14 February 2006

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.


  1. #4 is why I am not an ER doc - or an adult doc for that matter.

    #15. Patients will always identify their medications by pill color, sometimes by side effect, and unusually by name.

  2. Shadowfax,

    I hope like hell that the following is not truly a rule of emergency medicine. It's just that the ED docs in my community seem congenitally incapable of saying the words "YOU DO NOT NEED TO BE HERE", to the non-emergently ill patients.

    What would happen if you did?

    I'm doing my best to keep the non-emergently ill away from you. I could use a little help.



  3. You left out the classic "I was just minding my own business when 2 dudes..."

    It's the law of 2's

    2 beers
    2 dudes

  4. Long-time reader, first-time poster. Love your stuff.

    The first of your ER Laws sounds an awful lot like a passage from David Simon's book "Homicide: A Year on the Killing Streets." (You may recognize the name; David Simon is the creator of the HBO show "The Wire").

    This classic passage is used to describe the work of a homicide investigator trying to get a kid to tell him what happened to the gun that accidentally discharged and critically injured his brother:

    "It is a God-given truth: Everyone lies. And this most basic of axioms has three corollaries:
    A. Murderers lie because they have to.
    B. Witnesses and other participants lie because they think they have to.
    C. Everyone else lies for the sheer joy of it, and to uphold a general principle that under no circumstances do you provide accurate information to a cop."

  5. From the paramedic side, here is my law:

    The size of the patient will be inversely proportional to the size of the bathroom they code in, and directly proportional to the number of stairs you have to carry them down.


    The probability that any time you are tapped out for a stroke that you will find a patient with a UTI approaches 1.

    Tap-outs for code-1 "lift assists" usually mean you will return code 3 with an acute stroke.

  6. What a commendable work you have done, with simplest of language. I can’t resist myself to leave a comment and trust me it’s hard to impress me.



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