Brandt's Rants
2017; Lippincott Williams & Wilkins; Volume: 39; Issue: 11 Linguagem: Inglês
10.1097/01.eem.0000526867.68930.06
ISSN1552-3624
Autores Tópico(s)Health Sciences Research and Education
Resumoevaluation: evaluationFigureWe were taught on the first day of med school to ask open-ended questions to allow patients to tell their own stories. This works for the vast majority of patients, and most veteran EPs start here. This technique only works, however, in sane patients. As most readers know, the ED is the best place on the planet for interesting stories, and open-ended questions sometimes lead to interesting but useless information. Don't get me wrong, I'm not advocating against such questions. It's just that sometimes taking my patient's histories sound like listening to a drunk friend explaining a weird dream. It obviously made sense to them, but confusion seeps in during the retelling. Friend: OK, I was in the attic at my mom's old apartment complex, but it was also a submarine. You: Uh-huh. Friend: And the cat I had when I was in kindergarten was there, but the cat was also my brother wearing a Gumby shirt for some reason. Oh, and he was a mermaid. You: Right. Friend: And then my piano teacher's cousin burst into flames, but it was fine because we were playing Guitar Hero at the time. You: There is a point here, right? And like the insane stories I get from my patients, the answer is no. No, there is no point. I enjoy listening to my psychotic-acid-tripping patient maniacally yammering about his feet burning after he tried to perform a barefoot rain dance in his garage after pouring Drano on the ground. Unfortunately, trying to pry that story out of him in less than 40 minutes requires several interruptions and focused, not open, questions. The ED occasionally feels like a battle of logic in a world where common sense has not only died, but has also been autoclaved to ashes and is snorted by whiny teenagers. Stoned Teenager Dude One: Whoa, dude, have you tried this logic? Stoned Teenager Dude Two: It's like totally a rush like I've never experienced! When Questions Fail Am I being ridiculous? This is where I'd normally go into a top 10 list of infuriating behaviors of irrational patients. Instead, I will turn this into a reverse rant, and give you my worst nightmare, all of them combined. Another case where open-ended questions might not be the best choice. Me: Hello there, Jimmy. What brought you to the ED today? Jimmy (staring at his phone): Huh? The ambulance. Me: Ah. Can you tell me what happened? J (still on his phone): It started after my brother and I finished racing. Me: And that was...? J: Go-karts. It was go-karts we were racing. Me: Right. Tell me more. J: It was like a minute ago. And he had the General Lee out, since we got the governor off it so—” Me: A minute? J (dramatic sigh, followed by angrily putting down phone and actual eye contact): About two weeks. Then it went away, but it started up again. Me: What went away? How long has whatever it is been going on? J: A minute. Me (trying to remember policy about not throttling patient): Did you take anything for it? J: Yeah, I took the round white pill, and then I tried the blue one. Didn't work. Me: So are you here for an accident or pain? Which pills? I'm still somewhat lost on—” J: It's all in the computer. Me: Why you're here is in the computer? J: Should be. I was here earlier, but I left. Me: ... J: I mean, I was hungry, and the nurse was taking forever with her “coding” or whatever. Me: A patient was coding? That means they were dying. J: Well, yeah, whatever, so was I without my sandwich. Me (inhale, pause, exhale): It says here that you've had chronic back pain for years. Have you tried losing weight or physical therapy? J: No, they don't work. Me: So you've tried them? J: Why would I try them if they don't work? Me: Any fever? J: I was 98.9, but I run low, so that's a fever for me. Me: Right. J: Anyway, are you going to get the IV going or what? I'm a hard stick, probably since I hate needles so much. Me: You have 17 tattoos. How can you possibly— J: And the nurse still hasn't even come back with my meal tray. I asked for a Sprite like an hour ago. Me: You've literally been here 22 minutes. J: Yeah, well, I guess that's just your opinion, man. You do know my allergies, right? Me: No, but I'm pretty sure I can guess. All right. I'll stop before you claw out your own eyes out from remembering your own Jimmy. Maybe I'm being a little hard on open-ended questions, but you get it. When facing a Jimmy, remember to focus the laser of questions on the pertinent facts. I'll readily agree that this technique should never be attempted by med students and probably not by interns either. If that doesn't work, maybe sit back and enjoy a nice crazy story about your ex-landlord and his Wookiee.
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