The ER, just let me vent!

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  • #26645
    PremedRNPremedRN
    Participant

    I have had a bad week. My 4 yr old got sick this past Monday night, fever, headache, stomach ache, and vomiting. I was able to keep fluids somewhat down because I had phenergan supp. (anti-nausea med). I had to miss school on tues. (chemistry recitation) the day before the test. Ouch! I studied for the test in between giving meds in almost every orifice, cleaning puke, and soothing discomforts. Wed (the day of the test) my hub stayed home so I didnt have to miss. Which I am so appreciative of. So I took it. Dont know what I got yet, but Im sure it wasnt my best score. So anyway, that same night my 3 yr old starts getting sick (sure it is going to happen like this, I have a math test scheduled today.) Yesterday morning when we woke up his temp was 105, with tylenol suppository it was 104. He was seeing people who werent really there, he even saw Sponge Bob Square Pants–delerium. Was throwing up despite phenergan. I called the ped who was on vacation, and the doc on call was full and only in the office half day. I couldnt even talk to the doc on call. Great. I almost will never go to an ER because of my past experiences of being dismissed when my children needed to be admitted and after spending a hundred dollars on the ER my children are sent home to suffer and dehydrate even more until they are then seen by my ped when she gets in, and “bingo bango”, they are admitted. I dont go to the ER for BS. This frustrates me, not everyone is looking for a quick fix. I ended up paging a acquaintance of mine who’s a neurologist, and he said he would give it a couple more hours-if no change-he would admitt him directly himself.
    Another thing, why do ER docs sometimes go against the radiologists readings? I am curious to know. This has happened to me on more than one occassion and resulted in a delay of treatment.
    Thanks for hearing me out, and please, try to clear up some of my misconceptions.

    —Dana

    #26646
    DONOTDELETE ****DONOTDELETE**
    Participant

    So…did your baby get admitted afterall?

    Some people think they know everything…that may be why they override the radiologists reading. I don’t agree with doing that. It seems to me that the radiologist should know a bit more than I do about radiographs. Who am I to override him/her? :confused: I think that ER docs who do that are asking for trouble. What justification in court does one have for overriding the specialist? I know some colleagues who do that…and I don’t get it. :yes:

    So sorry you had to go thru this!! 🙁

    #26647
    maggie52maggie52
    Participant

    Maybe I am not used to the “big city” but do you have a radiologist in house/ or one who get tele-rad’d all the pictures to review before you go home? IN smaller places they only tele-Rad them the CT etc and everything else gets read by him/her the next am…

    #26648
    DONOTDELETE ****DONOTDELETE**
    Participant

    Oh WOW..sounds like you’ve had a terrible week!! I hope you are both feeling better soon.

    I sympathize with your dislike of ERs. We also don’t go unless there is no other way….My experience with the ER has been equally distasteful. This includes stories like the time my 2 year old fell and put his teeth through his lip…well…below the lip. My husband had just gotten home from a 36+ hour workday and I reheated his food in the microwave. My 2 year old ran to try and eat some of my husband’s food :p and tripped and fell into his chair.

    We waited for 8 HOURS to be seen…the entire time he cried and was fussy. I asked to be given some baby tylenol…ANYTHING…and was completely ignored. I cuddled him, rocked him, walked with him. I tried everything…the poor guy was just in pain. The other parents there were appalled by the fact that the staff was so rude. I was actually told by the staff in the waiting room to ‘quiet’ my crying child because they couldn’t hear themselves speak :yikes: . It was ridiculous. I told them at that point that maybe it would be better if I left and went to another ER…and they told me that if I left they would call the police :yikes:

    When the plastics guy finally saw us (in the middle of the night) he told me he thought too much time had passed to stitch it…then he told me to leave the room. At this point I had had it. I politely said “I’m going to go ahead and stay with my son”. He became enraged and yelled at me telling me “did I really want my son to see me standing by doing nothing while he was papoosed and in pain”. I told him that I wanted my son to see that I was there for him gently speaking to him while something frightening/painful happened…not that I abandoned him.

    The guy was furious. He papoosed Alex and then ended up dropping the needle w/ thread and then with my child still papoosed had to leave the room and get a whole new setup. 😡 He was so rude to me and all I did was stand at the foot of the bed and massage Alex’s foot and sing to him and just ignore this rood sob. I was nothing but polite and never said a negative word to this turkey.

    Anytime we had to go to the ER at the University of Florida something similar happened…that place is the pits….I understand that they treat a lot of people w/o insurance and I think that is great…but my husband was a FELLOW there and they knew it and still treated us like that.

