27 July 2007

What's in a greeting?

In our community, when we need to contact the police, we have to call 911. This is at the request of the local law enforcement agencies, I think because it makes it easier for them to route the call to the right department (local police, sheriff, state patrol, etc). But it's usually just routine stuff that we need ("Hi, this is The ER, Officer Jones dropped us off a suicidal patient but he didn't leave a report..."), and I always feel bad about bothering them. It's because of how they answer the phone:

"911, please state your emergency."

I love it. It's so direct and imperative. And it is utterly clear: if you do not have an emergency, you should not be calling 911. So even though we are supposed to call 911, I still feel guilty about doing so.

I should adopt this as my mode of greeting patients. Instead of my usual, "Hi, I'm Dr Shadowfax, what brings you in today?" I could introduce myself as "Hi, I'm Dr Shadowfax, what is the nature of your emergency?" It makes the point that we are not the 24-hour medical convenience clinic, but the Emergency Department.

There's no point to it, really. People would just think I'm nuts and be offended and my Press-Ganey scores would go down. Oh well, it is nice to imagine, though...


  1. What a fabulous and completely REASONABLE idea! I think we should push to make it the standard and then no one can point a finger for being "out of step". One could possibly imagine that 911 is simply the reservation line for either the fire department, jail or the emergency room. Doesn't that mean we get to assume people coming to the emergency department are having emergencies?

  2. I tried answering my answering service emergency calls this way for a while and got nowhere.

    The people who don't give a crap just start in with "It's not really an emergency, but I have a question about my roommate's trichomonas."

    And I started scaring some old people who really did need to call to ask a med question or tell me their right arm and leg weren't working great, but since it didn't hurt it probably wasn't an emergency.

    But the couple times it got people to apologize and call back monday was nice.

  3. I always start all my emergency visits by saying "Hi, I'm Dr. I, I understand [name] has an emergency today. What's going on?" Then, when they say "oh, well, he broke his toenail last night and I was hoping you could cut off the broken piece for me," I say "*oh*, gosh, did you realize you were booked in as an emergency? Would you rather just go home and not pay the emergency fee?" and half the time, they do, and they never do THAT again! :) I love veterinary medicine :)

  4. The only time I do that is when the patient starts rambling on about every BM and tingle and itch since 1995.

    "Yes, but what problem is that you believe is an emergency right now?"

    Some look at me dumbfounded and say, "Well, with all this stuff that's been going on, I figured I better come in and get it all checked out."

    That's when you know you'll find absolutely nothing wrong.

  5. I love your idea. It sounds like the medical hologram on Star Trek Voyager - "Please state the nature of the medical emergency."


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