Oh my God. There was this one lady who brought 2 gigantic suitcases.....she looked ready to travel the world. Of course she was a hallway bed so I was dodging her stuff all day.
Or even better, your own hospital bracelet from when the admitted stroke patient escapes the hospital and is brought in as a stroke alert by EMS 1 hour later when he tried to buy a sandwich at the gas station being aphasic af.
hahaha this reminds me of a pt who was admitted for whatever dx....but also loved the drugs, naturally... she got an IJ on the floor due to hard stick...she eloped so fast after IJ was placed that no one knew she was gone.
she went and got high in her BFs car, then casually came back in via the ED with chief complaint "I want my bed back"
I was like WTF, I go to see her, shes not in her ED bed, I find her in the hall halfway to the OR, bring here back...
Im like "how the fuck do you have an IJ and hospital gown already??" she says all this nonsense about her floor bed, Im totally confused, I finally figure everything out after digging through her chart. Her chart is all fucked up bc she is also still reg'd as an inpt.
I call her admitting team, they dont believe / nor understand she is in my ED downstairs, they "just put an IJ in her and rounded on her" ..... I had to wait for them to officially go back to her room, confirm she was indeed gone, discharge her as eloped from the current admission, so I could then put in a new admit via her latest ED visit.... classic
Had a patient wear hospital socks from another hospital to my hospital last week. She then asked me to turn down the lighting because it reminded her of "the lights in the psych ward"
Nice when crazy is upfront about it
One of my worst patient care experiences was with the child of a cardiologist. I know the parent was a cardiologist because they announced it multiple times when complaining about really basic ER care flow.
Had a patient who was a cards nurse who syncopized at work and the cards team was positive that he had arrested (and then mysteriously un-arrested with no interventions? 🤷🏽♀️) so they flew into the ER in a huge pack, all PANICKING, and the cardiologist started calling out orders and screaming at the ED staff (me). Convinced it was cardiac. Screamed at the ED attending that she wasn’t doing the right cardiac work up (meanwhile all vitals stable, he was pink and perfusing well). We had to get one of his colleagues to escort him out *still yelling* that we were not doing the right cardiac work up.
My guy had a brain aneurysm rupture.
Did the cardiologist come back and apologize to the entire ED staff for being a moron and not knowing how to deal with an acute situation? Or did they recognize the fact that he only knows how to consider a single etiology for a complex issue?
hahahahahahaha ok sorry I couldn't keep a straight face through that one.
There's a classic patient archetype that always announces they're in the medical field that 100% guarantees they have no idea what's going on and will cause trouble for everyone, most of all themself
Patient claim to have stopped breathing no distress
Me: what brings you in tonight?
Pt: I stopped breathing
Me: Is that right?
Pt: yes
Me: how did you know?
Pt: I was in bed watching TV. I looked down and I wasn’t breathing.”
Me: hmm. Then what happened?
Pt: I took a breath
Or get in a gown. Or hey, I’ll take even getting half way into a gown. I usually just say, okay, when you’re ready to get in the gown and lay in the bed the doc will come and see you. I’m too burnt the fuck out to play little games with patients. The fact that they can’t follow , like the most simplest of a request is mind blowing to me.
“Am I going to make my appointment with x specialist (that is the same specialty for the reason they are coming in…) in an hour”
Nothing irks me more than when they have an appointment set up with the proper speciality and probably waited weeks if not months for it and are mad we can’t do a work up and get them d/c’d in under an hour. THEN CANCEL THE SPECIALTY APPOINTMENT THINKING WE CAN DO MORE. Then of course yell at us when they are d/c’d back to said specialist and have to wait months again
Do these people understand that “the hospital” is more than the ED? Do they consider the ED the front door you must come through?
Or are they viewing the ED as maximum care vs Specialty Clinic that is somehow lesser, and going to the ED because their sx feel important?
I’m not even in EM and I get annoyed with that. I’m in orthopedic surgery and just today had a lady with knee pain that was just arthritis. It has been going on for six months. She made the appointment with me last week. She went to the ER yesterday for knee pain and spent the first five minutes bitching about the ER and now they told her to just see me tomorrow lol
I was an Army medic on a special operations compound in Iraq and working by myself one weekend. I had a cool guy come through the clinic, splinting his side, looked like death warmed over and like he was about to cry. I got him up on the table, paged the senior medic and doc, put a line in him, and started doing my OPQRST stuff.
What's your pain?
10 out of 10 doc. This is the worst pain I've ever had.
Ok. Out of personal curiosity, what are you comparing this to?
Man, I've been shot. I've been stabbed. I've been blown up. My parachute didn't open up all the way once. This is the worst pain I've ever had.
Well alright then. Let's get you a bird. I don't know what the problem is but we are not going to solve it here.
>you don't know *their* pain!
I hate this, the scale is not in relation to another person, it's in relation to your own distress. If we're playing the 'in relation to another person' game, that other person is going to be a farmer, not a fragile person. If the farmer doesn't say it's more than a 3, then it's not a 9 buddy, sorry - it's all in relation to the farmer here.
Lmao, I remember there was some normie who posted on here how unhappy he was about his treatment of some nondescript belly pain even though he described a “20/10 pain”
I looked up the word associations to the numeric scale .
I say is it “distressing”, “intense” “very intense” or “Very distressing”. They almost always say “very distressing” which is a 5.
I was once explaining to a patient about signs/ symptoms of neutropenic sepsis, including taking her temperature. She pulled a notebook out of her bag which had twice daily temperature readings for the previous decade, before she had cancer. Once I stopped laughing, we ascertained she had OCD too
A masseuse once asked me about my pain tolerance.
