Feeling Dismissed

I had a patient who presented to the ER with an episode of chest pain 24 hours prior. She also experienced an episode of severe nausea and sweating, which is consistent with a vasovagal response. Sweating and feeling warm in this context do not indicate a fever.

While we were discussing her many symptoms, the patient’s daughter mentioned that her mother had pain in her foot and that her toes were reportedly black. I examined her toes and noted some discolored nails, but there was clearly no new issue with her feet. Both feet were the same color and temperature; there was no evidence of infection, trauma, or other abnormality. However, the daughter seemed perturbed by my dismissal of the toe concern.

This situation is similar to taking your car to a mechanic and mentioning various issues. The mechanic may not acknowledge every concern, such as a rattle or noise, because they triage your information and dismiss what is irrelevant. In this case, whatever was happening with the patient’s foot and toes was clearly unrelated to her other symptoms.

It’s common for patients to feel offended when an ER doctor dismisses a minor detail. It should be noted that it’s acceptable for patients, their family, or friends to bring up such concerns, as they may not know what is actually relevant to the most pressing condition at hand. However, once discussed, patients, family, and friends should be willing to let it go. If the ER provider does not pursue further questions or discussion, it’s likely safe to assume the issue is unrelated. It’s okay to ask for clarification, as the doc may not feel the need to address every symptom. For the sake of everyone’s time and efficiency, many comments are often left unaddressed.

Before the visit was over, I recognized my mistake and apologized for dismissing the “black toes.” However, I’m quite sure this was not the first or last time I will ignore something, forget to address it, and leave someone feeling dismissed.

You should not be more concerned about your symptoms than your ER doctor.