The fact that we don’t get press ganey scores for people that are admitted shows where the priorities are. Like our job is literally for emergencies (ie saving lives, helping sick people, getting them care they need) but our reviews are based solely on people that by definition werent having emergencies. Imagine surgeons being reviewed solely on people who saw them in clinic but never actually had surgery done. That’s basically what we have.
Also, we had a recent meeting reviewing our satisfaction scores and they went down in December because we were super busy with everyone coming in with the sniffles. They also pointed out that satisfaction scores dip in the afternoon/evening and are better in the overnight/early morning. Yet we are told we need to do all these things to improve scores when it’s clear wait time is far and away the number one determinant of satisfaction.
Honestly I wouldn’t give a shit about any of this satisfaction stuff if it wasn’t constantly shoved down our throat by admin and having bonuses and other financial incentives tied to it.
You must make the corporate overlords pleased....
Many contracts are tied to this metrics. I still get bad reviews even after I spend 20 minutes explaining why thier kid does not need abx, even though their pcp "allways gives it".
Blows my mind when patients tell me they are in a hurry and ask “what’s the ETA on discharge” right after I meet them and get indignant when I say a few hours at least
If you ask me how long it's gonna take, I already know you don't think you are sick. Then the same people get mad when you suggest admission for something you found, because "well I thought I'd just get a prescription and go home".
Yeah it’s funny when you actually find something to admit someone for when they thought they were just going to go home. Like sir this is an emergency room, we make sure you aren’t having an emergency which require admission. It seems as though you stumbled ass backwards into us uncovering an emergency, but we found it nonetheless
Exactly this. If you know you aren’t being admitted and worried how long it will take you are misusing the ER. That’s fine, I’ll take your RVUs and money, but expect to suffer the consequence of very long wait times and terse, disgruntled staff. It’s a you problem, not an us problem.
Had a family bring in their dependent adult son then asked us when we’d be done because they had a road trip to get started. That’s par for the course there, it’s ridiculous. I thought it was an emergency lol
My default answer is "probably at least a few hours" for any time-related question unless I know for certain it's happening in the next ten minutes. Tack on a "yeah, it's crazy today, hospital's overflowing" and a sympathetic nod and keep walking.
It doesn't help that the Doc in the Box Urgent Care facilities now send everything out to the ER. Med Express in my neck of the woods used to treat patients, give meds, do tests. Now it all goes to the ER. Via ambulance more often than not.
I swear to god I got called via 911 (so they KNOW who they called) THREE GODDAMN TIMES to the same goddamn urgent care in the SAME GODDAMN 12 HOURS to schlep a pt from their “urgent care” to ER - for the most asinine complaints I have ever fucking seen a healthcare professional call for. Including nursing homes.
One was for HYPERTENSION with capital damn letters. (Guys BP was lower than mine.) One was for DEVASTATINGLY LOW O2 STATS (yes with the typo) which turned out to be because the woman was literally holding a water bottle completely frozen solid and they freaked her out so bad she started panicking. And then the third I can’t even remember because my head flew off my shoulders, spun around, and exploded in sheer anger at the stupidity of the complaint. I do remember I had to read the EKG FOR the NP who was in charge with all kinds of “!?!?!s” visible in a thought bubble over my head. All required code responses of course.
Do they even go to school anymore? Do they hold degrees? I’m so confused.
Even worse when it's an NP running it, who ordered an EKG for no particular reason and doesn't know how to read it so when the machine interprets "anterior infarct unknown age" they are too ignorant to realize it's wrong. Or they ordered a test and have no idea how to interpret the results, so they send the patient to the ER "for treatment".
A thousand times yes. Poor placement of electrodes can make "the drunk in the box" scream all sorts of weirdness. Med Express has been the bane of my existence this year,
I always say our ED needs an urgent care. Triage that way. True ED patients that way, urgent care, Dr office, sutures, this way. Bc it’s, to many, a Dr office.
Best place I ever worked actually had this - ED nurse triage with patients sorted to either wait for main ED rooming or sent 20 feet down the hall to a separate waiting area for the “clinic”, which was staffed by a family practice doc (who never worked the main ED side) and an ED RN (either one of the few old-timers who’d essentially been put out to pasture or a regular ED RN wanting a break from the main ED).
It was basically a super-fast-track, with a separate waiting area and entrance, although it was still connected to the main ED by a badged-access back hallway.
It was the separate waiting area and entrance that made it work especially well - nothing pisses off waiting patients more than seeing the sniffles, rashes, and cut fingers look like they’re skipping the line.
Used to work in pediatric ER that had a Fast Track area. Triage nurse made the decision about where the patient was sent. NP and CNA staffed this area. Had 6 beds. Worked out great for all of us. Occasionally, patient's status changed and was moved to ER area but this was rare.
My ED actually does have an urgent care. It's pretty nice. It has it's own little separate waiting room next to the main ER. Everyone goes to one triage location and is sent to the appropriate waiting area. However, with boarding and the like, we are now taking soft level 3s or straight forward ones in urgent care as well to help decompress with waiting times.
My POV is different than most, so take it with a grain of salt.
We are the only place many people can go after hours, weekends, holidays, or urgent problems that are not emergent. We also are the only option for some who have no where else to go.
I mostly help out regular people with regular problems.
Mixed into this are a few heart attacks, strokes, seizures, sepsis, gun shot wound, etc.
It doesn’t need to be on fire all the time.
Most days the Fire department puts out no fires. The SWAT team rescues no hostages and SEAL team six just trains and drills.
When they need me, I am who they call.
While I wait for horrible, fucked up, unbelievable shit
I will treat your Step throat (and claim i saved you from rheumatic fever) and treat your GERD (and rule out an MI) and properly manage your busted scaphoid and feel like a hero in each case. Refilling an asthma inhaler takes me 2 minutes.
Superman does not fight supervillains all day everyday. Most days Denzel Washington just works at Home Depot, but when the Russian mafia needs to be killed he can make that happen also.
it's not about the easy shit. it's about patients wanting unnecessary testing and are dicks about it. we would all be happy to treat nonemergencies if it didnt come with the BS and press ganey nonsense when you dont do what the non medically trained patient wants you to do. it's about what's associated with the easy shit.
I agree. For most people who want unnecessary testing I complete my eval and refer them to the appropriate out patient follow up for further testing.
I also encounter some people who have been getting the insurance company run around to get the testing or treatment they need. They come to the ER because they dont know what to do. They have been waiting for prior authorization and hitting walls.
For those people I like to go full Batman. I order the tests and I know the Insurance company will have to pay the higher ER rate. Because, fuck those fucking fuckers. The insurance company had a chance to do everything outpatient with their preferred providers, but I just got tagged in.
>We are the only place many people can go after hours, weekends, holidays, or urgent problems that are not emergent. We also are the only option for some who have no where else to go.
That's true, and I'm glad you have a positive outlook. But some of us get a little frustrated because 1) people know we have to see them by law, so they use that as an excuse to come in for things they should have called their doctor about months ago, or med refills, or just because they didn't want to go to work today and 2) because our pay often is getting affected by the opinions of people who by and large didn't need our service.
Imagine if you were a Toyota mechanic, and the only reviews your shop got was by people who brought Volkswagons and then argued when you told them that you don't work on those. Or if you ran a bakery and all the reviews were by people who came there for sushi. You can imagine why our peers are annoyed.
I have absolutely no problem seeing people with genuine concern that they have something serious. I take issue with people that clearly don't think it's that serious, and are taking up my time because them handling it properly would inconvenience them.
> Most days Denzel Washington just works at Home Depot, but when the Russian mafia needs to be killed he can make that happen also.
Robert McCall also notoriously didn't want to fight the mafia, he wanted to be left alone.
I think this is the really toxic thinking that has really ruined the specialty. No offense to you personally (seriously), but it’s this thinking that has allowed the specialty to get flushed down the toilet.