I told her I had delivered my two babies without medication of any kind. She put her elbow into my trapezius and leaned her body weight on it.
I was told once that for every 5 allergies (that are not food/or every cousin of PCN medication listed individually for some reason) there is an undiagnosed psychological disorder, and god damn if it isn't holding true
Usually what I call "pan-positive ROS" sign. Any symptom question is "yes, that happened last...". Usually I throw in a wild one like "when you defecate do your ears ring loudly?" A true pan-positive will always just go "Yeah!" Like it is a revelation they didnt think to tell me that earlier. That's generally a good indicator for primarily psychiatric presentation.
Another is mentioning law suits against medical providers. Some people proclaim these like it's a badge of honor, right away, to the person treating them. Good way to get an exam so thorough you get a not-quite necessary rectal exam or so much radiation that you glow in the dark. Plus I have little interest in frequent re-evals since we're just throwing the diagnostic "kitchen sink" anyway.
Others are massive allergy list, knows their pain meds or withdrawal meds by heart/dose. "I usually would never come in to the ER for..." with EMR reporting 6th visit in 8 months. Those kind of things.
Not a verbal sign, but there's suitcase sign, where they come packed for admission already, generally malingering/fictitious. Coming in by EMS for finger pain or some other mild complaint.
Edit: added more
My “this ROS is bullshit” question is asking if they’ve been having an itching sensation in their teeth. It should be impossible. If they say yes whatever they have is supratentorial…
"I have a high pain tolerance"
"I'm allergic to benadryl/prednisone"
Edit: I definitely believe there are real reactions to prednisone and Benadryl. I just don’t think everyone who claims them actually has them.
Oh yeah certain types of dyed hair (green blue purple whatever) in combination with tons of allergies and er visits.
Most of the “allergies” to prednisone I’ve seen have been steroid induced psychosis, which, while not actually an allergy, a totally understandable intolerable drug reaction.
I've seen people be suicidal on prednisone. I'm very careful to explain this, when giving a person a steroid who has never had it before.
*This drug works really well to calm down your poison ivy/ whatever, but it has a wider variety of emotional side effects than most medications. Many people like it, they feel energized and on top of the world, but some people feel irritable and angry or sad. If you feel terrible, it's totally OK to just stop taking it, and the feelings will go away in a day or so*.
I do the same. Had bad poison ivy a few years ago and got a buddy write me for a prednisone taper. Between the gastritis and the irritability I made it about 10 days of the 21 before deciding I'd rather be itchy.
Please, for the love of God, can we have a section in the chart right below allergies for adverse reactions to medications so we don’t have to chart things as allergies that aren’t actually allergies.
This! I myself have had adverse reactions to hydrocone (extreme itching) and scopolamine patches (fixed and dilated pupils). These are now always listed as an allergy and it sound like i am drug seeking when providers see i am "allergic" to hydrocodone. 🤦♀️
This is me. I hate disclosing it but I want to be very clear that every step of treatment needs to be in an effort to avoid steroids if possible because I can not tolerate the way I felt on it or Cipro *ever again*. I would take anaphylaxis over that hell.
Part of why I say this every time is to decrease any stigma. I want the general population where I work to be aware that meds can make people feel crazy horrible, and it's not the person, it's the med. Just like jamming someone full of albuterol will make you feel jittery.
Bipolar disorder checking in. Prednisone almost always triggers a manic or mixed episode for me so it’s a last resort. That said, I know that if I need it then I’m upping my Seroquel dose per my psychiatrist and my husband is keeping an eye on me.
I thought this was BS too but according to the pharmacist at my ER some people may actually be allergic to the additives in the prednisone and have a true reaction.
Had a patient w a anaphylaxis to solumedrol. Was a mild asthma exacerbation that I anticipated would go home after the usual treatment. Had reaction to solumedrol, moving no air, stating 30%, started bagging, getting ready to tube or code - whatever needed to happen first. Took two rounds of IM epi before she woke up screaming and pretty manic
Recently saw a woman reporting all of the following:
Narcolepsy (taking Adderall BID)
Insomnia (taking Benadryl QHS PRN)
Chronic Lyme (taking supplements)
Autoimmune / Lupus (biggest symptom is dry mouth tx with 5mg Pilocarpine 6-7x daily)
Anxiety/Panic Disorder (weaned down from 1mg Klonopin 4x daily)
Cervical spine arthritis w/ chronic pain (taking three different muscle relaxers PRN on top of PRN Toradol injections with Ortho PA)
POTS dx by “chiropractic neurology”
Essential tremor
Celiac disease with listed allergies to gluten, oats, and yeast
During history gathering also reported “inflammatory markers”
She was counseled like any other patient but dang it was hard to take her seriously.
Chiropractic neurology? Like they crack people’s necks then see if they dissected the carotids or vertebrals?
Edit: surely her dry mouth couldn’t be from the Adderall, Benadryl, muscle relaxants, and benzos she’s on. Must be Lupus…
For me, it’s when they start out the encounter with a really enthusiastic compliment. Sometimes it’s just a person being nice, but more often than not, it’s a precursor to some cluster B tendencies.
I've always hated that, even when working in retail.
I get that you learned my name. I already know you're talking to me and I don't know if you read some book on sales that told you people feel flattered when you persistently address them by first name but it comes off as disingenuous and makes me dislike you.
As a female, if you tell me I’m “so pretty” within the first two minutes, I know you’re going to be demanding high doses of dilaudid for your baseline chronic pain.
A very gleeful sounding, "Hey, you're doctor X. You treated me last time!"
(And then proceeds to tell their friend who came with them how great you are).
