Tuesday, September 16, 2008

Listen and Repeat

Following Shadowfax's post on overuse of the ER, an interesting article appeared in New York Times this morning about ER patient confusion over their discharge orders.

In some ways, I can see both sides of the argument.  I've been in patients' rooms pulling IVs and taking them off the monitor when a harried resident steps in and within 30 seconds or less explains there's nothing wrong, recommends followup with a PCP, hands them discharge orders, asks about questions and leaves.

On the other hand, it's equally if not more common for a patient, in a rush to leave after waiting for hours, to simply tune out the doctor, sign whatever discharge paperwork they're handed, and leave it at the bedside as they walk out.  Patients who don't present with true "emergencies" still often have underlying medical problems that simply can't be fixed in the ER, but many refuse to follow their instructions or make the effort to find primary care - something beyond the doctor's control.  I have trouble seeing how it should become the physician's responsibility to quiz the patient on their understanding after already taking the time to talk with them and providing written instructions.  

Regardless of what side of the argument you fall on, however, I think most people would agree that unlike the woman cited in the article, a diagnosis of PID should be enough to get the patient's attention.

No comments: