The ER and Porn

Lately, I think the ER is, in many ways, the same as porn. Porn overpromises and underdelivers. In a twisted sort of way, the ER does the same thing. That’s not because I think we do bad work in the ER—in fact, I think we do amazing work as we try to solve all the ills of society and all the problems in the medical system that arise when clinics are closed (the vast majority of the time—e.g., evenings, nights, weekends, and holidays). Do the math: If most clinics are open from 8:00 a.m. to 5:00 p.m., Monday through Friday, how many total hours per week are they open compared to how many hours per week they are closed? The majority of the time, we are the only game in town.

This is due to the healthcare system and the primary care system. Every after-hours call line for a clinic tells you to go to the ER. The vast majority of calls to nurse triage lines direct you to the ER. Patients themselves think the ER can fix every possible medical problem. I saw a 90-year-old gentleman yesterday who was in very poor health, with weakness, dizziness, balance issues, and shortness of breath. He made comments in triage that he hoped we could just “figure out what’s going on and get me feeling better.” I know what’s going on: You’re old. You’re slowly dying. You have multiple medical problems, and all of them are slowly getting worse. None of them are emergencies. You’re not dying today, but I can’t turn back the hands of time. You haven’t taken care of yourself for most of your life, and this is the end result. A few hours in my ER, or even a couple of nights in the hospital, does not turn back the hands of time. The patient was brought by his family, who mean well. They also think I have magic abilities. They think I have tests to explain every conceivable situation, feeling, or symptom a patient experiences. They think I have an antidote to everything that doesn’t feel okay for the patient. Had they called the nurse triage line, like the other handful of patients I saw yesterday, they would have been told to go to the ER—again creating this expectation that we’re going to fix everything.

Or, like the other elderly gentleman I saw yesterday—who has Parkinson’s disease and is very weak—he had fallen the day before I saw him. He was on the floor in his house for a couple of hours but was eventually able to get up. He had a second fall later that day. He then went about his day and went to bed. The next day, his home healthcare nurse sent him to the ER because she thought he might be having a stroke. When I discussed his symptoms in more detail, it turned out he was weak and shaky and had tremors because of his Parkinson’s disease, and none of that had really changed. He dressed himself that morning and did laundry. That’s when I told him very pointedly, “You’re not having a stroke. People who have strokes don’t do laundry.” I’m sure his home healthcare nurse meant well, but again, she thinks the ER can do more than we actually can.

All of these patients, their families, and anyone who recommended they go to the ER really have an overinflated impression of what the ER can do. In reality, we are just another Playboy magazine—overpromising and underdelivering.