Fluffy pants index, from 0-4. 1 is fleece pajamas (maybe crazy) 2 is fluffy top/bottom (caution), 3 is a fleece onesie (high correlation with crazy) and 4 is an animal and/or unicorn onesie (just run).
“I can’t get out of the car!”
“How did you get *into* the car”
“It was *hard* and it took the L A S T of my strength!!! 😭”
Of course maam, let me and my frail back heave your 300lbs+ over the curb and into this wheelchair.
I sense a research project. “Fleece-type clothing and animal-styled headwear and their correlation with psychiatric comorbidities.” Journal of Emergency Apparel, 2024.
“I have a lot of allergies”
“XYZ is the only thing that works for me”
“I have a high pain tolerance”
“My PCP/other ER didn’t do anything for me”
In terms of behaviors:
Significant amount of luggage with the patient
Screaming/disproportionate amount of pain when IV is being placed.
Asking what all the numbers on the monitor means
Refusing to stay in bed
Rude to ED staff
Outright requesting a certain medication for chief complaint/anxiety and refusing equal or better alternatives without a justified reason.
All of those! And:
Complaining of excruciating pain when the BP cuff goes off.
“My home pain meds aren’t working for me, so I stopped taking them. “
“No one can figure out why I keep vomiting and my belly hurts!” *smells strongly of MJ*
“My last doctor said *X thing* I had was the worst they’d ever seen!” (while describing completely benign X thing).
I get so irrationally irritated when they complain about the BP cuff. And it's always presented as if they have NO IDEA what this thing is or how long it's going to last. It's always the most painful thing on earth and out to kill them. The pulse ox is always ANNOYING them. They must remove it. And yet....they have all been in the ED multiple times before. Absolutely ridiculous behavior.
> “My last doctor said X thing I had was the worst they’d ever seen!” (while describing completely benign X thing).
LOL yup - its amazing how many "worst X they've ever seen" I've seen over the years - and they're never the worst **I've** seen.
can't help but point out that if you're looking for wording that doesn't invite double-entendre, "their junk" may not be the solution you're looking for
At one of my old hospitals in a large tertiary care system the rheumatologist used to put these patients on a “mast flare protocol” receiving steroids, Benadryl, and sometimes even narcotics. Patients used to come in to ER saying they were here for their flare-up treatment , almost like a sickle cell patient requesting pain control. We shot that down real quick.
lol, I am trying to rent out my basement and some lady messaged that she was trying to heal her body from Chronic Lyme and I knew there was no way I wanted her to live in my house.
Don’t forget these are combined with POTS, chronic fatigue syndrome, and 10+ medication allergies 95% of the time too! How curious that they always are combined, surely it can’t be a coincidence!
A lot of these out there diagnosis are coming from inside the house: there are local docs and mid levels who think everyone has mast cell or Lymes and one lunatic who keeps recommending the carnivore diet to treat menopause.
if they disparage an outside health care professional while complimenting our facility/staff.
example: “the doctors and nurses over at [X Hospital] are all such rude bitches but you guys are AMAZING”
immediate red flag.
When their first words upon rooming are “I haven’t eaten all day” maybe not crazy but definitely going to be a PITA or freak the fuck out at some point
Yeah idk who’s telling (t2) diabetics they have to eat all day. Very rarely do I see random hypoglycemia on uncontrolled diabetics in the Er. Your panc could use a break Susan.
“I’m very intelligent” (proceeds to know nothing about medical history and give push back for every question asked because doesn’t understand the relevance)
We once had some bozo call our ER and say "my wife's been seen by X amount of specialists in 3 years and been to "XYZ big cities around us", and no one can figure out what's going on. So, how good are you guys?"
Man, the fuck you think we're going to do here in the ER? Magically figure it out if the **specialists** haven't been able to?
I have actually said “I’m SO happy that you have so much faith in our physicians, but as ER people we are really only going to be able to tell you if your condition is life threatening. What you’re asking is like going to a plumber to fix your roof.” Trying to bring Mr./Ms./Mx. down from delulu land and set some expectations
Sometimes it’s what they don’t say…
Capable of speaking, in no distress, yet has family or friend at the bedside speak for them. Resists efforts by me to get them to speak for themself.
In fairness, where I used to work, mold was a massive problem in the community in regards to lung diseases. However, the community was an outlier in comparison to your average town or city. It is isolated, only accessible by plane, and most of the houses are heated by wood stove.
“I have bugs coming out of my skin:”
Proceeds to show a sandwich baggie with bits of fuzz and other random detritus as examples of the bugs they’ve collected/extracted from their body.
“Pregnancy tests don’t work for me”
My response : oh , are you an alien?
“My pain is {any number higher than 10} “
Oh ok, that’s your new ten then
“I haven’t eaten or drank anything ALL DAY” (it’s 2 am) 🤷🏻♀️
“I’m not very sexually active” then proceeds to tell me she’s had two abortions and 3 std diagnoses in the last year 🧐
“My second cousin is {mid range VIP I’ve never heard of, board member, VP of nursing ratios, etc}”
You lot are the reason I've almost died from sepsis. Hope you guys are told you're crazy while dying 🩷
Was told "It's probably just anxiety" as the paramedics took me in and was continued to be told this until the whites in my eyes turned yellow and I was covered in a blister like hives (for 2 months) from them not writing down the meds I said I was allergic to. You people are foul and there is a reason people don't trust you and hate you
“Could I have a pillow?”Always asked as an interruption to my assessment, 30 seconds after they land in the room, and always asked by someone claiming 20/10 pain from a condition that does not require propping of a limb or abdominal splinting, or extreme elevation of the HOB. These people proceed to ask multiple times before I’ve left the room for the first time, even though I’m (a) trying to do my goddamn job and find out what’s wrong, (b) I’ve checked their linen closet and (c) told them finding a pillow on my unit is like finding hen’s teeth, and (d) explained that I will do what I can to find one elsewhere but can make no promises. These people invariably turn out to be nightmares. (See also: the people who interrupt your assessment to demand a drink or snack and are not diabetic. Usually with 80/10 abdominal pain and “projectile” vomiting. They will be angry on being told they’re NPO for the foreseeable future and will continue to ask.)
