08 January 2010

Friday Flashback

The Laws of Emergency Medicine
There are a number of indisputable tenets of Life in the ED. Some are inherently obvious, such as "Unspeakable evil will befall us should anyone utter the "Q" word." (That would be "Quiet" for the non-medical folks.) There are, however, a number of other fundamental principles which any experienced emergency provider can attest to. I have assembled some here for your education and edification.

  1. The Patient will always lie.
  2. (Corollary to #1) If the Patient is unable to lie, the family will do so for them.
  3. If you allow them to, the Patient will likely hurt you.
  4. Never, ever, under any circumstances, take off the shoes.
  5. Never start a shift with an empty stomach or a procedure with a full bladder.
  6. Multiply the stated amount of alcohol consumed by two (by three on weekends).
  7. The room where you perform a rectal exam will never have hemoccult developer.
  8. The word "stool sample" cure diarrhea.
  9. Never stand when you can sit.
  10. If it looks like a donut, eat it.
  11. Don't fuck with the pancreas.
  12. The likelihood the pregnancy test will be positive is directly proportionate to the intensity of the patient's protestation that she cannot possibly be pregnant.
  13. The probability of *any* patient having an acute medical problem varies inversely with the number of patients checking in together.
  14. The most dangerous diagnosis an ED patient can have is "Just Drunk."
  15. Every patient who comes to the ED has this common goal: to find a way to die on you and make you look bad.
And I hate looking bad.

Feel free to propose additional Laws in the comments.

Originally posted 14 Feb 2006


  1. A little more ambulance based but
    1:The number of complaints a patient presents with is negatively proportional to the likelihood of any one of them
    actually requiring emergency treatment.
    2:No genuine call ever originated from a pay phone.
    3:Dont pet the dog that "never bites".
    4:When the Pt says "the baby's coming", believe her.

  2. Can you explain number 13 for those of us outside of medicine?

  3. If a patient comes in with 13 family members, they're all hypochondriacs, with a side order of acute anxiety, and a large helping of crayzee. They obviously had time to do the phone tree, call everyone over, and THEN go to the ER... A true EMERGENCY does not leave time for that kind of people-gathering.

  4. that's not quite right. It means that when 3 family members are all checking in together (ie Mom and three kids- "I just want to get them all checked out"), there is a far less probability that any one of them is actually sick.

  5. Anyone with more than 3 allergies listed on their chart is weird.

  6. Great list! I especially love (from my GI Surg/ICU background) - "don't fuck with the pancreas" - that is one *seriously* grumpy organ with the ability to eat itself. Not cool.

  7. 1. Discount any complaint from a patient that lists Irritable Bowel Syndrome or Scleroderma on their intake form.

    2. The facial laceration is never as bad as it initailly appears. Wash it out, close it in layers, line up anatomical landmarks. It will end up looking good. Trust me, and don't call me.

    3. Acute flexor tenosynovitis is as much of a surgical emergency as acute appendicitis

    4. The 3 biggest lies in medicine: The check is in the mail. It was dry when I closed. I won't c@m in your mouth.

  8. 1: All hypochondriacs eventually die of real disease

    2: fibromyalgia in a medical history, write you own rule here.

    3: If you have to consult with 3 people to convince you why the patient doesn't need to be admitted, they need to be admitted.

  9. Radiology is where patient's go to code.

  10. 1. the "code" at the beginning ot the shift will always stay dead. The code at the end of the shift will somehow require hours of resuscitation and start to make it and make you late.

    2. consultant specialist: the special ability to give bad advice over the phone with confidence.

    3. those complaining about the wait the loudest and most vulgar are usually not sick. The quiet dude in the corner slumped half over is getting ready to die.

    4. the consultant you call the least is getting paid the most.

    5. Don't F*** with the Lupus, ESRD, on steroids. They have something bad going on -- you just don't know what it is yet.

    6. If there is a real serious radiology discrepency that needs follow up the patient will have given a wrong phone number.

    I don't know why someone above poo pood scleroderma. That can be some real pathology and was the basis of one of my most nightmarish intubations ever

  11. The patient who is unhappy with the treatment she received from her last six doctors won't be happy with you, either.

  12. Re: Clown Car 'o Patients:

    I think I talked about it on my blog, but one time, a quiet, demure 20-something girl went to the ER with her mom in order to get "checked out" since her mom was going anyway...the mom was fine, but the tagalong girl had acute cholecystitis. I thought it was the first sign of the apocalypse.

  13. "Radiology is where patient's go to code." Struck a bell from my oral boards -- so afraid of that scenario, I took all my patients room to room to avoid having any patients out of sight. I had 3 triples and just had the nurses bring the gurneys into the same room as the new patient. Examiners were not happy with me, but it worked -- no one was out of my sight!!!

  14. The amount the patient is worth to his/her community or family in terms of plain GOODNESS and contribution, the worse the diagnosis or outcome.

  15. If you walk in the room and Jerry Springer is on it's going to be a long shift....

  16. Really funny stuff.

    #11 totally confuses me. Could you please elaborate.

  17. My law: Coumadin and the nursing home patient DOES NOT mix well.


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