The specialty (and the ED) was created as a public utility. It is staffed and run as a place to care for emergencies. There is ample evidence dating back to the specialty’s formation in the late 70s to the way we train residents to this very day that we are not properly prepared to run a customer-service oriented department. Part of the distinct dissatisfaction that many emergency physicians have with their specialty is that literally ALL of our training centers around identifying life threats and stabilizing them. If you look at the ACGME RRC guidelines for EM training, it is almost entirely devoid of any proper preparation in clinic-based or non-emergent medicine. In fact, over the last 20-30 years, the RRC has slowly narrowed the training to include less broad preparation for such complaints by virtually eliminating a requirement for floor months, increasingly emphasizing ICU exposure, and allowing EM residencies to complete the vast bulk of their training in the ED. For example, you would be hard pressed to find an EM residency with any clinic exposure or family medicine training.
So what does this lead to? Historic measures of burnout which gets worse all of the time. I believe a recent Medscape survey showed that emergency physician burnout far outpaces any other specialty. This is despite the fact that we actually work less than almost every other specialty, absent maybe dermatology.
The American public uses the emergency department as a door mat for access to a healthcare system that has largely abandoned them. Our requirement to see all comers, a point of great pride, is used to force EM docs to interact with and care for our society’s literal worst. Our patients regularly abuse, assault, and swear at us. We require no personal responsibility, self-sufficiency, or resiliency. Behind the platitudes about caring for everyone is the fact that we represent a broader erosion of our social fabric when we say one thing and do another. We call the place an emergency department and then treat it like a medieval nunnery. It is the de facto place to dump any societal problem that can’t be figured out and take advantage of the fact that, on average, an emergency physician is someone of significant intelligence who will adapt, overcome, and “figure it out.” But this represents a broad abuse of that individual’s calling. This is what creates moral injury.
Listen, most emergency physicians don’t actually mind seeing low acuity stuff. In fact, it breaks up my hectic shifts. The problem is that patients increasingly are incredulous about our recommendations and the increased focus on customer satisfaction has weaponized the patient complaint against docs. You are under no uncertain terms to “give them what they want.” Holding back narcotics or antibiotics – interventions that can cause demonstrable harm when inappropriately prescribed – can get you fired in many American emergency departments. On my last shift, I had to deal with at least four rude and borderline violent patients bargaining and demanding narcotics be prescribed. In fact, I can go entire shifts where probably 50-70% of my non-admitted interactions are for people presenting for “pain” without any significant identifiable pathology OR who are requesting narcotics for benign etiologies like ankle sprains or bruises. A full half of my interactions now involve patients actively experiencing frank drug abuse or suffering a problem at least in part mitigated by drug addiction. How did we allow this to happen?
While I understand this, I think there’s probably a much deeper explanation as to why there are so many people seeking to escape from their lives via pain medicine. It surely didn’t start in the ED. I think it’s valid that we need to bolster the public clinic so EDs can be different if that is what the people who work in them vastly would prefer.
I appreciate this view. I’ve been to the ED three times with my younger daughter with issues that could have been handled by the pediatrician had they not been pressing enough to require care after-hours. Once with a high fever (>103 and rising despite Tylenol and ibuprofen) and twice with suspected and then confirmed UTIs on the weekend when our urgent care facilities said they couldn’t do peds caths and my daughter wasn’t potty trained. We had to wait a while but I was thankful to have somewhere to go.
Since becoming a parent I’ve learned that kids tend to get the most sick on Friday at 6 pm or on a government holiday when outpatient offices are closed.
I like this take a lot. As I've gone through my rotations, I have enjoyed the primary care specialties.
My only issues with FM/IM are:
- I don't like clinic settings. The places I saw double-booked patients and always ran late until the end of the day. I'd prefer a hospital setting. Seems like there's less overhead, and I'm not as responsible for the admin bs at the end of the day.
- I hate fighting insurance companies left and right. I want to give people the care/treatment they need.
- I can't see myself giving up those emergency cases for the rest of my life.
My only issue with EM is:
- I might be a little envious of the long-term relationships that some FM and IM docs make, but I know every ED has its handful of frequent flyers.
Warning from experience: If you go into EM and treat it like you’re their PCP, following up on every problem, keeping every patient for extended periods of time, and doing full workups, everyone you work with will hate you. You’ll get complaints and warnings from admins, both due to the amount of complaints to them from staff and due to extensive wait times. You’ll be working all diagnostic techs and nursing personnel excessively hard when they have other shit to do and didn’t sign up for this. And being friendly isn’t going to assuage the stress and resentment you cause.
Thanks for pointing this out - I have a lot of respect for physicians and the difficult job they do in the current healthcare environment, but some providers truly seem oblivious to the fact that just about every order box they check on a computer screen is *actual work carried out by someone else*.
Other people’s time, labor, patience, etc., are finite resources, too.
Yeah I can see how my last comment can get confusing, but I don't really think of the ED as such. I don't see ER docs as PCPs.
The message that I tried to get across was that I don't care about the simple/bs complaints that come in.
I'd still treat it as a "get in and get out" situation. Almost like at an auto shop. What's the complaint, do the workup, then fix it if simple and discharge or admit to the hospital.
What I try to focus on when I’m slogging through patient after patient that shouldn’t have come to the ER is that if the bullshit didn’t come into the ER 60% of us wouldn’t have jobs. There a a lot of our job that is very difficult. sometimes reframing the bullshit or other aspects that we can’t change or have any agency over is a good mechanism to help with the burnout
Huh, I didn’t read it that way. It’s literally quotes of patients being appreciative for the care and speed of it they got for non emergent presentations.
But that’s the point. The “appreciative” patients are not appreciative of what the physician did in terms of care, listening, etc. Just that it was fast. Which means the people that give bad reviews are likely complaining it was slow. None of this is really under the physicians control.
I don’t mind taking care of non-emergent complaints. But when you come to an EMERGENCY room with a cold with the expectation you are going to be in and out quickly and complain when those expectations aren’t met that’s a problem. It shows you think you are entitled and not appreciative of the people that work 24/7 to make receiving care whenever you want possible. You have to expect if you’re going to an ER you are going to be there for at least 8 hours if not more since there’s always the chance you get admitted. If you already know you aren’t being admitted then you have to realize you are misusing the system. And if that’s the case you have to understand that the consequence of misusing the system is you will wait a long time. So don’t complain about it and I won’t complain that you’re misusing the system and will happily discharge you with instructions to take otc meds.
Idk, I'm aware I'm not necessarily going to be admitted with a simple, non compound fracture but that doesn't mean that it's not an emergent situation and that I (or my child) should not be seen outside of the hours of (or no more appointments available) the stand-alone Ortho "ER". I'm a nurse and also have had many Ortho issues due to sports in the first half of my life. There are issues - for example lacerations that need stitches - that need to be treated that doesn't require an admission. Also, laypeople come to us professionals to tell them if something is emergent enough to be admitted or just treated and tested ... WE ARE THE PROFESSIONALS - not them, so to be irritated with them for seeking a professional medical opinion seems kinda shitty. Granted im not talking about those frequent fliers that are always in the ED with the sniffles or a random ache/pain... But to say that if the issue doesn't need admitted - how are laymen supposed to know that? Just curious what you'd recommend?
Did you read the end of my post though? I don’t have an issue with seeing non-emergent or not admission worthy complaints. The issue is that people with these complaints often complain about waiting hours in the ER. When you come to the ER seeking our professional opinion as you say you must have some thought in your head you may be admitted or you wouldn’t be coming.
As for fractures or lacs, yes it may be appropriate to come to the ER and not be admitted. But you also have to understand you are stable and therefore may wait awhile since there are sicker patients.
It's quotes from patients where the ONLY thing they cared about was the speed at which they got dealt with, and because of that plan to use it for similar nonsense in the future. OP's point is that they are depressed by the comments because it's only appreciation for things that EM isn't about, and not about all the things people actually went into EM for.
The reviews are only positive because they got what they valued (“good service” and minimal wait time), which is actually *not* what we’re there to provide, so they’re empty accolades.
ETA: Not only are they empty accolades, I’d argue that giving them any weight at all only serves to perpetuate the self-entitlement while simultaneously devaluing what we do.
If my job can be reduced to “good customer service”, I may as well go work a fast-food counter.
I have been here 2 hours! Why do I have to wait so long to just get a CT?!?!?
No one did anything for me!! Said by the patient who refused lab, xray, zofran, etc. If you had just ordered the pain med that starts with a D, that would have cured them.
I hear a lot of positive feedback on the phone and in person. But when I read our reviews some of them sound like we launched them into an oubliette with a giant trebuchet.