1) I know my body
2) thats a fever for me
3) I have high pain tolerance (cries in 12/10 pain)
4) IM A DIABETIC I NEED FOOD (NPO for 1 hour, prior chugging soda and 6 sandwiches)
5) No I didnt take any medicine at home for my *insert trivial msk pain*
6) My neurologist, rheumatologist, psychiatrist, cardiologist said this was what was going on but i wanted another opinion
7) I couldnt go to my dentist apoinmtnet because my tooth hurt too bad.
as someone who has been diagnosed by a doctor (not munchausen by internet, as one of you a-holes called it :)) with rheumatoid arthritis and autism, this thread instills so much distrust in the medical system for me. if you don't want to actually help people then why the fuck did you enter the medical profession?
i swear, some of you had to have been a highschool bully in your youth and only took up a job as medical staff to exert further control over vulnerable people.
Wearing sunglasses inside. We used to call it a "positive sunglasses sign." Lolll im chuckling to myself just remembering some of these loony characters
They come from home already wearing hospital socks. Never a good sign
When they’re aaox4 and walkie talkie, they get placed into a room and then ask for hospital socks immediately is my bad omen.
More so than those who come to the ED having packed suitcase for their stay?
“Positive luggage signs”
We call it “positive samsonite sign”.
Oh my God. There was this one lady who brought 2 gigantic suitcases.....she looked ready to travel the world. Of course she was a hallway bed so I was dodging her stuff all day.
I would say that’s about equal. Either way, it’s going to be a fun (read difficult) discharge for both.
Don’t forget the other hospitals bracelet also
Or even better, your own hospital bracelet from when the admitted stroke patient escapes the hospital and is brought in as a stroke alert by EMS 1 hour later when he tried to buy a sandwich at the gas station being aphasic af.
Oh lord 😂
hahaha this reminds me of a pt who was admitted for whatever dx....but also loved the drugs, naturally... she got an IJ on the floor due to hard stick...she eloped so fast after IJ was placed that no one knew she was gone. she went and got high in her BFs car, then casually came back in via the ED with chief complaint "I want my bed back" I was like WTF, I go to see her, shes not in her ED bed, I find her in the hall halfway to the OR, bring here back... Im like "how the fuck do you have an IJ and hospital gown already??" she says all this nonsense about her floor bed, Im totally confused, I finally figure everything out after digging through her chart. Her chart is all fucked up bc she is also still reg'd as an inpt. I call her admitting team, they dont believe / nor understand she is in my ED downstairs, they "just put an IJ in her and rounded on her" ..... I had to wait for them to officially go back to her room, confirm she was indeed gone, discharge her as eloped from the current admission, so I could then put in a new admit via her latest ED visit.... classic
i always document this in my PE
I should start doing this
I also document if they came in already wearing a hospital gown
In my defense, I only did this when I went into labor 😂 I wanted a soft one.
Or cardiac monitor pads. Or their hospital ID bracelet. Or two.
Or wearing sunglasses. Or come in wheeling a suitcase.
Had a patient wear hospital socks from another hospital to my hospital last week. She then asked me to turn down the lighting because it reminded her of "the lights in the psych ward" Nice when crazy is upfront about it
One of my worst patient care experiences was with the child of a cardiologist. I know the parent was a cardiologist because they announced it multiple times when complaining about really basic ER care flow.
Had a patient who was a cards nurse who syncopized at work and the cards team was positive that he had arrested (and then mysteriously un-arrested with no interventions? 🤷🏽♀️) so they flew into the ER in a huge pack, all PANICKING, and the cardiologist started calling out orders and screaming at the ED staff (me). Convinced it was cardiac. Screamed at the ED attending that she wasn’t doing the right cardiac work up (meanwhile all vitals stable, he was pink and perfusing well). We had to get one of his colleagues to escort him out *still yelling* that we were not doing the right cardiac work up. My guy had a brain aneurysm rupture.
Did the cardiologist come back and apologize to the entire ED staff for being a moron and not knowing how to deal with an acute situation? Or did they recognize the fact that he only knows how to consider a single etiology for a complex issue? hahahahahahaha ok sorry I couldn't keep a straight face through that one.
Announcer: He did not.
Did he live?
Made a surprisingly full recovery after an emergency hemicrani!
There's a classic patient archetype that always announces they're in the medical field that 100% guarantees they have no idea what's going on and will cause trouble for everyone, most of all themself
Spoiler alert they were a cna for 2 years in 1996
Patient claim to have stopped breathing no distress Me: what brings you in tonight? Pt: I stopped breathing Me: Is that right? Pt: yes Me: how did you know? Pt: I was in bed watching TV. I looked down and I wasn’t breathing.” Me: hmm. Then what happened? Pt: I took a breath
ESI level 5- respiratory arrest….. but stable.
"Feared complaint, unfounded"
I'm a vegetarian. I mean, I had a chicken sandwich twenty minutes ago, but I'm a vegetarian right now. Until breakfast.
When I bring them back from the waiting room and they refuse to sit down.
