us puny mortals.

We do take this into account, and past medical history will be considered, in cases with no past medical history in a&e we can't jump straight to morphine etc for someone with no medical history who appears a-symptomatic. Even gas and air is addictive, so we ha e to be cautious with undiagnosed pains.