20 August 2010

Friday Flashback - A Plea

To whom it may concern:

IF: you are a patient who has a complex ongoing medical problem, for example: cancer for which you are being treated; a major surgery for which you have had a series of awful complications; a recent transplanted organ; or some extremely rare genetic condition,

AND IF: your treatment is being coordinated by doctors at The Big Hospital Downtown

THEN: please, please, please for the love of God, do not come to my ER.

It's not that we don't want to see you. We would love to, but the fact is that we will not be able to care for you properly at our hospital, so don't come here. It's that simple. We are not bad doctors here, nor are we unused to to complex patients. Believe me, we have lots of cancer patients here, and our surgeons have lots of complications of their own, etc, etc, etc. But your doctors are not here. And your records are not here. I may not be able to get your records, and even if I do, it will take me hours and I will probably not get everything I wanted. Your care will be delayed and possibly harmed. And I may have trouble reaching your doctors because I don't know the secret access number to the paging services at The Big Hospital. And even if I am able to get your doctors on the phone, they don't know me, which means they won't trust me. They may assume that I am an idiot (a common prejudice towards community docs by academics), in which case they won't listen to a word I say. They may think that I am trying to "dump" a problem patient back on them, in which case they will resist any recommendation that I transfer you back to their hospital. Worse, they may actively try to "dump" a difficult case on us by refusing to accept you back. (It's funny how doctors' sense of "ownership" of a patient diminishes when the patient shows up at a distant hospital.) Or I may just get a resident who doesn't know you and doesn't give a crap; it's hard to get an academic attending on the phone at 2AM. And what's more, if the doctors at The Big Hospital Downtown refuse to accept you in transfer, it's also possible that my specialists here will also refuse to take you on as a patient. They aren't supposed to, but it is predictable that they will tell me that you should just "go back Downtown." And then you, and I, are stuck in the middle with nowhere to go.

So don't come here. If you think you are getting worse, get in the car and drive yourself back to the Mecca where you were treated. By the way, that means don't call 911 for convenience of transport. They will ignore your protestations that you want to go Downtown and take you to the closest hospital, because they don't want to be out of service for an hour and half driving to the next county.

This is all assuming that you are not experiencing a true emergency. If you have sudden trouble breathing, or collapse, or have some other true, acute problem, then we are here for you.

Otherwise, don't come to my ER.

Thank you.

Originally Posted 17 December 2007


  1. This is my favortie post of yours of all time, especially now that I work in a big community hospital outside a city with not 1 but 3-4 meccas

  2. EMS may not be able to legally transport them to anywhere except the closest ER either. Just saying.

  3. I have to totally agree. Had to call 911 a few times when I was caring for my father during his lung cancer and each time he was going to the ER in the hospital that was treating his cancer. End of discussion, they tried to play lawyer and i told them if they want to play Perry Mason then join a theatre group.

    It never got so bad that I would have told them to put him in my car, but I would have. I can get to the ER faster than the Ambo drivers.

    I think that a lot of people seem to think that medical records are instantly available (thank suck ass prime shows revolving around doctors).

  4. Hell, our paramedics will drive patients across state lines at their whim. I've often thought I'll call 911 and ask to go to a hospital in Las Vegas next time I feel the need for a vacation.

    Seriously, they've brought us simple back pains from 30 miles away. It is amazing, past 5 or 6 other hospitals.

    Another favorite, along with the patients receiving treatment for a chronic or serious condition is the pelvic pains who were seen last night at a different ER but decide to go to a different ER for follow up. Its always a pelvic pain.


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