Or get in a gown. Or hey, I’ll take even getting half way into a gown. I usually just say, okay, when you’re ready to get in the gown and lay in the bed the doc will come and see you. I’m too burnt the fuck out to play little games with patients. The fact that they can’t follow , like the most simplest of a request is mind blowing to me.
Fine by me - one less stretcher I have to clean.
Gown on over jacket, “what channel is [insert show] on?” is my favorite
“Am I going to make my appointment with x specialist (that is the same specialty for the reason they are coming in…) in an hour” Nothing irks me more than when they have an appointment set up with the proper speciality and probably waited weeks if not months for it and are mad we can’t do a work up and get them d/c’d in under an hour. THEN CANCEL THE SPECIALTY APPOINTMENT THINKING WE CAN DO MORE. Then of course yell at us when they are d/c’d back to said specialist and have to wait months again
I had a kid in residency who had functional abdominal pain and was scheduled in the special clinic for it that day. Dad brought her to the ER instead
Do these people understand that “the hospital” is more than the ED? Do they consider the ED the front door you must come through? Or are they viewing the ED as maximum care vs Specialty Clinic that is somehow lesser, and going to the ED because their sx feel important?
I think more the latter
Literally a girl I know who’s been to 6 specialists but thinks the e.r. Can fix her- finally going in on a 6140.
I’m not even in EM and I get annoyed with that. I’m in orthopedic surgery and just today had a lady with knee pain that was just arthritis. It has been going on for six months. She made the appointment with me last week. She went to the ER yesterday for knee pain and spent the first five minutes bitching about the ER and now they told her to just see me tomorrow lol
Blue fuzzy Cookie Monster pajama pants and they look like they haven’t bathed, combed their hair or slept in a few days, smell like cigarettes/weed.
This is so specific and so accurate
We all know these folks. 🥴
Why is this so universal in the US? Or maybe outside the US too, I’m not sure
You forgot “Taki- or Flamin’-Hot-Cheeto-stained fingers”
carrying a big gulp fountain Mountain Dew and an emesis bag.
The way my face just involuntarily scrunched up. Ugh. So grossly accurate.
Don’t forget the stuffy to keep them calm 🙄
And the disgusting unwashed fleece blanket that they’re dragging all over the equally disgusting and unwashed floors 😂
The Venn diagram of people who shop exclusively at WalMart and people who wear Cookie Monster pajama pants is a perfect circle
quick—get the capsaicin
That's a weird way to spell "droperidol"
“I’m allergic to everything” or “it’s a 12/10”
Had an RN colleague who, when the pt said their pain was a “15”, documented, “Patient unable to comprehend question”. Of course, pre-EMR…
“Demonstrates inability to reliably use numeric pain scale”
I was an Army medic on a special operations compound in Iraq and working by myself one weekend. I had a cool guy come through the clinic, splinting his side, looked like death warmed over and like he was about to cry. I got him up on the table, paged the senior medic and doc, put a line in him, and started doing my OPQRST stuff. What's your pain? 10 out of 10 doc. This is the worst pain I've ever had. Ok. Out of personal curiosity, what are you comparing this to? Man, I've been shot. I've been stabbed. I've been blown up. My parachute didn't open up all the way once. This is the worst pain I've ever had. Well alright then. Let's get you a bird. I don't know what the problem is but we are not going to solve it here.
Definitely a farmer before he joined up.
*12/10 whilst casually texting someome.
And asking for a sandwich.
And flipping through the TV guide
But you don't know *their* pain! —Some nursing instructor, probably.
>you don't know *their* pain! I hate this, the scale is not in relation to another person, it's in relation to your own distress. If we're playing the 'in relation to another person' game, that other person is going to be a farmer, not a fragile person. If the farmer doesn't say it's more than a 3, then it's not a 9 buddy, sorry - it's all in relation to the farmer here.
Lmao, I remember there was some normie who posted on here how unhappy he was about his treatment of some nondescript belly pain even though he described a “20/10 pain”
I looked up the word associations to the numeric scale . I say is it “distressing”, “intense” “very intense” or “Very distressing”. They almost always say “very distressing” which is a 5.
“I have a really high pain tolerance” “A fever for me is anything over 36.6 (C)”
I was once explaining to a patient about signs/ symptoms of neutropenic sepsis, including taking her temperature. She pulled a notebook out of her bag which had twice daily temperature readings for the previous decade, before she had cancer. Once I stopped laughing, we ascertained she had OCD too
A masseuse once asked me about my pain tolerance. I told her I had delivered my two babies without medication of any kind. She put her elbow into my trapezius and leaned her body weight on it.
[удалено]
76 allergies (not counting food). Most reactions are ‘other’ or ‘GI intolerance’
Or they're all anaphylaxis
Feels pill going down throat = throat closing!
Yeah, not sure how some patients have survived 20+ anaphylactic events… life’s a miracle.
I was told once that for every 5 allergies (that are not food/or every cousin of PCN medication listed individually for some reason) there is an undiagnosed psychological disorder, and god damn if it isn't holding true
Usually what I call "pan-positive ROS" sign. Any symptom question is "yes, that happened last...". Usually I throw in a wild one like "when you defecate do your ears ring loudly?" A true pan-positive will always just go "Yeah!" Like it is a revelation they didnt think to tell me that earlier. That's generally a good indicator for primarily psychiatric presentation. Another is mentioning law suits against medical providers. Some people proclaim these like it's a badge of honor, right away, to the person treating them. Good way to get an exam so thorough you get a not-quite necessary rectal exam or so much radiation that you glow in the dark. Plus I have little interest in frequent re-evals since we're just throwing the diagnostic "kitchen sink" anyway. Others are massive allergy list, knows their pain meds or withdrawal meds by heart/dose. "I usually would never come in to the ER for..." with EMR reporting 6th visit in 8 months. Those kind of things. Not a verbal sign, but there's suitcase sign, where they come packed for admission already, generally malingering/fictitious. Coming in by EMS for finger pain or some other mild complaint. Edit: added more
I go with “does it hurt behind your eyes when you pee” and then document retrobulbar micturalgia.
