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After the Match

After the Match

If It's in the News, It Won't Happen to You

Cook, Thomas MD

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doi: 10.1097/01.EEM.0000470683.49348.7e

    A few years back, the news was all about flesh-eating bacteria. Stories surfaced about a small number of people who died from necrotizing fasciitis, and one happened to be a young guy living in my hometown of Columbia, SC. Soon after, everyone with a rash came to the ED to make sure it wasn't that flesh-eating stuff. Parents lined up to ignore our opinion that it was not serious and to demand antibiotics (not realizing antibiotics caused these rare flesh-eaters in the first place).

    Recently on an evening shift, we were taking care of a teenage girl with pleuritic chest pain. It was her second visit that week, and her mother was demanding and anxious. We eventually did x-rays, blood and urine tests, an ECG, and even an echocardiogram and chest CT. All normal.

    This still did not make the mother comfortable. “The previous doctor we saw here told us that if she did not get better, we should come back so she could be admitted.” Of course, the previous doctor was one of my interns. Even though she had come for our opinion and received an extensive workup, she clung to the idea that we were overlooking something. She wagged her finger in our faces. “What if something terrible happens to her tonight? Are you sure you know what you are doing?”

    How do you talk someone off this cliff of anxiety? Despite our best efforts to inject reality into the discussion, she clung to her fear and the interaction ended tensely. Situations such as these are common in our job, and learning how to manage and deal with the frustration they cause is a part of becoming an emergency physician.

    Every day, the media tell us about incredibly rare ways people have been maimed or killed. Last year it was Ebola. The United States has seen four cases with one death. Preventing the spread of the disease is necessary, but you would think thousands of Americans were going to die if you watched the news at that time. My hospital spent millions to provide quarantine areas in the ED, buy special equipment and protective gear, and train personnel on proper decontamination techniques. None of it has been used.

    Common Causes

    But what choice did anyone have? If you were the unlucky hospital (or emergency physician) taking care of the first Ebola patient, you were skewered by the press for missing the diagnosis of a disease that had never been seen on the continent. I'm surprised they did not hang the emergency physician, but you can be sure he will be in court. (Seriously, I would have missed the diagnosis, too.)

    All of this overlooks the most common causes of unexpected death in the United States, however. Every day, 110 people die in car accidents, 57 from self-inflicted gunshot wounds, and a whopping 44 from prescription drug overdose. But you can be sure you will not see anyone stop driving their cars (while texting, no less) or asking for pain meds. If I could tell the mother of the young girl with chest pain what to worry about, it would be to teach her to drive safely, secure their firearms, and lock up their pain meds. These are way more likely to cause the tragedy she intensely fears.

    The bottom line is human beings are irrational and natural worriers, and our unique gift of communication fans the flames of panic. If the story involves sharks, large snakes, lightning, terrorist attacks, tornados, child abductions, or any other number of incredible events that are almost entirely viewed in movie theaters, we cannot wait to worry about it. But if we are advised to alter the activities in our day-to-day lives of convenience so that we may safeguard our future existence, it will be a hard sell to get us to change.

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