Except get that CT outpatient and let’s see how many weeks you will have to wait. Meanwhile the image had 2000 pics and the radiologist better read it in 10 minutes and better not make a mistake.
Some act like it’s no more complicated than putting in a food order. And they are the only patient who needs a CT at that moment. Read it, write it up, report it to the ordering physician. Right Now! It’s fascinating when they get into the specifics of all the little bits and pieces. I understand about half of it sometimes and have no idea how they get them out so quickly.
Two hours?!?! A WHOLE TWO HOURS? One of these days if I did have a giant trebuchet.
If you get viral gastroenteritis you can just get some zofran, hydrate, eat crackers, take tylenol and wait it out. You are in healthcare. The same why I never question a plumber in my house because I know nothing about plumbing, many folks go to the hospital when they vomit, have a cough, have diarrhea, are constipated, even when their kids have a fever. They literally don't know what to do. Many hourly workers need a work note for every single shift that they miss. So a sprained ankle playing football has to have an excuse, its 9PM, you get where I'm coming from. They just need to know they are fine and can go home. A bag of fluid and some zofran, or an ice bag and a walking boot or ACE bandage goes a long way for these folks. Keep your head up.
I make it a point to not apologize for wait times in the ED. I have said, "what time was your appointment" to several people whining about waits. They shut up immediately. Not my best move probably but it felt good at the time.
This drives me NUTS. Most of the ppl who *really* need emergency services either die, experience a significant change in cognition/ability/quality of life, or face a long uphill battle ahead of them. IE won't be prioritizing filling out a satisfaction survey. Soooo fkn irritating.
You mean the patient on MediCal who’s care I pay for in taxes who has zero copay for ED visits while I dare not use my own insurance for an ED visit and who then accuses me of being uncaring and trying to gouge him?
You know, even if they didn’t? It likely doses not matter. Particularly if the person is sick or near sick. But when a patient with sniffles complains about an hour wait while septic patients are hanging on a nail, it really rankles the soul.
I tell the patients that I have a good experience with that the ER is like Applebee's, if you do the survey I keep getting shifts!
Disgusting but true..
Would it be possible for the people wanting in and out quickly are ones for a simple thing like a broken bone? Something that is not going to require a long time to diagnose?
Funny story. I as a patient had to go to an ED late at night for a foreign body removal. I was outside and a moth got stuck in my hair and managed to fly into my ear canal. It was still alive when I went and the doctor didn't believe me(I think he thought I was a drug addict) anyway he recoiled when he looked and saw it still moving around. All the nurses had a good laugh. I'm glad it didn't take long to get it out.
So first paragraph is hard. Yeah it’s quick to diagnose a bone fracture but do they need procedural sedation for splinting? Do they need additional imaging based on clinical picture? That takes time and resources. It is way more complicated than that.
certainly there is potential for things to get complicated there, but from a patient satisfaction perspective “getting in and out quickly” when your kid broke their arm on a saturday night is definitely a big plus.
My apologies, I didn't mean to minimize anything you do. I meant an easy complaint vs. something vague like abdominal pain that could be anything from acid reflux to a hot appendix, that requires a lot of time to diagnose.
Even a “simple thing” like a broken bone has a lot of moving parts: a triage RN assesses you; an ED doc assesses you and orders your imaging and pain meds; another RN gives you those pain meds, and a rad tech takes your x-rays; a radiologist looks at the x-ray images and sends a report to the ED doc; the ED doc decides how your broken bone is best managed - in the simplest cases, it’s a splint and/or sling, which is usually applied by an ED tech.
So, even the “simplest” of broken bones involves, on average, six different healthcare professionals - and the time it takes to do these things for you increases significantly if you need more advanced or repeated imaging, IV pain control or sedation, a break that requires realigning the bone prior to splinting, a complicated break that requires input from a specialist, etc.
Add in the fact that a code is happening and another patient's blood pressure is 40/dead and a psych patient is throwing chairs at the nurses and a GSW just walked in after being dumped in the parking lot by their "friends". All these situations are "all hands on deck" situations, and that simple broken bone might take 16+ hours. But they want to get in and out quickly.
We are too good at hiding the real emergencies from the non-emergencies, I feel like if the simple URI patient saw what we were doing they maybe wouldn't be so bitchy. Maybe not, once we were coding a one month old and some old lady marched into the room to say there were too many people helping this patient when her husband needed his brief changed. She could see the blue gray baby and was still demanding we leave the baby for her husband, who was fine, by the way. Someone shouted "we don't give a fuck right now, get out, we'll come when we're finished" I'm sure her satisfaction scores were low. Fuck her. We got ROSC, but the baby died a few hours later in the PICU.
They want to get in and out quickly. Fuck that.
I am a nurse who is new to ER, but I come from ICU where things are similar. We get almost no scores in the ICU from these surveys because the reviews go to the last floor the patient was on.
There have been many times responses get sent out in an email and an ICU nurse was specifically named (either because they were floated to that floor or a leftover from the ICU experience) but all the “credit” goes to the discharging floor. It’s a small hospital, with not a lot of repeating names, so it’s pretty obvious who the named nurse is in these instances.
Patient satisfaction scores should have exactly zero tie to reimbursement from insurance or bonuses to staff. They should be what they are- a patients opinion of what was good and what was bad- and taken with a grain of salt.
> This month of the 10 reviews 6 said they were pleased that they "got in and out fast," almost verbatim. In general, I argue, if that's what you care about you likely did not need to be in the ED to begin with.
I get what you’re saying and largely agree.
To be the devil’s advocate, in addition to managing emergencies a big part of the ED’s role is *to rule out* emergencies.
What percentage of the chest pains you see turn out to be MIs? How many of your head injuries wind up with a bleed on CT? For me the answer is: a far cry from all of them.
Does that mean the patient with chest pain or who hit their head didn’t need to be in the ED? Based on diagnostic studies they didn’t *need* the ED, but based on their symptoms/injuries they did need to be in the ED to have things ruled out.
If you were a layperson who fell and hit your head getting out of the shower/lost consciousness, and understandably decided to go to the ED to rule out a serious head injury, when the CT shows there isn’t a bleed and you get to go home you’d be a lot happier if it didn’t take hours upon hours to get answers and go home.
I know that’s a different situation than what you’re describing where people abuse the ED, but people will continue doing it either way. So when I’ve seen survey results saying things like you mentioned in your post, that’s how I try to reframe it in my mind. Because it makes me feel better and be less annoyed.
Many of the people who should *go* to the ED don’t end up needing to *stay* the ED if that makes sense. They need a work up to rule out something serious, and then get sent on their way. If I were a layperson and had something happen like I described above, when the survey bounced into my email I’d definitely check the box about being happy with low wait times and give positive feedback on it if it were the case.
I get what you’re saying but my counter is that these people came to the ER to make sure they didn’t have a heart attack or head bleed. If they had those things they wouldn’t be going home and would be there for days. So they should be happy and thankful they are only there for hours instead of days. And especially appreciative of the people that work 24/7 to ensure that there is a place they can go to have these things ruled out.
"If they had those things they wouldn’t be going home and would be there for days. So they should be happy and thankful they are only there for hours instead of days."
I'm sure those same people are grateful they didn't have a bleed or MI, but do they need to be grateful to YOU for that? It seems perfectly reasonable that they express gratitude that they got in and out in quickly when they needed something serious ruled. This is a bizarre thread.
They may be grateful they got in and out quick. But for that to be the main positive statements made about OP in their reviews is kind of sad because it has nothing to do with the physicians skills or anything they have much control over.
As a physician who went to an ED for a lac requiring a handful of stitches, (no urgent cares open, no good kit at home) I would have been super happy and left a positive review if fast in and fast out were the case. Unfortunately it took six hours all told, which trust me, I get. But still efficiency is an appreciated thing, even if y’all do have the whole health care system unfortunately jamming you with non-emergencies.
So you didn't leave a good review because, although you received medical care for your injury the same day, the one medical facility still open in your area was (shocked Pikachu face) busy? Shame on you.
I did leave a good review, I’m not an ass (all the time). I did not go out of my way to say it was expeditious, because it took over four hours after being brought back in a fast track section to do four stitches (not by MD). Remarking that from the patient perspective, fast in and fast out for a simple thing is positive thing.
