I caught myself with a furrowed brow and my arms crossed tightly across my chest. I had stopped listening to the woman’s story as soon as the first words were out of her mouth. I must have looked angry. A slow, dull pounding sensation in my head began growing stronger and stronger until I could not ignore it anymore. At that moment, I realized that there is a part of my job that I hate and will never be able to get rid of…because I’m too good at it.
I hate listening. At least today I did. When you’re so busy in the ED that the extra 3 seconds spent waiting for the new dication service recording starts to feel like wasted time, patients who don’t answer questions and family members who digress begin to infuriate me.
Today we were busy. Every patient who came in was having a heart attack, severe chest pain, difficulty breathing…one young man had a pneumothorax (air in his chest cavity compressing the lung). Nobody was a simple case, and the rooms just keep filling up.
They say the majority of your diagnoses are made with history and physical alone. But taking a history requires a thorough, methodical questioning about symptoms, onset, history, meds, etc, etc. Sometimes you need to ask many questions that seem unrelated to the patient’s presenting problem. When this happens, frequently family members will inturrupt, and try to divert you back to some episode in the past…or repeat what you’ve already been told…they think you don’t believe what they’ve told you. But all they end up doing is sidetracking you, wasting your time and consuming more of their time…and ultimately delaying the blood work, x-ray, EKG or medicine that is going to help their loved one.
When seconds count, I don’t have five minutes to listen to a wife comes in after I’ve started the interview, interrupts me and chastises her husband, “Did you tell her about the time when you…, and the other doctor that said…”
Frankly, unless a doctor has provided documentation of a specific finding (EKG, Lab, Xray, Catheterization, Operative Note)…I could not care less what another doctor thought. I went to medical school to learn to see, examine and evaluate patients in order to come to my own conclusions about the current disease process. Anything short of that is neglegence as far as I see it.
So today was just one of those days. I was sick of listening to stories. Just let me give your mother some beta-blocker to slow down her atrial fibrillation and you’ll all feel a lot better. Next time your mother has a heart rate of 174, please don’t listen to her when she insists on still going shopping. Please don’t just return her to the nursing home and tell them she’s tired. Bring her here, immediately. “But she’s got DNR (Do Not Resuscitate) Orders,” the daughter protests to me. Well, if you want to be sure that they’re carried out, just go ahead and keep taking her out when her heart rate is sky high. She’ll eventually have a heart attack, or she’ll fall and bonk her head and end up with a hematoma in her brain since she’s on coumadin. Either way, it’ll be less work for us since she’s DNR.
Of course I didn’t say any of that. And I listened to everything they had to say, because I knew they needed to get their concerns off of their chest. They don’t realize that after I make a diagnosis and start treatment I won’t be caring for them after they get admitted. They don’t know they’re wasting their time telling me that their mother has been hiding her bananas in her room at the nursing home. But they feel better after they tell me. So I listen.