As the country wrestles with the cost of health-care, and as various media outlets address the role of emergency departments, I thought this little guide-might be helpful!  I pulled it out of my archives from several years ago.  Enjoy!

All too often, I discharge a patient and think to myself, What instructions can I give for this? Sometimes there are problems and questions that don’t have obvious solutions or answers. And in these situations, coming up with something useful for the patient to read at home is, to say the least, difficult. I’ve come up with a few based on some of the enigmas I see at Oconee Memorial Hospital.

Virginity evaluation: The emergency physician has not determined the status of your daughter’s virginity. In fact, the emergency physician does not wish to know the status of your daughter’s virginity. Furthermore, this doesn’t constitute an emergency. Unfortunately, no one has so far developed any simple home kits for making this determination. If you do, please notify the emergency department so that we can refer other families to your product. If you wish to know more about your daughter’s sexuality, try talking to her. If you found her naked in bed with a boy, you don’t need us.

Drug use evaluation: The emergency physician has not performed a random drug test on your teenage son. He has no complaints, is not suicidal, and has no apparent medical problem. This is not a family counseling center. If you want to know if he is using drugs, talk to him. Admittedly, he is a surly, unpleasant, disheveled, and foul-mouthed young man, whose multiple piercings make him look like a Stone Age erector set. But finding out if he is using drugs simply doesn’t constitute what we like to call an emergency. If he isn’t using drugs, be certain that repeated trips to the emergency department accompanied by screaming parents will certainly give him good reason to start.

Whole body numbness: It simply isn’t possible to be awake, walking, talking, and functioning and be entirely numb from head to toe. Admittedly, your ability to overcome the sensation of sharp needles and other painful stimuli is impressive, and may herald a future career with the CIA. For now, however, our physician has determined that the one thing likely to be numb on your person is your skull.

Pain scale overview: We’re sorry that you are in pain. We have attempted to evaluate your complaint fully and treat it appropriately. By now, we feel your pain also. But it is apparent that you don’t fully understand the system we use called the pain scale. On a scale of zero to 10, zero means no pain. This actually happens, believe it or not. Every day, millions of people wake up, work, go home, play, and do everything else without pain or the use of narcotics. It sounds spooky, we realize, but it happens.

A 10 on the pain scale, however, means the worst pain you can possibly imagine. Because this can be difficult to assess, here is a list of 10 very painful things with which to compare your obviously impressive degree of suffering: A dental drill through the front tooth without anesthesia; being eaten alive by an extremely hungry shark; having your legs crushed under the wheels of a train; being boiled in water or oil; being dragged behind a truck through cacti while naked; cutting halfway through your leg with a chainsaw; being hit in the face with the butt of a rifle by a well-seasoned Marine; having your hand smashed by a sledgehammer; breaking your leg so badly that the bone comes through the skin; sparring with Mike Tyson. We hope this helps.

Alleged spider bite: In the summer, insects and spiders can be real trouble. Thank you for allowing us to evaluate the faint red mark on your body that you are convinced will prove fatal. The good news is, it won’t! The bad news is, we can’t tell you exactly what species caused it. It probably wasn’t a spider. It certainly doesn’t matter because your only complaint is of said red mark. If you begin to show signs of dying or being dead in relation to this event, please return immediately. Otherwise, remember that insect bites are seldom an emergency. And please wear a shirt from now on.

Fight with significant other: Please know that we understand your situation. We all have fights with spouses, boyfriends, girlfriends, and the rest. It’s part of what we like to call life. It’s unfortunate that your event was so earth-shattering that it required an ambulance to bring you to the emergency department. But it has become evident that you suffered only emotional scars. You may have passed out, but in the good old days, doctors simply referred to this behavior as hysterical, whether it involved a man or a woman. The bad news is that we have no control over your relationship, and really have no interest in being involved in it unless you are actually injured by someone. If you look outside the hospital, you’ll notice the striking absence of any sign that says Jerry Springer Show. So please, take your drama somewhere else. And, by the way, this doesn’t constitute what we like to think of as an emergency!