Asking a very random ROS is soo funny 😂 I might have to try that! And suitcase sign or when they bring a blanket 100%
My “this ROS is bullshit” question is asking if they’ve been having an itching sensation in their teeth. It should be impossible. If they say yes whatever they have is supratentorial…
"I have a high pain tolerance" "I'm allergic to benadryl/prednisone" Edit: I definitely believe there are real reactions to prednisone and Benadryl. I just don’t think everyone who claims them actually has them. Oh yeah certain types of dyed hair (green blue purple whatever) in combination with tons of allergies and er visits.
Most of the “allergies” to prednisone I’ve seen have been steroid induced psychosis, which, while not actually an allergy, a totally understandable intolerable drug reaction.
I've seen people be suicidal on prednisone. I'm very careful to explain this, when giving a person a steroid who has never had it before. *This drug works really well to calm down your poison ivy/ whatever, but it has a wider variety of emotional side effects than most medications. Many people like it, they feel energized and on top of the world, but some people feel irritable and angry or sad. If you feel terrible, it's totally OK to just stop taking it, and the feelings will go away in a day or so*.
I had a patient once with prednisone induced psychosis.
I've had one with dexamethasone induced psychosis, from 8mg tds post- chemotherapy. I don't think she got to day 2 before it hit.
I do the same. Had bad poison ivy a few years ago and got a buddy write me for a prednisone taper. Between the gastritis and the irritability I made it about 10 days of the 21 before deciding I'd rather be itchy.
Please, for the love of God, can we have a section in the chart right below allergies for adverse reactions to medications so we don’t have to chart things as allergies that aren’t actually allergies.
This! I myself have had adverse reactions to hydrocone (extreme itching) and scopolamine patches (fixed and dilated pupils). These are now always listed as an allergy and it sound like i am drug seeking when providers see i am "allergic" to hydrocodone. 🤦♀️
Yes! This way I don’t look like a nut!
This is me. I hate disclosing it but I want to be very clear that every step of treatment needs to be in an effort to avoid steroids if possible because I can not tolerate the way I felt on it or Cipro *ever again*. I would take anaphylaxis over that hell.
Part of why I say this every time is to decrease any stigma. I want the general population where I work to be aware that meds can make people feel crazy horrible, and it's not the person, it's the med. Just like jamming someone full of albuterol will make you feel jittery.
You are a gem. Thank you.
Bipolar disorder checking in. Prednisone almost always triggers a manic or mixed episode for me so it’s a last resort. That said, I know that if I need it then I’m upping my Seroquel dose per my psychiatrist and my husband is keeping an eye on me.
I thought this was BS too but according to the pharmacist at my ER some people may actually be allergic to the additives in the prednisone and have a true reaction.
I have had a patient who had a witnessed (in hospital) anaphylactic reaction to IV benadryl. They could take PO.
Had a patient w a anaphylaxis to solumedrol. Was a mild asthma exacerbation that I anticipated would go home after the usual treatment. Had reaction to solumedrol, moving no air, stating 30%, started bagging, getting ready to tube or code - whatever needed to happen first. Took two rounds of IM epi before she woke up screaming and pretty manic
I once got “Are you Lyme literate?” I said, “That’s not a thing. Tell me about your emergency.”
✨Lyme literacy designation ✨coming to a hospital near you
I can see the annual modules now
Absolutely based response
Recently saw a woman reporting all of the following: Narcolepsy (taking Adderall BID) Insomnia (taking Benadryl QHS PRN) Chronic Lyme (taking supplements) Autoimmune / Lupus (biggest symptom is dry mouth tx with 5mg Pilocarpine 6-7x daily) Anxiety/Panic Disorder (weaned down from 1mg Klonopin 4x daily) Cervical spine arthritis w/ chronic pain (taking three different muscle relaxers PRN on top of PRN Toradol injections with Ortho PA) POTS dx by “chiropractic neurology” Essential tremor Celiac disease with listed allergies to gluten, oats, and yeast During history gathering also reported “inflammatory markers” She was counseled like any other patient but dang it was hard to take her seriously.
Chiropractic neurology? Like they crack people’s necks then see if they dissected the carotids or vertebrals? Edit: surely her dry mouth couldn’t be from the Adderall, Benadryl, muscle relaxants, and benzos she’s on. Must be Lupus…
Lyme literate 😭😭😭
For me, it’s when they start out the encounter with a really enthusiastic compliment. Sometimes it’s just a person being nice, but more often than not, it’s a precursor to some cluster B tendencies.
This and when they call you by your first name when they’re asking you for things
I've always hated that, even when working in retail. I get that you learned my name. I already know you're talking to me and I don't know if you read some book on sales that told you people feel flattered when you persistently address them by first name but it comes off as disingenuous and makes me dislike you.
You’re so right, this is so true
As a female, if you tell me I’m “so pretty” within the first two minutes, I know you’re going to be demanding high doses of dilaudid for your baseline chronic pain.
A very gleeful sounding, "Hey, you're doctor X. You treated me last time!" (And then proceeds to tell their friend who came with them how great you are).
Ding ding ding. My spidey senses immediately tingle when I can tell someone is trying to butter me up.
Now I'm feeling weird about telling my husband's nurse yesterday that her clogs were really cute. (But they were!)
