Two Be or Not Two Be
This nurse needs a vacation.
Now!
She is experiencing one of the rarer symptoms of burn-out.
The free-floating Coke bottle visual hallucination.
As long as she doesn’t reach for it, her co-workers will be none the wiser.
The minute her hand rises up to grab the non-existant beverage…well…it may be too late.
So, if you see your co-worker staring longingly into space, parch lipped and glassy eyed, intervene!
Go get them a Coke!
Better yet, a Pepsi! (I can’t stand Coke…)
******************************
It is present in every emergency department.
You don’t see it coming…
…until it is too late.
You’ll want to cry.
You’ll feel like screaming.
It can drive you over the edge on a busy shift.
You can’t control it.
You can’t stop it.
Yes, my friends it is…..
The Two-Fer!
*****
What exactly is a “two-fer”?
The term is slang meaning “two for the doc”. It occurs when someone presents to the emergency room for treatment and someone in the group accompanying the patient decides that they, too, need emergency services.
Right then.
*****
A two-fer can present in various forms:
- The Upfront Two-fer
These patients usually walk in together but sign in as separate patients on the triage sheet. Often, they were in the same vehicle that was rear-ended at five miles-per-hour ninety minutes prior to arrival. Neither of them have any symptoms, but they feel they needed to be checked out because they were in a car accident, after all. Sometimes, a parent will present two children for treatment at the same time because they both have a fever or cough. Pretty straightforward - what you see is what you get.
- The You-Have-GOT-to-Be-Kidding Two-Fer
A few examples will explain this form of the two-fer better than a dry description.
Example: a young female presents with abdominal pain and discharge, bringing along her friend for support. Sometime during the visit, the friend, like, thinks she might, like, have discharge too and like, wants to sign in.
Example: the patient presents with something simple like an ankle sprain. Their bring a posse of friends for support. Sometime during the visit, a friend tells the nurse they have itchy toes and wonders what it could possibly be. Wait…a….minute! They are in the emergency department and there is a doctor there, right? They go to triage to sign in. A seven-hundred dollar case of athlete’s foot.
Not all two-fers are actually comprised of only two patients. This brings us to our third category.
- The Multiple Two-Fer
A two-fer can also come in as a multiple of two. You might have two. Or four. Or six. For some reason it is never an odd number.
It’s the family of six who have that bumper bump and demand that all of them be signed in and seen, even though five of them have no symptoms and the kids are playing and laughing on the floor.
It’s the mother of six who brings all of the children into the emergency department because they all have been coughing for over a week. She wants all of them signed in.
Now, there are some legitimate two-fers out there. The spouse of a patient who develops chest pain. A visitor who develops an allergic reaction while sitting in the ER. These are truly cases of being in the right place at the right time.
But the others? We have to see them all. Even if there are no symptoms, we are required to see every single one of the bumper bumps. Every single one of the kids with upper respiratory infections. Every athlete’s foot and “oh, gee, I may have an STD, too!” person who decides to take advantage of the fact that they happen to be near a doctor.
I once spent an hour triaging six children (from the age of six and down) from one family for something they should have seen a pediatrician for (and yes, they did have one!).
There are really no answers, just observations.
It’s just another form of the system abuse we all see everyday.
But…what is actually broken here? The program or the participants?
That sounds like a good topic for another post.