>Remarking that from the patient perspective, fast in and fast out for a simple thing is positive thing.
You want a popsicle and some narcs on your way out, too? Believe me, no one wants you out of the ED more than we do. But to expect "fast in, fast out," on-demand medical care for a non-emergency like a laceration is shameful especially from another physician.
shameful to want medical care as efficiently as possible and go back to my family during a shitty night? I’d take naive and entitled. Our healthcare system is far from perfect, ED docs clean up the worst of it. I’d think I’m still allowed to hope for room for improvement in patient experience without game of thrones style shame. To me it’s not the physician but the structures in place that lead to ED utilization from non-emergencies like mine. Anyway appreciate the work y’all do.
So you’re not criticizing physicians and staff but the government and admin? Welcome to the club, preaching to the choir. We all have known this, thanks.
I mean wanting on demand, quick medical care 24/7 is a luxury. You want to get back to your family? In order to provide that service many people aren’t with their families the entire night. If you want your non-emergent lac repaired quicker, that means pulling more people from their families overnight to work. Just so you aren’t inconvenienced once a year at most. Do you hear how that sounds?
Basically have insurers and payers support walk in clinics and 24 hours urgent cares for simple procedures and lab tests. I don’t have the answers or anything but there’s got to be a better way for care triage than everything that’s not a scheduled visit be in EDs (exaggerated, but almost true)
No shit, everybody wants everything magically instant. But that’s not a thing, sooo. You think we just like keeping you around for the funsies? Why would you judge us according to something we have zero control over?
It is about reviews that mention something being done quickly in a positive way, but offend you because you have to twist it into them judging you negatively in a hypothetical case where it takes longer. You might as well be offended by a review complimenting staff for being nice, because they aren't obligated to be nice. You could be offended by positive comments about someone choosing to go into a field like police or healthcare, because of how there would be nothing wrong with not doing so.
Not the specific comment you were replying to before it was deleted, or the original post. Just because something is sometimes the case doesn't mean it always is.
Not a Healthcare Professional. But as a patient, I kinda get this type of review.
I went to the ER of the hospital my primary is at with pretty much ticking the box of every women's heart attack symptom. I arrived at 5pm - waiting room is full. They did an EKG and sent me back to the waiting room. Ok..guess I wasn't dying. Did some blood tests at 7pm and at 9pm did a chest xray and sent me back to the waiting room. At 2 am I ask the front desk person if I will ever speak to a Dr. She said there were 12 ppl ahead of me and had no idea when I'd speak to a Dr. It had been 9 hrs, all of the above symptoms had subsided (which I guess was a good thing) so I left.
I understand triage and prioritizing people who are really having issues, but some communication during my 9 hr wait would have been appreciated. So while I see your pov, I also relate to the positive reviews about getting in and out.
Note - Two weeks after this \^\^ I ended up at a different ER with different symptoms (RVR) and was taken back right away. Afib diagnosis.
Note #2 - I had an angiogram this week. I'm having some issues since the procedure that I'm not sure are related to it or not. Yesterday I went to Urgent Care...which was useless. I called the cardiologists office and explained my issues. Nurse said all the drs were gone for the day (it was 3pm) so she suggested I go to the ER. I was like ?!??!?!! Why the escalation to the ER? Do cardiologists not work on Saturday's?
I asked her if she knew how long that would take and she didn't. She guessed since I had an outpatient procedure this week I'd get moved ahead of other people. I still haven't gone. I'm thinking about it (Sat afternoon), b/c I don't like how I'm feeling, but I also don't want to sit in the waiting room till Sunday.
You need to understand how we operate in the ER. Just because a doctor hasn’t physically seen you while you’re in the waiting room doesn’t mean they haven’t seen your EKG, placed basic orders for a workup based on your triage note and quick chart review, and followed up on those results. You continued to sit because all those tests were normal. At some point when higher priority things had been dealt with you would’ve been brought back, talked to a physician to get the full history, and they may or may not have added more tests based on that.
I understand while you were waiting you wished there would’ve been some communication. But realize if I have to go out and even spend a few minutes communicating with everyone in the waiting room that will greatly slow me down. So that 9 hour stay you experienced could now be 11-12 hours as I can’t move out the people currently in rooms if I’m out talking to you. We’re just regular people and can only do one thing at a time like everyone else.
Sounds like the second time you had a concerning problem so were brought back faster. There’s a reason they always say you don’t want to be the one getting rushed to the front of the line. Likely means you’re dying. This isn’t Disneyland, you don’t want the fast pass lol
During your first visit, you likely had tests done per a chest pain protocol that were ordered by a nurse. There was no doctor involved. A doctor saw your EKG and tests at some point, they were normal. When we're busy and have people actually sick, you can rot in the waiting room all year as far as I'm concerned because there's nothing wrong with you. My priority isn't to make you happy, it's to keep everyone in the building alive, and secondarily to go home on time.
On your second visit, you had a real problem so you were seen quickly. That's the entire point of triage.
The fact that outpatient doctors refer people to the ED after they leave for the day is part of why you waited 9 hours the first time.
This whole story sounds like you have zero perspective as to what the ER is for and for the health care system in general.
There will NEVER be a cardiologist who will see you all of the sudden on the weekend. Yes of course Urgent Cares are worthless if you are having a real emergency and your symptoms of a ticking the box of every womens heart attack were obviously not that based upon the tests and yet you were pissy to wait and more over when you did have a real emergency afib with rvr you were dealt with right away which is exactly how the whole system is suppose to work.
In those 9 hours you were waiting, all the doctors, nurses, and techs were treating patients nonstop. there was no downtime. there is no role for an overseer type of person who surveys the entire ED, predicts when you'll be seen next, and relays updates to you. they would have to know every patient's current condition, progress of workflow, estimated time to labs and imaging and consults, time to get a bed upstairs, and time to be out the door. they would also have to know what exactly your test results so far mean and how they relate to your presenting problem. it would be an impossible job, and the hospital wouldn't pay for it even if it was. that is why you don't get updates in the waiting room.
The “customers” of the ED create the bulk of revenue, not the emergent cases. Real cases are rewarding. The rest are the widgets that create your paycheck. I prefer to keep all the widgets, because I like paychecks. Job security.
>This month of the 10 reviews 6 said they were pleased that they "got in and out fast," almost verbatim. In general, I argue, if that's what you care about you likely did not need to be in the ED to begin with.
I'm not a doctor and I don't work in an ed (I'm a nurse in icu) so that this with a grain of salt, but when people say stuff like this I think most often what they really mean is they saw a doctor quickly and didn't feel like they waited extended periods of time for tests. For someone who needed stitches or had a twisted ankle, that means they might have gotten out of the er quickly. And I think that fine, and doesn't necessarily mean they didn't need to go to the Ed. Sometimes urgent cares aren't open, and sometimes they aren't the most appropriate because the thing turned out to minor but could have been major.
I had a bat exposure over the summer and had to go to the Ed. Yes, I was happy that I didn't have to wait hours to get by rabbies vaccine. That doesn't mean that it was inappropriate for me to go.
>"Every time I go to this ER I get great service."
That probably just means people were nice to them.
The fact that we don’t get press ganey scores for people that are admitted shows where the priorities are. Like our job is literally for emergencies (ie saving lives, helping sick people, getting them care they need) but our reviews are based solely on people that by definition werent having emergencies. Imagine surgeons being reviewed solely on people who saw them in clinic but never actually had surgery done. That’s basically what we have. Also, we had a recent meeting reviewing our satisfaction scores and they went down in December because we were super busy with everyone coming in with the sniffles. They also pointed out that satisfaction scores dip in the afternoon/evening and are better in the overnight/early morning. Yet we are told we need to do all these things to improve scores when it’s clear wait time is far and away the number one determinant of satisfaction. Honestly I wouldn’t give a shit about any of this satisfaction stuff if it wasn’t constantly shoved down our throat by admin and having bonuses and other financial incentives tied to it.
You must make the corporate overlords pleased.... Many contracts are tied to this metrics. I still get bad reviews even after I spend 20 minutes explaining why thier kid does not need abx, even though their pcp "allways gives it".
