One of the most important things I do as an emergency physician is reassure people. True, I occasionally do something that might save someone’s live. I frequently provide treatment to help people feel better and assist in a more rapid recovery from injury or illness. But most of the people I take care of don’t have a serious condition and can go home with little or no treatment. All they need is to understand they will be fine. They need reassurance.
Most people in this situation are glad to have an explanation and happy to be reassured. They are relieved to know their chest pain is not coming from a heart attack. They are thankful to know they don’t have a broken bone or appendicitis.
I get frustrated when I determine that someone has nothing worrisome but he or she refuses to accept my explanation and reassurances. I have found it nearly impossible to satisfy such a patient.
Here are two stories of people who were completely unsatisfied with my explanations and reassurances:
A sixteen-year-old boy fainted after spraining his thumb. The most common reason for someone to faint after a sudden, painful event is what we call a simple faint. There are some bad things that can cause fainting but all of them are very rare in an otherwise healthy youngster. After asking this patient some questions and looking at him carefully, it was clear to me he had just fainted and would be perfectly fine.
I spent quite a bit of time with the patient, his mother and siblings. I explained how I came to a conclusion that he had only fainted and why I felt comfortable sending him home.
As I finished my explanation, the mother put her head down and shook it, apparently displaying some dissatisfaction with what I had said. I asked if there were some problem. She said, “No,” and resignedly added she would take him to be checked by his own doctor.
At this point, the sister got upset and angrily said if the patient left and became “comatose or died,” she was “going to come and get” me.
The brother then became irate and hollered that this was a “charity hospital and no one is going to do anything for you here.”
I tried to discuss the situation with these family members but they were not interested in any more discussion. They all stormed out without waiting for their discharge papers.
Nausea, Vomiting and Diarrhea
A fifteen-year-old boy came in by ambulance with nausea, vomiting and diarrhea. The paramedics had started an IV so I ordered some intravenous fluids and medicine for the nausea. I then continued seeing other patients who had been waiting longer and were more likely to be ill.
When I finally got to the room, the patient told me he started vomiting and having diarrhea after eating nachos for dinner. He had looked weak and his mother thought he was going to pass out, so she called the ambulance. However, after the IV fluids and medicine I had given him, he was now feeling fine and had no more symptoms. His examination and vital signs were normal.
I explained to the mother what I found and why I thought her son had food poisoning or stomach flu. I reassured her he would most likely be fine in a day. I promised to prescribe medicine for vomiting and diarrhea in case he needed it at home, and again reassured her that he was going to be fine.
This is my basic speech to reassure people when they have gastroenteritis. Most people are glad to have such an explanation. Not this mother!
As I spoke, she filled with angry indignation. He had almost passed out! How could I just look at him, not do anything and know he was going to be fine? I had not even done any blood or urine tests on him!
I started my explanation over again and reviewed my thinking with her. He was a young, healthy boy who was very unlikely to have anything serious the matter with him. He had symptoms that are really only consistent with one of two minor, self-limited illnesses. He had a normal examination and vital signs. He had responded to the treatment he got and was feeling and looking fine.
The more I explained, the madder she got. She was just not going to believe that her son, who almost passed out, could be sent home without any tests being run. I asked her what tests she would recommend running. Of course, she had no idea about what tests one might run and the fact that I asked her just seemed to make her even madder. If I had done some sort of tests and told her they were normal, she would have been happy. The irony completely evaded her that she would have had no idea if the tests were really able to find any problems in a patient like this.
At this point, she refused to talk to me. I asked if she had any other questions or if there was anything else we could do for them. She didn’t reply and fixed her steely gaze on the wall behind my back.
The patient did have a question but when he tried to ask me, she told him to just shut up. He tried again and again she told him to shut up and not say anything as they were going home.
I told her the nurse would bring the prescriptions. She said she didn’t want any prescriptions. I told her they were coming anyway and she could do with them what she wished. They left without the prescriptions or discharge papers.
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