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Life in Emergistan


A Little More of the God's Honest Truth

Leap, Edwin, MD

doi: 10.1097/01.EEM.0000554299.09394.a7
Life in Emergistan



A patient came to my ED complaining of anxiety-like symptoms after using methamphetamine. He was young, he was shaky, but in the end he was fine. He told the nurses that his girlfriend was about to have their son.

In my discharge comments, I wrote this: “Get your life together, and for the sake of your child, stop using drugs.” I felt good about that. And when I said it to him, he nodded assent. “You're right, doc. I need to do that.”

Maybe it's the father in me. Maybe it's the husband. It could be all the gray in my beard. But there are times I say things like that. Not very client-friendly, but I truly don't care.

We often discharge our patients with dozens of pages of detailed, carefully crafted and chosen instructions about whatever complaint brought them to the hospital. I frequently struggle to find the right set to give them because their complaints are often unclear. All too often the final diagnosis bears little resemblance to the initially-stated problem.

Nevertheless, I strongly believe in discharge instructions. It's important that people have some information to help guide them, not only as reassurance but in case things change. (To the extent anyone reads them.) I even send instructions with my AMA patients, as I think one should.

As the entire world of medicine settles around our shoulders with a thud, however, I fear that much of what our patients need is a little less technical education and a little more of the God's honest truth.

Here's an introductory list of discharge instructions I think we need to consider. Do not under any circumstances run these past legal. You know what they'll say.

Chief Complaint: 53-year-old woman intoxicated, vomiting. D/C: You were very, very drunk last night. You were also obnoxious and threatening. Alcohol is not your friend. Avoid it. Really. We mean it. Drunk is not a good look on you.

Chief Complaint: 22-year-old man, burning with urination. D/C: Your recurrent sexually transmitted infections are directly caused by having unprotected sex with lots of different people. Pick one and be faithful. Unless you think herpes sounds fun or are keen to die from AIDs or syphilis.

Chief Complaint: 60-year-old man with bump on leg, one hour. Saw spider in house. Brought via EMS. D/C: You were brought to the ED by highly trained paramedics who are an essential community asset. You were not in any way having an emergency that was worth the cost of an ambulance crew or worth making them unavailable to those who are really sick. Next time, ask a friend to bring you or call Uber or a friend. P.S. It's not a spider bite.

Chief Complaint: 18-year-old man assaulted in bar by two other patrons after verbal exchange (per law enforcement). Facial swelling. D/C: Your facial CT scan shows no fracture, and you can go home. Take ibuprofen, apply ice, and learn to keep your mouth shut. Otherwise, some dudes will eventually send you back to us with a knife sticking out of something. And don't insult anyone's girlfriend, boyfriend, favorite stripper, or dog. Didn't your daddy teach you anything?

Chief Complaint: 4-year-old brought by mother for fever. No antipyretics given. No other complaint. 3 a.m. (Has appointment in morning with peds.) Child running around room, opening drawers. D/C: Your child appears to have a viral upper respiratory infection. It's winter, and it's dark and nighttime is dangerous. If the same situation returns, please consider treating your child's fever and going to your pediatrician.

Chief Complaint: 35-year-old woman with wart on toe. Here with sister who has cough and brother who needs work excuse for being hung over. States: “I figured I'd get seen too.” D/C: Your wart needs to be evaluated by a dermatologist or family doctor. We don't remove them in the ED. Furthermore, it's a hospital emergency department. Watch Netflix for entertainment. You'll be shocked at the bill from this visit. No, you can't have a work excuse.

Chief Complaint: 48-year-old man, drove to ED, cellulitis not better. Didn't fill antibiotic prescription. D/C: We told you where to get the prescription for free. Free. How hard is this? If it isn't worth your effort, it isn't worth mine.

Chief Complaint: 40-year-old man, needs work excuse because he is a single parent with a sick child. (Verified that the child was seen earlier in the day.) D/C: Thank you for your honesty. Here's your excuse.

Chief Complaint: 8-year-old girl, anxious, can't sleep, holding iPad and iPhone. D/C: Dear parents, your child doesn't need a cell phone; she needs a book. And for you to actually talk to her!

Chief Complaint: 25-year-old woman severely assaulted by ex-boyfriend. D/C: You have a broken jaw. See oral surgeon. Take pain medicine as prescribed. Nobody deserves this. If he did it once, he'll probably come back.

Chief Complaint: 4-month-old with cough and dyspnea. Mother states: “I've tried for five days to get an appointment with his doctor.” D/C: Croup. You come back any time you're worried. No problem.

Chief Complaint: 90-year-old man, anxious. Wife died yesterday. D/C: Grief reaction. Return as needed for hugs from staff. No need to check in; just tell the triage nurse what you're here for and someone will come out.

And that's how we start to educate our patients. I mean, customers.

Dr. Leappractices emergency medicine in rural South Carolina, is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available, and Working Knights, Cats Don't Hike, and The Practice Test, all available, and of a blog, Follow him on Twitter @edwinleap, and read his past columns at

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