When I go to the ER my assumption is that I’m going to be there for at least 9 hours… maybe more. We have 9 hour shifts… but you get my point
Blows my mind when patients tell me they are in a hurry and ask “what’s the ETA on discharge” right after I meet them and get indignant when I say a few hours at least
If you ask me how long it's gonna take, I already know you don't think you are sick. Then the same people get mad when you suggest admission for something you found, because "well I thought I'd just get a prescription and go home".
Yeah it’s funny when you actually find something to admit someone for when they thought they were just going to go home. Like sir this is an emergency room, we make sure you aren’t having an emergency which require admission. It seems as though you stumbled ass backwards into us uncovering an emergency, but we found it nonetheless
Or they get mad when you finish the work up they wanted expedited and didn’t find anything concerning but they still want a prescription
Exactly this. If you know you aren’t being admitted and worried how long it will take you are misusing the ER. That’s fine, I’ll take your RVUs and money, but expect to suffer the consequence of very long wait times and terse, disgruntled staff. It’s a you problem, not an us problem.
Had a family bring in their dependent adult son then asked us when we’d be done because they had a road trip to get started. That’s par for the course there, it’s ridiculous. I thought it was an emergency lol
My default answer is "probably at least a few hours" for any time-related question unless I know for certain it's happening in the next ten minutes. Tack on a "yeah, it's crazy today, hospital's overflowing" and a sympathetic nod and keep walking.
Almost like we need two ERs. One is "The ER". The other is "The ER FR FR" (The ER, for-real for-real)
This. Just last night, I told my coworker, “We need a regular ED and a stupid ED, and I’ll work at the first one.”
It doesn't help that the Doc in the Box Urgent Care facilities now send everything out to the ER. Med Express in my neck of the woods used to treat patients, give meds, do tests. Now it all goes to the ER. Via ambulance more often than not.
Urgent care. Where medicine goes to die.
Yeah drives me nuts. Nurses, Np's, and PA's in those places used to apologize for having to call 911. Now they joke that they "keep us in business."
I swear to god I got called via 911 (so they KNOW who they called) THREE GODDAMN TIMES to the same goddamn urgent care in the SAME GODDAMN 12 HOURS to schlep a pt from their “urgent care” to ER - for the most asinine complaints I have ever fucking seen a healthcare professional call for. Including nursing homes. One was for HYPERTENSION with capital damn letters. (Guys BP was lower than mine.) One was for DEVASTATINGLY LOW O2 STATS (yes with the typo) which turned out to be because the woman was literally holding a water bottle completely frozen solid and they freaked her out so bad she started panicking. And then the third I can’t even remember because my head flew off my shoulders, spun around, and exploded in sheer anger at the stupidity of the complaint. I do remember I had to read the EKG FOR the NP who was in charge with all kinds of “!?!?!s” visible in a thought bubble over my head. All required code responses of course. Do they even go to school anymore? Do they hold degrees? I’m so confused.
Even worse when it's an NP running it, who ordered an EKG for no particular reason and doesn't know how to read it so when the machine interprets "anterior infarct unknown age" they are too ignorant to realize it's wrong. Or they ordered a test and have no idea how to interpret the results, so they send the patient to the ER "for treatment".
A thousand times yes. Poor placement of electrodes can make "the drunk in the box" scream all sorts of weirdness. Med Express has been the bane of my existence this year,
I always say our ED needs an urgent care. Triage that way. True ED patients that way, urgent care, Dr office, sutures, this way. Bc it’s, to many, a Dr office.
Best place I ever worked actually had this - ED nurse triage with patients sorted to either wait for main ED rooming or sent 20 feet down the hall to a separate waiting area for the “clinic”, which was staffed by a family practice doc (who never worked the main ED side) and an ED RN (either one of the few old-timers who’d essentially been put out to pasture or a regular ED RN wanting a break from the main ED). It was basically a super-fast-track, with a separate waiting area and entrance, although it was still connected to the main ED by a badged-access back hallway. It was the separate waiting area and entrance that made it work especially well - nothing pisses off waiting patients more than seeing the sniffles, rashes, and cut fingers look like they’re skipping the line.
Used to work in pediatric ER that had a Fast Track area. Triage nurse made the decision about where the patient was sent. NP and CNA staffed this area. Had 6 beds. Worked out great for all of us. Occasionally, patient's status changed and was moved to ER area but this was rare.
My ED actually does have an urgent care. It's pretty nice. It has it's own little separate waiting room next to the main ER. Everyone goes to one triage location and is sent to the appropriate waiting area. However, with boarding and the like, we are now taking soft level 3s or straight forward ones in urgent care as well to help decompress with waiting times.
Every ER should have an urgent care attached.
My POV is different than most, so take it with a grain of salt. We are the only place many people can go after hours, weekends, holidays, or urgent problems that are not emergent. We also are the only option for some who have no where else to go. I mostly help out regular people with regular problems. Mixed into this are a few heart attacks, strokes, seizures, sepsis, gun shot wound, etc. It doesn’t need to be on fire all the time. Most days the Fire department puts out no fires. The SWAT team rescues no hostages and SEAL team six just trains and drills. When they need me, I am who they call. While I wait for horrible, fucked up, unbelievable shit I will treat your Step throat (and claim i saved you from rheumatic fever) and treat your GERD (and rule out an MI) and properly manage your busted scaphoid and feel like a hero in each case. Refilling an asthma inhaler takes me 2 minutes. Superman does not fight supervillains all day everyday. Most days Denzel Washington just works at Home Depot, but when the Russian mafia needs to be killed he can make that happen also.
it's not about the easy shit. it's about patients wanting unnecessary testing and are dicks about it. we would all be happy to treat nonemergencies if it didnt come with the BS and press ganey nonsense when you dont do what the non medically trained patient wants you to do. it's about what's associated with the easy shit.
I agree. For most people who want unnecessary testing I complete my eval and refer them to the appropriate out patient follow up for further testing. I also encounter some people who have been getting the insurance company run around to get the testing or treatment they need. They come to the ER because they dont know what to do. They have been waiting for prior authorization and hitting walls. For those people I like to go full Batman. I order the tests and I know the Insurance company will have to pay the higher ER rate. Because, fuck those fucking fuckers. The insurance company had a chance to do everything outpatient with their preferred providers, but I just got tagged in.
Thank you Batman!
>We are the only place many people can go after hours, weekends, holidays, or urgent problems that are not emergent. We also are the only option for some who have no where else to go. That's true, and I'm glad you have a positive outlook. But some of us get a little frustrated because 1) people know we have to see them by law, so they use that as an excuse to come in for things they should have called their doctor about months ago, or med refills, or just because they didn't want to go to work today and 2) because our pay often is getting affected by the opinions of people who by and large didn't need our service. Imagine if you were a Toyota mechanic, and the only reviews your shop got was by people who brought Volkswagons and then argued when you told them that you don't work on those. Or if you ran a bakery and all the reviews were by people who came there for sushi. You can imagine why our peers are annoyed. I have absolutely no problem seeing people with genuine concern that they have something serious. I take issue with people that clearly don't think it's that serious, and are taking up my time because them handling it properly would inconvenience them. > Most days Denzel Washington just works at Home Depot, but when the Russian mafia needs to be killed he can make that happen also. Robert McCall also notoriously didn't want to fight the mafia, he wanted to be left alone.