    I hated that place…as a result we only go to the ER if a limb is hanging off.

    kris

    #26649
    EM momEM mom
    Participant

    What a horrible week! (Here I was whining because my dog ate my daughter’s breakfast and I had to make another breakfast…really puts things into perspective!)

    I’m so sorry that so many have had bad experiments in the ER. I really think that being a parent has increased my sensitivity as a physician to these issues-I have a whole new compassion because of having seen it from the side of the parent. Telling a parent to leave is never a good idea, for the patient or the parent, unless the parent requests it. Instead, getting a chair (to prevent possible fainting…it has happened) and trying to be reassuring to both is usually the best course of action. And overriding a radiologist call, well, I hope those people have good malpractice insurance because they won’t have a leg to stand on when brought to court. I can’t say that I always agree, but I will never be a radiologist, nor have all of their expertise or training so here I have to defer to them.

    As far as the wait time, unfortunately overcrowding is a fact of life right now, and until we figure out how to fix this problem the long wait will continue. Of course there are many issues here, primary care with too few acute care visit timeslots, too few primary care physicians overall, patients with no insurance, and those with insurance who utilize the ER inappropriately (ie taking ambulance to see physician in ED regarding having his stitches removed from his toe-2 weeks later than they should have been, at midnight-don’t laugh, I had to see that person in our ER…it took everything I had not to rant about misuse of the system, but unfortunately I haven’t figured out a tactful way to point out stupidity, so I just kept my mouth shut). Of course these are in no order of importance or contribution. Difficult to fix most of these problems but we need to keep trying!

    #26650
    PremedRNPremedRN
    Participant

    MYA,
    No, my son got somewhat better so I didnt call to be admitted. But then he got worse better…My 4 year old is till throwing up a bit, running temp Day 4-starting to think he may need an antibiotic, my 3 yr old–Im going to see how it goes tonight. I feel so bad, in such a perdicament. I couldnt get in Yet AGAIN despite calling early to the doc on call, they told me to go to ER===I laughed. I think to myself that my kids are suffering, but I reassure myself that when I go to the ER, we would just be sent home, and I will be back to point A. Aside from this, the hospital is FULL–they’re busy (I know cause they called trying to get me to work). Definately not a good time to visit the ER, my kids will get the glance and boot. For 100 a wack, that’s not in my budget especially with 6 kids. I dont want to help pay for services NOT rendered.
    Let me tell you about not giving a damn about what the radiologist thinks,CT ABD: radiologist impression: torsion of r ovary—overlooked intially delayed treatment, peritonitis.
    CT ABD: Small bowel dilation, air pocketing rad impression: possible adynamic ileus—overlooked by ED doc. And what about the dehydration that I came in for? Led to a 2 week hospitalization. I didnt know all this initially how they werent going by the rad.’s impression, I knew this after the fact reading reports from the chart. It blew my mind.
    My sister was supposed to have been 8 wks pregnant, had severe abd pain==went in ER did pelvic ultrasound, couldnt find yolk sac in uterus, HCG levels high (as you would expect in pregnancy) WAS SENT HOME===went to a diff. ER 3 days later in pain, etc….EMERGENCY SURGERY. Ectopic pregnancy. The OB said it was the absolute largest she had ever seen without rupture, needless to say she had a R salphingectomy. My sister could have died.

    I understand that you cant order everything because of costs, but I think docs should be more aware that these are peoples lives, because like MYA stated, they get desentisized (sp).

    And yeah, people on medicaid are more likely to go to ER for silly stuff because they dont have to pay. I think, those people when approved for medicaid should have to go to a education course on illness that usually are emergent, or something of that nature. It probably would help keep costs down. Make everyone more happy.

    Mom2b, that is outrageous. I dont think I could have contained myself like you did. Where the HEL_ did he get his training and education from? Even as a nurse, you are taught to include the parent. What a JERK. OOOOOHHH! I am HOT!

    #26651
    PremedRNPremedRN
    Participant

    MYA, other ER doc’s please dont think I mean to bash you all. I dont like to make unrightful generalizations. It can be very demeaning. I just know how it is with my ER, unless there is a certain doc on.

    The thing with my neuro friend is that he is outta network. Dont know how my insurance would look at the whole situation being the admitting doc and never have seen my son as a “patient” so to speak.

    Another thing I wanted to ask, do you think it would be a bad choice to call a great FP doc I know and am pretty acquainted with that my kids have never been to given my perdicament. Or would it be seen as a nuisance? I have done this doc favors before, like coming in and discharging a nonenglish speaking patient who he couldnt communicate with, etc. Not that I had or do expect anything in return, I wouldnt be mad if he couldnt or wouldnt. What do you guys think?