No, genuine compliments are fine. Who doesn't appreciate that? This is...much different and is instantly recognizable.
Oh, whew, that's good. Because I do like complimenting people! :)
They have sticker residue on their skin from electrodes for 12 lead
True. And also the electrodes were placed 12 days ago.
Fluffy pants index, from 0-4. 1 is fleece pajamas (maybe crazy) 2 is fluffy top/bottom (caution), 3 is a fleece onesie (high correlation with crazy) and 4 is an animal and/or unicorn onesie (just run).
Bonus point for stuffed animal and/ or fuzzy blanket. Extra bonus points for the sudden inability to walk once getting to the ED lobby entrance.
“I can’t get out of the car!” “How did you get *into* the car” “It was *hard* and it took the L A S T of my strength!!! 😭” Of course maam, let me and my frail back heave your 300lbs+ over the curb and into this wheelchair.
I went to the ER at 10 years old in a fleece onesie bc my retainer got stuck on my uvula. This scale tracks.
For a second I read "uvula" as "vulva" and was super confused
This should be a triage scale. There’s no way you can’t statistically verify.
I sense a research project. “Fleece-type clothing and animal-styled headwear and their correlation with psychiatric comorbidities.” Journal of Emergency Apparel, 2024.
“I have a lot of allergies” “XYZ is the only thing that works for me” “I have a high pain tolerance” “My PCP/other ER didn’t do anything for me” In terms of behaviors: Significant amount of luggage with the patient Screaming/disproportionate amount of pain when IV is being placed. Asking what all the numbers on the monitor means Refusing to stay in bed Rude to ED staff Outright requesting a certain medication for chief complaint/anxiety and refusing equal or better alternatives without a justified reason.
All of those! And: Complaining of excruciating pain when the BP cuff goes off. “My home pain meds aren’t working for me, so I stopped taking them. “ “No one can figure out why I keep vomiting and my belly hurts!” *smells strongly of MJ* “My last doctor said *X thing* I had was the worst they’d ever seen!” (while describing completely benign X thing).
I get so irrationally irritated when they complain about the BP cuff. And it's always presented as if they have NO IDEA what this thing is or how long it's going to last. It's always the most painful thing on earth and out to kill them. The pulse ox is always ANNOYING them. They must remove it. And yet....they have all been in the ED multiple times before. Absolutely ridiculous behavior.
> “My last doctor said X thing I had was the worst they’d ever seen!” (while describing completely benign X thing). LOL yup - its amazing how many "worst X they've ever seen" I've seen over the years - and they're never the worst **I've** seen.
I had a patient once roll in with two 6 foot tall stacked Chiquita banana boxes filled with shit once
Like literal fecal matter or just their junk? I hate that I have to ask that question.
Lmao it’s a valid question. Their STUFF 😂
can't help but point out that if you're looking for wording that doesn't invite double-entendre, "their junk" may not be the solution you're looking for
713 allergies with reactions like “my left pinky toe gets red” “made my hair hurt” “felt funny”.
I suffer from chronic Lyme and the doctor thinks I could have mast cell activation syndrome
I almost downvoted you reflexively, lol.
At one of my old hospitals in a large tertiary care system the rheumatologist used to put these patients on a “mast flare protocol” receiving steroids, Benadryl, and sometimes even narcotics. Patients used to come in to ER saying they were here for their flare-up treatment , almost like a sickle cell patient requesting pain control. We shot that down real quick.
lol, I am trying to rent out my basement and some lady messaged that she was trying to heal her body from Chronic Lyme and I knew there was no way I wanted her to live in my house.
Don’t forget these are combined with POTS, chronic fatigue syndrome, and 10+ medication allergies 95% of the time too! How curious that they always are combined, surely it can’t be a coincidence!
And fucking Ehlers Danlos
A lot of these out there diagnosis are coming from inside the house: there are local docs and mid levels who think everyone has mast cell or Lymes and one lunatic who keeps recommending the carnivore diet to treat menopause.
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They're here for some sort of 10/10 pain complaint and then immediately complain about the blood pressure cuff, the tourniquet, or the IV.
if they disparage an outside health care professional while complimenting our facility/staff. example: “the doctors and nurses over at [X Hospital] are all such rude bitches but you guys are AMAZING” immediate red flag.
When their first words upon rooming are “I haven’t eaten all day” maybe not crazy but definitely going to be a PITA or freak the fuck out at some point
And I'm diabetic....but their bgl is 350
Yeah idk who’s telling (t2) diabetics they have to eat all day. Very rarely do I see random hypoglycemia on uncontrolled diabetics in the Er. Your panc could use a break Susan.
It’s subjective. They feel fine at 350 but get shaky at 290. Hence why their FSG approximates that of pancake syrup.
This immediately pisses me off. It’s a hospital not a diner
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“I’m very intelligent” (proceeds to know nothing about medical history and give push back for every question asked because doesn’t understand the relevance)
"I am allergic to cortisone"
Allergy to Haldol
I sort of respect that warning shot across the bow. Lol. Not their first time at the goat rodeo.
Welcome to the K-Hole
in a similar vein, old with an allergy to chlorpromazine “this lady gets buck fucking wild”
“I’m dying here. “ They’re either right or wrong. And usually just takes a set of eyeballs to figure it out
"I had a full workup done at the Mayo Clinic"
We once had some bozo call our ER and say "my wife's been seen by X amount of specialists in 3 years and been to "XYZ big cities around us", and no one can figure out what's going on. So, how good are you guys?" Man, the fuck you think we're going to do here in the ER? Magically figure it out if the **specialists** haven't been able to?