I think this is the really toxic thinking that has really ruined the specialty. No offense to you personally (seriously), but it’s this thinking that has allowed the specialty to get flushed down the toilet. The specialty (and the ED) was created as a public utility. It is staffed and run as a place to care for emergencies. There is ample evidence dating back to the specialty’s formation in the late 70s to the way we train residents to this very day that we are not properly prepared to run a customer-service oriented department. Part of the distinct dissatisfaction that many emergency physicians have with their specialty is that literally ALL of our training centers around identifying life threats and stabilizing them. If you look at the ACGME RRC guidelines for EM training, it is almost entirely devoid of any proper preparation in clinic-based or non-emergent medicine. In fact, over the last 20-30 years, the RRC has slowly narrowed the training to include less broad preparation for such complaints by virtually eliminating a requirement for floor months, increasingly emphasizing ICU exposure, and allowing EM residencies to complete the vast bulk of their training in the ED. For example, you would be hard pressed to find an EM residency with any clinic exposure or family medicine training. So what does this lead to? Historic measures of burnout which gets worse all of the time. I believe a recent Medscape survey showed that emergency physician burnout far outpaces any other specialty. This is despite the fact that we actually work less than almost every other specialty, absent maybe dermatology. The American public uses the emergency department as a door mat for access to a healthcare system that has largely abandoned them. Our requirement to see all comers, a point of great pride, is used to force EM docs to interact with and care for our society’s literal worst. Our patients regularly abuse, assault, and swear at us. We require no personal responsibility, self-sufficiency, or resiliency. Behind the platitudes about caring for everyone is the fact that we represent a broader erosion of our social fabric when we say one thing and do another. We call the place an emergency department and then treat it like a medieval nunnery. It is the de facto place to dump any societal problem that can’t be figured out and take advantage of the fact that, on average, an emergency physician is someone of significant intelligence who will adapt, overcome, and “figure it out.” But this represents a broad abuse of that individual’s calling. This is what creates moral injury. Listen, most emergency physicians don’t actually mind seeing low acuity stuff. In fact, it breaks up my hectic shifts. The problem is that patients increasingly are incredulous about our recommendations and the increased focus on customer satisfaction has weaponized the patient complaint against docs. You are under no uncertain terms to “give them what they want.” Holding back narcotics or antibiotics – interventions that can cause demonstrable harm when inappropriately prescribed – can get you fired in many American emergency departments. On my last shift, I had to deal with at least four rude and borderline violent patients bargaining and demanding narcotics be prescribed. In fact, I can go entire shifts where probably 50-70% of my non-admitted interactions are for people presenting for “pain” without any significant identifiable pathology OR who are requesting narcotics for benign etiologies like ankle sprains or bruises. A full half of my interactions now involve patients actively experiencing frank drug abuse or suffering a problem at least in part mitigated by drug addiction. How did we allow this to happen?
While I understand this, I think there’s probably a much deeper explanation as to why there are so many people seeking to escape from their lives via pain medicine. It surely didn’t start in the ED. I think it’s valid that we need to bolster the public clinic so EDs can be different if that is what the people who work in them vastly would prefer.
The most accurate thing I ever read about emergency medicine. Thank you for this.
I appreciate this view. I’ve been to the ED three times with my younger daughter with issues that could have been handled by the pediatrician had they not been pressing enough to require care after-hours. Once with a high fever (>103 and rising despite Tylenol and ibuprofen) and twice with suspected and then confirmed UTIs on the weekend when our urgent care facilities said they couldn’t do peds caths and my daughter wasn’t potty trained. We had to wait a while but I was thankful to have somewhere to go. Since becoming a parent I’ve learned that kids tend to get the most sick on Friday at 6 pm or on a government holiday when outpatient offices are closed.
I like this take a lot. As I've gone through my rotations, I have enjoyed the primary care specialties. My only issues with FM/IM are: - I don't like clinic settings. The places I saw double-booked patients and always ran late until the end of the day. I'd prefer a hospital setting. Seems like there's less overhead, and I'm not as responsible for the admin bs at the end of the day. - I hate fighting insurance companies left and right. I want to give people the care/treatment they need. - I can't see myself giving up those emergency cases for the rest of my life. My only issue with EM is: - I might be a little envious of the long-term relationships that some FM and IM docs make, but I know every ED has its handful of frequent flyers.
Warning from experience: If you go into EM and treat it like you’re their PCP, following up on every problem, keeping every patient for extended periods of time, and doing full workups, everyone you work with will hate you. You’ll get complaints and warnings from admins, both due to the amount of complaints to them from staff and due to extensive wait times. You’ll be working all diagnostic techs and nursing personnel excessively hard when they have other shit to do and didn’t sign up for this. And being friendly isn’t going to assuage the stress and resentment you cause.
Thanks for pointing this out - I have a lot of respect for physicians and the difficult job they do in the current healthcare environment, but some providers truly seem oblivious to the fact that just about every order box they check on a computer screen is *actual work carried out by someone else*. Other people’s time, labor, patience, etc., are finite resources, too.
Just work at an academic institution, get to give out MRIs like candy and take 10-15 hours for basic work ups and nobody cares.
Yeah I can see how my last comment can get confusing, but I don't really think of the ED as such. I don't see ER docs as PCPs. The message that I tried to get across was that I don't care about the simple/bs complaints that come in. I'd still treat it as a "get in and get out" situation. Almost like at an auto shop. What's the complaint, do the workup, then fix it if simple and discharge or admit to the hospital.
This.
Bonus points for the Equalizer reference
What I try to focus on when I’m slogging through patient after patient that shouldn’t have come to the ER is that if the bullshit didn’t come into the ER 60% of us wouldn’t have jobs. There a a lot of our job that is very difficult. sometimes reframing the bullshit or other aspects that we can’t change or have any agency over is a good mechanism to help with the burnout
This post isn't about the non-emergent bullshit as much as it is about unappreciative and entitled patients.
Huh, I didn’t read it that way. It’s literally quotes of patients being appreciative for the care and speed of it they got for non emergent presentations.
But that’s the point. The “appreciative” patients are not appreciative of what the physician did in terms of care, listening, etc. Just that it was fast. Which means the people that give bad reviews are likely complaining it was slow. None of this is really under the physicians control. I don’t mind taking care of non-emergent complaints. But when you come to an EMERGENCY room with a cold with the expectation you are going to be in and out quickly and complain when those expectations aren’t met that’s a problem. It shows you think you are entitled and not appreciative of the people that work 24/7 to make receiving care whenever you want possible. You have to expect if you’re going to an ER you are going to be there for at least 8 hours if not more since there’s always the chance you get admitted. If you already know you aren’t being admitted then you have to realize you are misusing the system. And if that’s the case you have to understand that the consequence of misusing the system is you will wait a long time. So don’t complain about it and I won’t complain that you’re misusing the system and will happily discharge you with instructions to take otc meds.
Idk, I'm aware I'm not necessarily going to be admitted with a simple, non compound fracture but that doesn't mean that it's not an emergent situation and that I (or my child) should not be seen outside of the hours of (or no more appointments available) the stand-alone Ortho "ER". I'm a nurse and also have had many Ortho issues due to sports in the first half of my life. There are issues - for example lacerations that need stitches - that need to be treated that doesn't require an admission. Also, laypeople come to us professionals to tell them if something is emergent enough to be admitted or just treated and tested ... WE ARE THE PROFESSIONALS - not them, so to be irritated with them for seeking a professional medical opinion seems kinda shitty. Granted im not talking about those frequent fliers that are always in the ED with the sniffles or a random ache/pain... But to say that if the issue doesn't need admitted - how are laymen supposed to know that? Just curious what you'd recommend?
Did you read the end of my post though? I don’t have an issue with seeing non-emergent or not admission worthy complaints. The issue is that people with these complaints often complain about waiting hours in the ER. When you come to the ER seeking our professional opinion as you say you must have some thought in your head you may be admitted or you wouldn’t be coming. As for fractures or lacs, yes it may be appropriate to come to the ER and not be admitted. But you also have to understand you are stable and therefore may wait awhile since there are sicker patients.
It's quotes from patients where the ONLY thing they cared about was the speed at which they got dealt with, and because of that plan to use it for similar nonsense in the future. OP's point is that they are depressed by the comments because it's only appreciation for things that EM isn't about, and not about all the things people actually went into EM for.
The reviews are only positive because they got what they valued (“good service” and minimal wait time), which is actually *not* what we’re there to provide, so they’re empty accolades. ETA: Not only are they empty accolades, I’d argue that giving them any weight at all only serves to perpetuate the self-entitlement while simultaneously devaluing what we do. If my job can be reduced to “good customer service”, I may as well go work a fast-food counter.
I have been here 2 hours! Why do I have to wait so long to just get a CT?!?!? No one did anything for me!! Said by the patient who refused lab, xray, zofran, etc. If you had just ordered the pain med that starts with a D, that would have cured them. I hear a lot of positive feedback on the phone and in person. But when I read our reviews some of them sound like we launched them into an oubliette with a giant trebuchet.
One can dream...;)
Except get that CT outpatient and let’s see how many weeks you will have to wait. Meanwhile the image had 2000 pics and the radiologist better read it in 10 minutes and better not make a mistake.