    #26652
    PremedRNPremedRN
    Participant

    BUMP

    #26653
    MomMDMomMD
    Participant

    I’m moving this to general.

    #26654
    DONOTDELETE ****DONOTDELETE**
    Participant

    PremedRN…

    Wow…it sounds like you still have sick kiddos…that is terrible….and to be referred back to the ER :tired:

    #26655
    coopsmomcoopsmom
    Participant

    As a pediatrician, I agree that ER’s are seldom the best place to get treatment for a sick child. When I am on call, I try to discourage parents to go there if at all possible.
    One compromise if you do find that you have to go to the ER. If you have been seen by the ER physician and are not happy with the care or just want a second opinion, have them page your doctor (or on-call associate) before you leave the ED. Depending on the situation, many doctors would be willing to come to the ER to see the kid themselves. At the very least, you may be able to talk to the pediatrician and check to make sure everything’s ok. It actually helps your doctor, too, because they know what’s going on with your kid instead of getting a copy of the ER note 2 weeks later.
    In regards to the radiology issue, there is a big difference between OVERRIDING a radiologist’s opinion and OVERLOOKING a finding that is later discovered by the radiologist. The first is arrogant and a set-up for a malpractice case…the second may or may not indicate a subtle finding that could have been easily missed by a non-radiologist. (Ok…so I don’t see how you could miss a huge ectopic, but you get the point.)

    #26656
    rugratdocrugratdoc
    Participant

    Whew. Feel the heat! As a pediatrician working in a big ER with a trauma center I hear your pain. This whole flu thing and the panic the media has generated in people has made for ungodly wait times in our ER. We are having to call more staff in as if some diaster has struck. People complain about the wait times, but unfortunately when you have so many people using the ER inappropriately and doctors who send patients in because, they dont have any room in their schedules, it can be frustrating. Legally we have to see everyone and evaluate them completely, regardless of complaint. You wouldnt believe how many children I see whose parents bring them in with less than a day of fever or one episode of vomiting. There is a great misnomer in the public that an ER is faster regardless of your problem. Sure you will be seen that day….but at what cost for time. I see people getting irrate when they bring their child in for the “sniffles” and we place a patient on top in respiratory distress with a pulseox of 89. It doesnt bother me too much, I am glad to see who ever comes through the door, after all, I am there for a ten hour shift.

    I always try to explain the circumstances in the ER to parents. I find when I take the time, people begin to understand better and find more patience.

    #26657
    PremedRNPremedRN
    Participant

    Yeah, I usually wait for about 3 days with fever, unless there’s a complaint of the ears, or they havent held down anything in more than 24 hours with severe diarrhea,—then I wait until morning to see the ped, unless they look shocky.
    I paged the ped that is on call for my ped because my son who as you know has been very sick, and I tried to get him seen by that ped for days but scheduled himself half days (usually not the case) knowing he would be on call for my ped for weeks so I couldnt get in. He didnt allow himself time to see his own, let alone someone else’s patients. My son was impacted to the point where when he was trying to expel stool, it was causing him to prolapse. When he answered my page, before I could tell him what was going on he said I would have to make it quick, he only had a minute, he was going to a c-section. OKay, not a good greeting to a concerned mother of a sick child, for all he knew I could have been in the middle of a crisis. I was referred to the ER. I went, and did have a good experience for a change. I was there 6 hours, but no complaints here, my son was receiving adequate care. The doc was awesome (a woman of course!) She even hooked me up with a pediatrician who was willing to see ALL my kids for follow-up do to my circumstances, he supposed to be really good and nice. I am so grateful. The ER doc listened to me.
    I love my pediatrician, she listens to me, we make decisions together, and she trusts my instinct. Im gonna have to tell her to never leave me like that again!!! 😀
    Mom2b,
    That is awful. Sounds like a no win situation. Had to go through all that and probably just needed an antibiotic and fever control. Too bad…
    Coopsmom,
    The situations I referred to were read by a radiologist….dont know, does she or he get a better glance or something when they come in, if they were read at home? Help clear up any misconceptions I might have, please.

    BTW, do you guys think that maybe part of this number of deaths with this certain strain of flu is because it is more virulent/harsh on the body so people are dehydrating quicker or that it extends over a more lengthy time, and some people dont realize that the flu can be dangerous if you get to a certain point of dehydration? I just think some people may not be aware, and think they will get over it like most people and may let it go too far……maybe Im wrong.
    —Dana

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