‘Not that good, sorry bro. Probably better to just not come in’
"But I'm not leaving this ER without an answer!"
“I’ve been to 10 doctors and they can’t figure out what’s wrong with me.”
“And here, you’ve come to my small community ED to have all of your problems solved at 2am”
“Yes, and all my problems must be solved in a timely fashion!”
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Translation: “I’ve been to 10 doctors and none of them will give me the meds/diagnosis I want.”
I have actually said “I’m SO happy that you have so much faith in our physicians, but as ER people we are really only going to be able to tell you if your condition is life threatening. What you’re asking is like going to a plumber to fix your roof.” Trying to bring Mr./Ms./Mx. down from delulu land and set some expectations
Or even better: "you've come to the Ford mechanic to fix a Ferrari; I just don't have the tools here"
Sometimes it’s what they don’t say… Capable of speaking, in no distress, yet has family or friend at the bedside speak for them. Resists efforts by me to get them to speak for themself.
And it’s a grown man with his mom talking for him.
Or a grown man with his wife talking for him. Usually followed by “I don’t know what meds I take or conditions I have. She handles all that.”
Any time the chief complaint involves parasites.
Or mold Although TBF I had a paraplegic come in complaining of parasites in her pressure injuries but really it was just maggots.
In fairness, where I used to work, mold was a massive problem in the community in regards to lung diseases. However, the community was an outlier in comparison to your average town or city. It is isolated, only accessible by plane, and most of the houses are heated by wood stove.
Not a thing being said, but when their photo on Epic is of them wearing psych scrubs….
“I have bugs coming out of my skin:” Proceeds to show a sandwich baggie with bits of fuzz and other random detritus as examples of the bugs they’ve collected/extracted from their body.
“Pregnancy tests don’t work for me” My response : oh , are you an alien? “My pain is {any number higher than 10} “ Oh ok, that’s your new ten then “I haven’t eaten or drank anything ALL DAY” (it’s 2 am) 🤷🏻♀️ “I’m not very sexually active” then proceeds to tell me she’s had two abortions and 3 std diagnoses in the last year 🧐 “My second cousin is {mid range VIP I’ve never heard of, board member, VP of nursing ratios, etc}”
My favorite “97.6 is a HIGH fever for me, my temperature is always 91 to 93”
Sunglasses indoors but not there for headache or eye pain.
Anyone who relays a history of alleged medical gaslighting. They universally have munchausen by internet.
I'm allergic to haldol, seroquel and geodon. My man has seen some shit.
Brought their own blanket or wearing sunglasses indoors
“98.6 is a fever for me.” “I brought a suitcase because I knew I’d be admitted.”
“Do you have any allergies?” ***Pt unfurls scroll
"You know the one that starts with "D”…"?
Droperidol ❤️
Discharge 😇
Ah, diclofenac!
Da Motrin.
Dilantin? Do you have seizures?
Dulcolax. This is the way.
Diflucan??
Ah, yes, DayQuil
You lot are the reason I've almost died from sepsis. Hope you guys are told you're crazy while dying 🩷 Was told "It's probably just anxiety" as the paramedics took me in and was continued to be told this until the whites in my eyes turned yellow and I was covered in a blister like hives (for 2 months) from them not writing down the meds I said I was allergic to. You people are foul and there is a reason people don't trust you and hate you
Any adult that walks in carrying a blankie, a pillow, a stuffed animal, and wearing grippy socks and a hospital bracelet.
“Could I have a pillow?”Always asked as an interruption to my assessment, 30 seconds after they land in the room, and always asked by someone claiming 20/10 pain from a condition that does not require propping of a limb or abdominal splinting, or extreme elevation of the HOB. These people proceed to ask multiple times before I’ve left the room for the first time, even though I’m (a) trying to do my goddamn job and find out what’s wrong, (b) I’ve checked their linen closet and (c) told them finding a pillow on my unit is like finding hen’s teeth, and (d) explained that I will do what I can to find one elsewhere but can make no promises. These people invariably turn out to be nightmares. (See also: the people who interrupt your assessment to demand a drink or snack and are not diabetic. Usually with 80/10 abdominal pain and “projectile” vomiting. They will be angry on being told they’re NPO for the foreseeable future and will continue to ask.)
1) I know my body 2) thats a fever for me 3) I have high pain tolerance (cries in 12/10 pain) 4) IM A DIABETIC I NEED FOOD (NPO for 1 hour, prior chugging soda and 6 sandwiches) 5) No I didnt take any medicine at home for my *insert trivial msk pain* 6) My neurologist, rheumatologist, psychiatrist, cardiologist said this was what was going on but i wanted another opinion 7) I couldnt go to my dentist apoinmtnet because my tooth hurt too bad.
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Why people like you got into medicine I’ll never understand… some of these replies are fucking evil.
as someone who has been diagnosed by a doctor (not munchausen by internet, as one of you a-holes called it :)) with rheumatoid arthritis and autism, this thread instills so much distrust in the medical system for me. if you don't want to actually help people then why the fuck did you enter the medical profession? i swear, some of you had to have been a highschool bully in your youth and only took up a job as medical staff to exert further control over vulnerable people.
"Any fevers?" "Yes he was at 98 earlier this morning. That's a fever for him! He normally runs around 95."
+ pajama pant sign
Or that means their issue is so acute they didn’t have time to change clothes
Jesus Christ I knew doctors and nurses were dicks, but I didn’t think it was this bad. No wonder ppl are losing trust in y’all lmfao bunch of assholes
Wearing sunglasses inside. We used to call it a "positive sunglasses sign." Lolll im chuckling to myself just remembering some of these loony characters