Things never to do in the ED if you want to be taken seriously

Things Not to Do:

  • Never wear sunglasses in the department (= tinted speculopathy)
  • Never wear a soft neck collar and use a crutch. (+ tinted speculopathy = the Trifecta!)
  • Never bring a soft toy with you unless you’re less than 6 years old.
  • Never bring your mother with you if you’re male and over 18.
  • Never let a relative stroke your head. (excused if you’re intubated)
  • Never let a relative answer the doctors questions for you (again, excused if you’re intubated)
  • Never provide a pain score response ‘outwith’ the requested limits (e.g. 11/10 pain)
  • Never describe diarrhoea as explosive or vomiting as violent.
  • Never claim to have had ‘double pneumonia’.
  • Never claim to have just had ‘a couple’ of drinks.
  • Never make out in the waiting room, or have your partner lie on the ED trolley with you (especially if you’re >50 years old.)
  • Never bring your own word processed medical history with you.
  • Never close your eyes when a doctor examines your abdomen.
  • Never take an overdose in front of another human being – it’s just possible they might call an ambulance and your cunning suicide plan will be undone

Things Not to Say:

  • ‘I have a really high pain threshold.’
  • ‘I fell over in the shower.’
  • ‘I was painting in the nude.’
  • ‘I’m allergic to everything but Pethidine.’
  • ‘I have Fibromyalgia / Chronic Fatigue Syndrome.’
  • ‘I know my body.’
  • ‘I have a pain in my heart.’
  • ‘My Methadone/Diazepam/Oxycodone was stolen/lost/eaten by the dog.’
  • ‘My Chiropracter/Pharmacist/GP receptionist/Healthdirect said I should come here.’
  • ‘I was just standing there minding my own business…’
  • “I need a sick note … preferably retrospective”
  • I fell asleep at a party and when I woke up…

This list will continue to grow, feel free to contribute your own!

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Comments

  1. Finnbarr says

    “Why no, I haven't taken any painkillers for this pain that is my sole reason for presenting. Why do you ask?”

  2. Felicity says

    I'd like to suggest that you never include a decimal point or a fraction in your pain score. Telling me it's 7.35/10 is actually going to make me less sympathetic than if you'd said 1/10.

  3. Abhishek says

    Never turn up in flannel pyjamas because you are too unwell to change, especially if you are a man! (CVA, MI and sexual injuries excused)

  4. Rajiv says

    I think that elderly ladies that put on makeup prior to calling the ambulance fall I to the same category as the positive suitcase sign and the fresh flannelette pyjamas.

  5. Pookers says

    Funny stuff! But are fibromyalgia and CFS still on the list of “possible psychosomatic illnesses”? I was diagnosed with fibromyalgia when it was just beginning to be taken seriously; even if I’ve been misdiagnosed, whatever I’ve got really sucks. Seems a lot of kooks adopted fibromyalgia and chronic fatigue syndrome as their disease sdu jour and cast a bad light on genuine sufferers. Curious about the author’s educated opinion?

    • says

      G’day Pookers,

      I’m hardly an expert on these conditions -- their etiologies remain baffling to me. At some level, all illness is an interplay between physical and psychosocial factors (especially anything that involves pain). Patients with fibromyalgia, or any other chronic pain disorder, can be a challenge to the emergency physician simply because they are chronic conditions, and we are not well equipped to sorting out chronic problems. I’m aware of some interesting theories that fibromyalgia may be a generalized form of complex regional pain syndrome -- another puzzling condition. I’ve also had some satisfying experiences helping people with fibromyalgia where the patient’s expectations of what can be achieved in the emergency department were realistic.

      Good luck and thanks for the comment,
      Chris

  6. says

    Out of curiosity, why should you not say you have Fibromylgia if you do in fact have it? As a legitimate condition with a myriad of treatments, it’s important to mention it, if for no other reason than the drugs you take because of it.

    Similarily, if a patient suffers from Chronic Pain, and presents in the ED with pain that is different, or is out of control compared to “normal” pain experienced, how will the patient be met? I take two narcotic drugs and several other medications to manage my Fibro, my chronic pelvic pain and the ongoing hip pain I suffer from. If for some reason my pain flairs up beyond what my regular medication and my breakthrough medication can handle, am I going to be treated like a drug addict in your ED?

    Thanks in advance for your answers. I truly am interested in what you have to say.

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