Frustrated, incorporated

How’s that for a 90s shout-out to Soul Asylum? In all seriousness, it’s a fairly accurate description of a recent ER shift I recently worked. All the examples listed below are true stories. They are frustrating. They are perfect examples of people not claiming ownership of their own well-being. This is a reminder that we are all still responsible for our own individual health care.

The night started by seeing a sweet older lady that spends 6 months of the year in the warmer climates of the American south. She has good health insurance coverage for the half year she’s abroad. Last week she was walking with the assistance of her Zimmer frame (colloquially known as a “walker”), but a few days ago, she had more difficulty and pain and couldn’t get around as well. This prompted her to visit her local American hospital. In true American fashion, they ordered every test under the sun except for a prostate test. Specific to her situation, they had performed x-rays and even did a computerized tomography (CT, or “cat” scan). So when asked what the American doctors discovered, her answer was she didn’t know. She hadn’t paid attention because she had decided to return to Canada. Her son picked her up from the airport and drove her straight to the Emergency Department in her Canadian hometown. Fortunately we were able to get a diagnosis with not having to do as many tests, but the entire visit could have perhaps been avoided all together since she received a full work-up south of the border.

A few patients later, I met a pleasant lady who had called an ambulance because she was having a bad headache and saw that her blood pressure was very high. After speaking with her, I learned that a few months ago she decided on her own to stop taking her blood pressure medication, against the advice of her family doctor. In fact, she had called an ambulance and came to our same Emergency Department 4 days prior for the exact same complaint! According to the notes of her treating physician for that first presentation, they spent a good deal of time making sure it was in fact just high blood pressure not being treated. There was quite a thorough work-up. He prescribed her one of the blood pressure medications she was no longer taking and recommended she have a follow-up appointment in 2 weeks to gauge how her blood pressure to the re-introduction of the medication. As the story unfolded, she actually didn’t start taking the medication again until the evening that she came back to the Emergency Department. Coincidentally (or not), as we kept an eye on her vital signs, her blood pressure began to come down to a safer level without us having given her anything at all – she had already started the treatment by finally taking the medication she was supposed to have been taking all along! The visit could have been avoided all together had she resumed the medication as recommended to her when she was seen 4 days ago, or better yet, if she had not stopped taking her medications to begin with.

The final example in this edition of the Doctors’ Rant goes along the same theme. A middle-aged gentleman came to our Emergency Department complaining of belly pain. Not an overly unusual presentation except for the part where this same middle-aged gentleman was in our same Emergency Department earlier in the day, and was diagnosed with pancreatitis. This involves swelling of the pancreas, an organ in the abdomen that secretes enzymes, such as insulin. The treatment for pancreatitis calls for pain control and bowel rest. Once upon a time it was common to treat people suffering from pancreatitis by fasting, thus allowing the inflammation to settle. Nowadays the evidence agrees more with soft light diets rather than fasting. Our middle-aged gentleman opted to have a meal of cheezies, a bologna sandwich, 2 ice cream sandwiches and cookies. Unfortunately, most experts would not classify this as a light or soft diet. This resulted in our middle-aged gentleman having a recurring flare of his abdominal pain prompting him to return to the Emergency Department. This visit could have also been avoided had he adhered to the instructions from the first treating physician.

As you have my surmised, the theme of today’s rant is about Emergency Department visits that could have been avoided had individuals took ownership of their health care, and followed the recommendations given to them at their original visit. I’m not attesting that all advice given by every doctor is absolutely spot-on every time, but when basic instructions are suggested and they are ignored, only to cause further discomfort, the individual should be at least part liable. It’s just a travesty that resources, money and time are wasted on repeat offenders who did not bother listening to the advice to help them take care of themselves.

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