Confused or weak nonagenarian with dementia: We appreciate the love that you obviously have for your family member. Thank you for trusting us to care for them. But just take a minute and ask yourself: When I have dementia and I am 90 to 100 years old, can I expect to be weak or confused? The answer, dear friend, is yes. So treat grandma or grandpa with love and respect, keep them happy and comfortable. But don’t expect them to take up jogging or web site development as hobbies.

Insomnia: The inability to sleep is very frustrating. We in the emergency department are familiar with this problem. In fact, we may be awake right now when we would prefer to be asleep. (We also may be asleep, but appear to be awake.) As frustrating as your insomnia is, two facts remain. It isn’t an emergency, and being in the hospital after midnight is not going to increase your chances of slipping off to dreamland. So run along, and stare at the ceiling at home. If you go home now, one of the nurses will call and sing you a lullaby.

Get out of jail free card: Thank you for the opportunity to evaluate you on the way to your incarceration. It makes us feel part of the criminal justice system. Unfortunately, you have not exhibited any symptom that might keep you from your just rewards. If your complaint was chest pain, it isn’t your heart or anything else dangerous. If your complaint was seizure, please practice more, as your attempt was substandard. If the police brought you here because you are intoxicated, we apologize. They obviously underestimated your capacity for surviving large amounts of alcohol. At any rate, you are good to go! Enjoy your well-deserved rest at public expense. Hopefully, you’ll learn your lesson this time.

I think I have something I read about on the Internet: The Internet is a wealth of knowledge. Your willingness to research your symptoms via computer is very self-motivated. But remember, just because you read about it doesn’t mean you have it. And just because it says that our physician should give you a particular drug for your supposed illness doesn’t mean she will. After all, the computer can’t actually see you or touch you. And the computer didn’t go to medical school. We have examined you, and we believe that you do not have the illness you are concerned about. So surf the web if you like, but look at something more interesting than medical sites.

The emergency department menu: Your doctor may have suggested you need a powerful narcotic, or your friend may have told you that you need an antibiotic, but no one told us about it. You may have decided you need a prescription weight loss medication. Your wife may have told you to get some Viagra. (Ouch!) But the point is this emergency department doesn’t have a menu. Don’t look for it because it isn’t here. And the doctors and nurses aren’t waiters. So the bottom line is this: we aren’t giving you what you want. And you didn’t have anything approaching an emergency. The administration office opens at 8:30. You can lodge your complaint then.

My nerves are shot: We’re sorry that life is overwhelming. But because you don’t appear to be a danger to yourself or to anyone else, you’re going to have to leave to make room for sick people. Hopefully, your anger at our department for failing to admit you for a much-needed rest will galvanize your will and give you something to live for. And to add to your anger, your life stresses are not actually an emergency.

Pre-litigation physical: Your motor vehicle accident sounds as if it were horrible. Having spoken to the paramedics, it is obvious from the lack of damage to your car that all of the impact was transmitted through the frame of your vehicle, up into the upholstery of your seat, and directly to your neck and back. The problem is, this is not possible. You have not been injured. But cheer up, that hasn’t stopped anyone else from getting a multi-million dollar settlement!

Work excuse: Boy, wouldn’t we like to stay home from work because we partied too late! It’s admirable of you to develop a bizarre and physically impossible series of medical complaints to obtain a work excuse. We respect your willingness to continue contributing to society by actually working. In fact, it puts you a notch above some of the folks we see whose main goal is avoiding work altogether. However, the answer is no. Several of us feel horrible today, and a few actually had to care for sick, crying children all night before coming to work. But hey, here we are! Next time, just be up front. I’m here because I need a work excuse. You might actually get it! By the way, this wasn’t really an emergency, was it?

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