There’s Somethin’ Happening Here…..
This is an interesting little gem.
I believe it was part of an ad for health insurance.
Interesting because it looks about circa 1950.
Because for what I spend on amazon.com, I could have my appendix out every ten days.
With the Grade A anesthesia!
And because this patient looks to be headed for surgery in an evening gown!
Honey, in my facility, you don’t even get to keep your underwear on!
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I’ve lived through many changes in health care over the last three decades.
Seen trends come and go.
Seen fancy “miracle” drugs come and go. And come back again.
But something is happening.
The changes are coming faster.
I’m coming up on three years in my current ER.
Here are a few of the changes I’ve seen in that relatively short length of time.
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Patients are more open about their health issues.
- Patients seem more willing to let you know when they have infections like Hep C or HIV.
- Words and intitials that used to be whispered with averted gaze are now spoken outright and without shame.
- I like to think that patients are more comfortable because they don’t feel the stigma that was once attached to infectious disease. Maybe I’m naive. I hope not.
- I’ve had more than one patient warn me to be extra careful when taking their blood!
- Patients are more upfront about their sexuality and medications taken for it.
- I used to have to ask about Viagra specifically; no nitroglycerin if Viagra is on board! I still ask, but have noticed an increased willingness to mention the presence of Viagra without being asked.
- Again, I’d like to think this is due to increased patient education from both health-care providers and that patients feel more comfortable informing us of these medications.
More patients are using the emergency department as their source for narcotics.
- This leads to me believe one of three scenarios:
- 1. The patient has chronic pain and they must utilize the ER when they experience breakthrough pain or when their coping mechanisms are overwhelmed. Or…
- 2. The patient does not have an adequate pain control regimen in place as yet and continues to experience episodes of pain requiring narcotics. This is also legitimate. Or…
- 3. The patient is a drug-seeker. You know them. It’s a feeling in your gut. Daily visits for two weeks. Two visits in 24 hours, more than once. Overly-solicitous behavior to the nurses. (I’m good, but no, I’m not Mother Teresa, thank you anyway.) “Allergic” to every medication other than the one(s) they are asking for. There have been shifts when I have seen 6-7 of our “regulars”. Some call in ahead to see how busy we are. This is not legitimate.
- So how do you know which is which?
- Many times, you don’t.
- That means everyone is treated as if their request is legitimate and they are not drug seeking.
- But I can tell you there are more narcotics flowing out of emergency departments today than I’ve ever seen. I can also tell you that when
- I know the patient’s name when they walk in the door,
- when I can write their medical history from memory on the triage chart, and
- when I am giving amounts of medication that would put me out for eternity, we have a problem, Houston.
- Sometimes, I can’t help but feel like a drug pusher – in the literal sense. We are doing these patients a dis-service by continuing to feed their addiction. It’s a sad situation; it’s almost like they live from visit to visit. But they still come in. Because they get what they want.
There are more patients in the emergency department.
This isn’t my imagination, we’re adding more nurses like crazy to handle the load!
I’ll use my shift, the night shift, as an example:
- The old night shift
- Clear out the patients left over from PM shift by 0100
- Stock the unit and order meds.
- Catch up on all the nursing journals and research papers you have not had a chance to read. (Translation: knit, crochet, write letters, catch up on your novel, do crossword puzzles, gossip and eat, eat, eat!)
- Put all evidence of professional journals away by 0530 so that the day shift doesn’t think you sat on your butt half the night.
- Get ready for the daily hip fracture patient that is sure to come in between 0545 and 0630 and the daily pulmonary edema patient that will come between 0615 and 0700
- Come in at 2300, pour coffee.
- Run your derrierre off with a nearly full department.
- At 0200, make more coffee (you never had a chance to sip the first cup).Run your derrierre off with the new patients that have just arrived as you hit the “on” button on the coffee pot.
- At 0400, make more coffee. Actually drink half of this cup. Go attend to the four pediatric patients from the same family who all have fevers and just walked in with all four grandparents and a fourth cousin once removed.
- At 0600, forget any more attempts at coffee. Grab your six-inch high pile of charts and begin documenting what you did five hours previously.
- Take the next hip fracture and pulmonary edema patients.
- Kiss the day shift.
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The paperwork has become unmanageable.
I’ve blogged on this ad nauseum.
Ostensibly, the paperwork is supposed to document good patient care.
- In reality, it borders on preventing adequate patient care as the nurse spends more time at the chart than at the bedside.
- You don’t get a “gold star” on your record for making sure your patients received good skin care.
- You get a “gold star” for filling in all the blanks on the chart.
So it appears the rapid changes I’ve witnessed in the last three years are a mixed bag.
On the one hand, patients are more willing to discuss intimate aspects of their care with their health-care providers.
On the other hand, the census of my emergency department is swelling secondary to non-emergent patients utilizing our services.
A major factor are patients with chronic pain utilizing the ER for pain relief services on a continual basis. Most are legitimate. Many are not. And that is sad for two reasons.
- Addiction sucks.
- The abusers make it that much harder for legitimate pain patients to be viewed clearly and dispassionately.
Add the increasing amounts of paperwork, and you see a much different ER than you saw just three years ago.
I wonder what changes I’ll be writing about in 2010…..
