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Same Shift, Different Day

Same Shift, Different Day

There Are No VIPs in Triage

Harmon, Stacy MD

doi: 10.1097/01.EEM.0000695624.15465.8e
    triage, emergency department, VIPs

    Patients have questions, and we do our best to answer them. Some of them are easy. A psych patient once asked me, “Are you stupid?”

    But most of the time they ask why? Why did this happen to them? Why are they sick? I tell them we in medicine are pretty good at the what questions but not so good at why. There are few questions that make me uncomfortable. My wife calls me Analogy Boy because that's my usual way of explaining things. But the question that really gets to me is when a patient (ego intact) asks, “Do you know who I am?”

    I have a vague memory of taking the Hippocratic oath during the white coat ceremony in medical school. The oath was modernized, of course. I didn't pledge to serve the Greek Gods to the best of my ability, but it was still a big deal. Some medical schools have the ceremony at the beginning of the first year, others later. It symbolizes becoming a doctor and conveys the tremendous commitment, sacrifice, and dedication required.

    I quickly found out, though, that being a doctor was much more than that coat. I can remember informing a seasoned nurse that one of the patients needed to use the bedpan. She gave me a look that clearly said, are your legs broken? And then she went back to reading her newspaper. Got it. Short coat, long coat, you had to earn your chops.

    Eventually that happens. Putting patients first is really the whole oath in a nutshell and the way to get respect from staff and colleagues. We swore an oath to do whatever it takes to care for patients. Period. The modern version I took said in part: I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other social factor to intervene between my duty and my patient.

    Sickest Go First

    So back to the question. We've all heard it in some form. “Do you know who that is? I just want to give you a heads-up about who is coming in.” Usually it's an administrator's family member or maybe an athlete or a movie star. The implication is that we are going to up our game and give them the care reserved for important people, like pulling out a special bottle of wine or something.

    I can remember young mothers bringing in their kids and picnicking in the waiting room for 12 hours waiting to be seen. As broken as the county system was, they were grateful to get care, from residents no less. But some VIPs expect to cut in front of people like that and then later cut a ribbon dedicating the new hospital wing to the underserved.

    Lady Justice is blindfolded and holding a scale to depict fairness and impartiality. Triage is the same. It's not that hard. It's the way we all want it. The homeless guy with urine-soaked socks and chest pain goes before the CEO with a backache. It's not a deli where you can take a number and wait to be treated for an aneurysm. You want to be last in triage; first is not good. Don't tell me you have 12 out of 10 pain.

    You can learn a lot about people in just a few words or with just one question. Go ahead and tell me you're allergic to Haldol, call to ask the wait time, tell me your pain is a 12, or say I should hurry up because your ride is waiting. Tell me you're a VIP. I'll be good to you because I took a vow. I will treat you to the best of my ability, impartially and equally.

    It's time we develop our own slogans for the waiting room to reset expectations. Maybe a poster that says, “Sickest Go First” or “Be Grateful You're Waiting.” Or maybe the new catchphrase should be modeled after that famous line, “There's no crying in baseball,” from the movie “A League of Their Own.” The ED's motto should be, “There are no VIPs in triage.”

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    Dr. Harmonis an emergency physician at Marian Region Medical Center in Santa Maria, CA.

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