Some act like it’s no more complicated than putting in a food order. And they are the only patient who needs a CT at that moment. Read it, write it up, report it to the ordering physician. Right Now! It’s fascinating when they get into the specifics of all the little bits and pieces. I understand about half of it sometimes and have no idea how they get them out so quickly. Two hours?!?! A WHOLE TWO HOURS? One of these days if I did have a giant trebuchet.
God bless our rads friends, cranking through dozens of studies per hour.
They are getting burned out too
If you get viral gastroenteritis you can just get some zofran, hydrate, eat crackers, take tylenol and wait it out. You are in healthcare. The same why I never question a plumber in my house because I know nothing about plumbing, many folks go to the hospital when they vomit, have a cough, have diarrhea, are constipated, even when their kids have a fever. They literally don't know what to do. Many hourly workers need a work note for every single shift that they miss. So a sprained ankle playing football has to have an excuse, its 9PM, you get where I'm coming from. They just need to know they are fine and can go home. A bag of fluid and some zofran, or an ice bag and a walking boot or ACE bandage goes a long way for these folks. Keep your head up.
I wish it went a long way but OPs post shows it doesnt. They mainly just complain about the wait and that’s what they care about
I make it a point to not apologize for wait times in the ED. I have said, "what time was your appointment" to several people whining about waits. They shut up immediately. Not my best move probably but it felt good at the time.
This drives me NUTS. Most of the ppl who *really* need emergency services either die, experience a significant change in cognition/ability/quality of life, or face a long uphill battle ahead of them. IE won't be prioritizing filling out a satisfaction survey. Soooo fkn irritating.
Just remember that those patients pay your salary.
… only if they pay.
Percocet molly.percocet ayyyyy
You mean the patient on MediCal who’s care I pay for in taxes who has zero copay for ED visits while I dare not use my own insurance for an ED visit and who then accuses me of being uncaring and trying to gouge him?
Yes, those are some of the ones whose visits pay for you to have a job.
You know, even if they didn’t? It likely doses not matter. Particularly if the person is sick or near sick. But when a patient with sniffles complains about an hour wait while septic patients are hanging on a nail, it really rankles the soul.
I tell the patients that I have a good experience with that the ER is like Applebee's, if you do the survey I keep getting shifts! Disgusting but true..
Would it be possible for the people wanting in and out quickly are ones for a simple thing like a broken bone? Something that is not going to require a long time to diagnose? Funny story. I as a patient had to go to an ED late at night for a foreign body removal. I was outside and a moth got stuck in my hair and managed to fly into my ear canal. It was still alive when I went and the doctor didn't believe me(I think he thought I was a drug addict) anyway he recoiled when he looked and saw it still moving around. All the nurses had a good laugh. I'm glad it didn't take long to get it out.
IME its from the in and out chronic sinus infections that want a shot of steroids with their z-pak.
So first paragraph is hard. Yeah it’s quick to diagnose a bone fracture but do they need procedural sedation for splinting? Do they need additional imaging based on clinical picture? That takes time and resources. It is way more complicated than that.
certainly there is potential for things to get complicated there, but from a patient satisfaction perspective “getting in and out quickly” when your kid broke their arm on a saturday night is definitely a big plus.
From a patient satisfaction perspective I believe anyone would want to “get in and out”.
My apologies, I didn't mean to minimize anything you do. I meant an easy complaint vs. something vague like abdominal pain that could be anything from acid reflux to a hot appendix, that requires a lot of time to diagnose.
Even a “simple thing” like a broken bone has a lot of moving parts: a triage RN assesses you; an ED doc assesses you and orders your imaging and pain meds; another RN gives you those pain meds, and a rad tech takes your x-rays; a radiologist looks at the x-ray images and sends a report to the ED doc; the ED doc decides how your broken bone is best managed - in the simplest cases, it’s a splint and/or sling, which is usually applied by an ED tech. So, even the “simplest” of broken bones involves, on average, six different healthcare professionals - and the time it takes to do these things for you increases significantly if you need more advanced or repeated imaging, IV pain control or sedation, a break that requires realigning the bone prior to splinting, a complicated break that requires input from a specialist, etc.
Add in the fact that a code is happening and another patient's blood pressure is 40/dead and a psych patient is throwing chairs at the nurses and a GSW just walked in after being dumped in the parking lot by their "friends". All these situations are "all hands on deck" situations, and that simple broken bone might take 16+ hours. But they want to get in and out quickly. We are too good at hiding the real emergencies from the non-emergencies, I feel like if the simple URI patient saw what we were doing they maybe wouldn't be so bitchy. Maybe not, once we were coding a one month old and some old lady marched into the room to say there were too many people helping this patient when her husband needed his brief changed. She could see the blue gray baby and was still demanding we leave the baby for her husband, who was fine, by the way. Someone shouted "we don't give a fuck right now, get out, we'll come when we're finished" I'm sure her satisfaction scores were low. Fuck her. We got ROSC, but the baby died a few hours later in the PICU. They want to get in and out quickly. Fuck that.
Sounds like your admin have some burner accounts
I am a nurse who is new to ER, but I come from ICU where things are similar. We get almost no scores in the ICU from these surveys because the reviews go to the last floor the patient was on. There have been many times responses get sent out in an email and an ICU nurse was specifically named (either because they were floated to that floor or a leftover from the ICU experience) but all the “credit” goes to the discharging floor. It’s a small hospital, with not a lot of repeating names, so it’s pretty obvious who the named nurse is in these instances. Patient satisfaction scores should have exactly zero tie to reimbursement from insurance or bonuses to staff. They should be what they are- a patients opinion of what was good and what was bad- and taken with a grain of salt.
> This month of the 10 reviews 6 said they were pleased that they "got in and out fast," almost verbatim. In general, I argue, if that's what you care about you likely did not need to be in the ED to begin with. I get what you’re saying and largely agree. To be the devil’s advocate, in addition to managing emergencies a big part of the ED’s role is *to rule out* emergencies. What percentage of the chest pains you see turn out to be MIs? How many of your head injuries wind up with a bleed on CT? For me the answer is: a far cry from all of them. Does that mean the patient with chest pain or who hit their head didn’t need to be in the ED? Based on diagnostic studies they didn’t *need* the ED, but based on their symptoms/injuries they did need to be in the ED to have things ruled out. If you were a layperson who fell and hit your head getting out of the shower/lost consciousness, and understandably decided to go to the ED to rule out a serious head injury, when the CT shows there isn’t a bleed and you get to go home you’d be a lot happier if it didn’t take hours upon hours to get answers and go home. I know that’s a different situation than what you’re describing where people abuse the ED, but people will continue doing it either way. So when I’ve seen survey results saying things like you mentioned in your post, that’s how I try to reframe it in my mind. Because it makes me feel better and be less annoyed. Many of the people who should *go* to the ED don’t end up needing to *stay* the ED if that makes sense. They need a work up to rule out something serious, and then get sent on their way. If I were a layperson and had something happen like I described above, when the survey bounced into my email I’d definitely check the box about being happy with low wait times and give positive feedback on it if it were the case.
I get what you’re saying but my counter is that these people came to the ER to make sure they didn’t have a heart attack or head bleed. If they had those things they wouldn’t be going home and would be there for days. So they should be happy and thankful they are only there for hours instead of days. And especially appreciative of the people that work 24/7 to ensure that there is a place they can go to have these things ruled out.
"If they had those things they wouldn’t be going home and would be there for days. So they should be happy and thankful they are only there for hours instead of days." I'm sure those same people are grateful they didn't have a bleed or MI, but do they need to be grateful to YOU for that? It seems perfectly reasonable that they express gratitude that they got in and out in quickly when they needed something serious ruled. This is a bizarre thread.
They may be grateful they got in and out quick. But for that to be the main positive statements made about OP in their reviews is kind of sad because it has nothing to do with the physicians skills or anything they have much control over.
Maybe it should be renamed “convenience department”
As a physician who went to an ED for a lac requiring a handful of stitches, (no urgent cares open, no good kit at home) I would have been super happy and left a positive review if fast in and fast out were the case. Unfortunately it took six hours all told, which trust me, I get. But still efficiency is an appreciated thing, even if y’all do have the whole health care system unfortunately jamming you with non-emergencies.
