Some new, important screening questions for the EMR

Scrolling through FEEMRS (you know, Fancy Expensive Electronic Medical Records System), I was stricken by just how much data is on the chart.  I mean, it’s pretty dang amazing.  But I was, simultaneously, reminded that most of it doesn’t help me.

It helps someone, mind you.  For instance coders and insurance companies.  The complexity of EMR also helps those who track our car to door, door to chair, chair to chair, chair to bed, bed to bathroom, bed to X-ray, request to blanket, request to sandwich, request to TV remote, request to ice chips, complaint to Dilaudid and discharge to angry times.  (The really important stuff!)

But so often, FEEMRS just gets in my way.  I mean, I struggle to find little things like triage information, medications or last menstrual period. And as for visual acuity?  Faggettaboutit!

However, I do think there are some things that might be useful screening questions.  So, here are a few things I think we should have the nursing staff ask on the way into the ED.  I mean, we always ask about drug abuse, interpersonal violence, immunizations, sexual activity, whether or not the withered 98 year old has lately traveled to any Ebola infested exotic locales.  But is it really enough to know if the newborn has stopped smoking? Or are there other more interesting things with which we could further clutter the hallowed screens of our FEEMRS?

I hereby suggest:

What is your preferred pronunciation of the only pain medicine that ever worked for you?  With what letter does it begin?  (Incidentally a patient recently pronounced their favored drug ‘Laudy-dah.’  Awesome.)

What unfortunate thing has lately happened to your medication?  Eaten by dog, stolen by neighbor, smashed by meteorite?   Hey, it could happen…

Is there some species with which you identify and would prefer to be treated as?  Because if so, we may need to call a vet. Or tree surgeon.  (It’s no joke.  Tree-kin is a real thing…I mean, ‘real’ thing.)

First thing that pops into your mind when I say ‘outstanding warrants.’  Go!

What is your favorite kind of sandwich to eat while waiting on your psychiatric commitment.  Just kidding. We have Turkey.  (It’s empowering to offer a choice even if we really don’t have one.)

This is to be asked immediately on arrival into triage.  Right now, how long do you believe you have waited to be seen? One hour, two hours, three hours.

Do you know the patient advocate’s name and phone number?

For abdominal pain:  Please tell me what kind of cheeseburger, chicken sandwich or friend food you have consumed on the way to the ED, and when you finished….oh, you’re still eating it.

This is very useful and instructive: Why are you on disability? With a few mental health exceptions, if it isn’t evident in triage, it will be a good story.

How many times have you been committed to a state or private psychiatric hospital? If the number of suicidal commitments is greater than ten, patient can probably go to the waiting room.  Especially if eating cheeseburger and suffering from simultaneous abdominal pain.

Is there a particular physician you would like very much to see or not to see? Or want to hurt?

Full disclosure.  What are you here to get, and if you had it, you wouldn’t be here at all?  For instance, work excuse, pain medication, etc.

Who told you you should come to the ER, if anyone:  your physician’s office, your attorney, a police officer, your sister’s best friend who is a CNA at a nursing home, or a 24-hours health line?

Do you find it difficult to stop playing video poker on your phone while talking to a clinician?  

Will you please eat these chips and fill out my satisfaction survey while waiting to come back?

Just scratching the surface.  Send me some of yours!

edwinleap@gmail.com

 

5 thoughts on “Some new, important screening questions for the EMR

  1. How many warm blankets?

    Chocolate or butterscotch pudding?

    When a young man comes in w/a friend (usually he’s trying to get pain meds) and they don’t appear gay, ask if it’s OK to talk in front of their partner and watch the room explode w/2 men trying to get as far from each other as possible. It’s my favorite.

  2. No mam’..we do not have an agreement with your family doctor to continue your oxycodone prescription indefinitely

    What part of “NO” do you NOT understand…the N, the O, or the 2 letters together.?

    Did you make your own diagnosis from an article in Readers Digest?…or…do your signs and symptoms match those in any recent article from Readers Digest?

    Why are your taking your sister’s antibiotics prescription, and your nephews blood pressure medication?

    Does your oxygen nasal cannula get in the way of your cigarette?

    Are your two wrist ID bracelets from other local hospitals?

    Is that Greyhound bus outside waiting for you?

    Sir, were you hear yesterday dressed as a woman?

  3. I would love to see a montage of the collective faces we all wear when asking such questions. We have to be good at it, or we’d give ourselves away!

  4. Thanks, Dr. Leap, for your epistle re Christianity in the ER. It holds true in my low income clinic too.

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