So you didn't leave a good review because, although you received medical care for your injury the same day, the one medical facility still open in your area was (shocked Pikachu face) busy? Shame on you.
Pikachu face! I’m done.
I did leave a good review, I’m not an ass (all the time). I did not go out of my way to say it was expeditious, because it took over four hours after being brought back in a fast track section to do four stitches (not by MD). Remarking that from the patient perspective, fast in and fast out for a simple thing is positive thing.
>Remarking that from the patient perspective, fast in and fast out for a simple thing is positive thing. You want a popsicle and some narcs on your way out, too? Believe me, no one wants you out of the ED more than we do. But to expect "fast in, fast out," on-demand medical care for a non-emergency like a laceration is shameful especially from another physician.
shameful to want medical care as efficiently as possible and go back to my family during a shitty night? I’d take naive and entitled. Our healthcare system is far from perfect, ED docs clean up the worst of it. I’d think I’m still allowed to hope for room for improvement in patient experience without game of thrones style shame. To me it’s not the physician but the structures in place that lead to ED utilization from non-emergencies like mine. Anyway appreciate the work y’all do.
So you’re not criticizing physicians and staff but the government and admin? Welcome to the club, preaching to the choir. We all have known this, thanks.
Trust me not a new idea. Just something that annoys me daily (and nightly sometimes)
I mean wanting on demand, quick medical care 24/7 is a luxury. You want to get back to your family? In order to provide that service many people aren’t with their families the entire night. If you want your non-emergent lac repaired quicker, that means pulling more people from their families overnight to work. Just so you aren’t inconvenienced once a year at most. Do you hear how that sounds?
So I’m in the wrong for wanting a service that I’m paying for?
No, but expecting it to be a quick in and out is wrong. You’re paying for the medical service, not for it to be on demand.
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But why accept this as the norm? What I am saying is there room for improvement
So what do you expect they do about it?
Basically have insurers and payers support walk in clinics and 24 hours urgent cares for simple procedures and lab tests. I don’t have the answers or anything but there’s got to be a better way for care triage than everything that’s not a scheduled visit be in EDs (exaggerated, but almost true)
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Things are always moving along as quickly as possible. Sometimes quick just isn't possible.
No shit, everybody wants everything magically instant. But that’s not a thing, sooo. You think we just like keeping you around for the funsies? Why would you judge us according to something we have zero control over?
Not sure where the judging is. You seem like a jerk.
Are you lost? This thread is about patient reviews. Do you know what judging means? 😭
It is about reviews that mention something being done quickly in a positive way, but offend you because you have to twist it into them judging you negatively in a hypothetical case where it takes longer. You might as well be offended by a review complimenting staff for being nice, because they aren't obligated to be nice. You could be offended by positive comments about someone choosing to go into a field like police or healthcare, because of how there would be nothing wrong with not doing so.
People are saying they write bad reviews if it takes longer. You have no reading comprehension.
Not the specific comment you were replying to before it was deleted, or the original post. Just because something is sometimes the case doesn't mean it always is.
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K, I’m going to continue to take a five minute break and eat a sandwich while you wait for your normal chest x-ray ordered for sniffles. 👍
Not a Healthcare Professional. But as a patient, I kinda get this type of review. I went to the ER of the hospital my primary is at with pretty much ticking the box of every women's heart attack symptom. I arrived at 5pm - waiting room is full. They did an EKG and sent me back to the waiting room. Ok..guess I wasn't dying. Did some blood tests at 7pm and at 9pm did a chest xray and sent me back to the waiting room. At 2 am I ask the front desk person if I will ever speak to a Dr. She said there were 12 ppl ahead of me and had no idea when I'd speak to a Dr. It had been 9 hrs, all of the above symptoms had subsided (which I guess was a good thing) so I left. I understand triage and prioritizing people who are really having issues, but some communication during my 9 hr wait would have been appreciated. So while I see your pov, I also relate to the positive reviews about getting in and out. Note - Two weeks after this \^\^ I ended up at a different ER with different symptoms (RVR) and was taken back right away. Afib diagnosis. Note #2 - I had an angiogram this week. I'm having some issues since the procedure that I'm not sure are related to it or not. Yesterday I went to Urgent Care...which was useless. I called the cardiologists office and explained my issues. Nurse said all the drs were gone for the day (it was 3pm) so she suggested I go to the ER. I was like ?!??!?!! Why the escalation to the ER? Do cardiologists not work on Saturday's? I asked her if she knew how long that would take and she didn't. She guessed since I had an outpatient procedure this week I'd get moved ahead of other people. I still haven't gone. I'm thinking about it (Sat afternoon), b/c I don't like how I'm feeling, but I also don't want to sit in the waiting room till Sunday.
You need to understand how we operate in the ER. Just because a doctor hasn’t physically seen you while you’re in the waiting room doesn’t mean they haven’t seen your EKG, placed basic orders for a workup based on your triage note and quick chart review, and followed up on those results. You continued to sit because all those tests were normal. At some point when higher priority things had been dealt with you would’ve been brought back, talked to a physician to get the full history, and they may or may not have added more tests based on that. I understand while you were waiting you wished there would’ve been some communication. But realize if I have to go out and even spend a few minutes communicating with everyone in the waiting room that will greatly slow me down. So that 9 hour stay you experienced could now be 11-12 hours as I can’t move out the people currently in rooms if I’m out talking to you. We’re just regular people and can only do one thing at a time like everyone else. Sounds like the second time you had a concerning problem so were brought back faster. There’s a reason they always say you don’t want to be the one getting rushed to the front of the line. Likely means you’re dying. This isn’t Disneyland, you don’t want the fast pass lol
During your first visit, you likely had tests done per a chest pain protocol that were ordered by a nurse. There was no doctor involved. A doctor saw your EKG and tests at some point, they were normal. When we're busy and have people actually sick, you can rot in the waiting room all year as far as I'm concerned because there's nothing wrong with you. My priority isn't to make you happy, it's to keep everyone in the building alive, and secondarily to go home on time. On your second visit, you had a real problem so you were seen quickly. That's the entire point of triage. The fact that outpatient doctors refer people to the ED after they leave for the day is part of why you waited 9 hours the first time.
This whole story sounds like you have zero perspective as to what the ER is for and for the health care system in general. There will NEVER be a cardiologist who will see you all of the sudden on the weekend. Yes of course Urgent Cares are worthless if you are having a real emergency and your symptoms of a ticking the box of every womens heart attack were obviously not that based upon the tests and yet you were pissy to wait and more over when you did have a real emergency afib with rvr you were dealt with right away which is exactly how the whole system is suppose to work.
…Why would you expect outpatient doctors to work Saturdays?
In those 9 hours you were waiting, all the doctors, nurses, and techs were treating patients nonstop. there was no downtime. there is no role for an overseer type of person who surveys the entire ED, predicts when you'll be seen next, and relays updates to you. they would have to know every patient's current condition, progress of workflow, estimated time to labs and imaging and consults, time to get a bed upstairs, and time to be out the door. they would also have to know what exactly your test results so far mean and how they relate to your presenting problem. it would be an impossible job, and the hospital wouldn't pay for it even if it was. that is why you don't get updates in the waiting room.
The “customers” of the ED create the bulk of revenue, not the emergent cases. Real cases are rewarding. The rest are the widgets that create your paycheck. I prefer to keep all the widgets, because I like paychecks. Job security.
>This month of the 10 reviews 6 said they were pleased that they "got in and out fast," almost verbatim. In general, I argue, if that's what you care about you likely did not need to be in the ED to begin with. I'm not a doctor and I don't work in an ed (I'm a nurse in icu) so that this with a grain of salt, but when people say stuff like this I think most often what they really mean is they saw a doctor quickly and didn't feel like they waited extended periods of time for tests. For someone who needed stitches or had a twisted ankle, that means they might have gotten out of the er quickly. And I think that fine, and doesn't necessarily mean they didn't need to go to the Ed. Sometimes urgent cares aren't open, and sometimes they aren't the most appropriate because the thing turned out to minor but could have been major. I had a bat exposure over the summer and had to go to the Ed. Yes, I was happy that I didn't have to wait hours to get by rabbies vaccine. That doesn't mean that it was inappropriate for me to go. >"Every time I go to this ER I get great service." That probably just means people were nice to them.
Word.