https://paulnystrom.com/tags/middleman/Recent content in Middleman on Paul NystromHugoen-usMon, 04 May 2026 00:00:00 +0000https://paulnystrom.com/posts/work-notes/Mon, 04 May 2026 00:00:00 +0000https://paulnystrom.com/posts/work-notes/<p>Patients come to the ER for work notes, and I wish they would just be honest upfront about it rather than concoct complaints and then slip in a comment about a work note. It’s frustrating to do all the song and dance about some potential problem they have that they often have difficulty describing. Their answers to my line of questioning about symptoms sometimes don’t make sense, and I’m left scratching my head, sometimes worried there is really something sinister going on. In reality, they are only halfway paying attention because the goal is the work note, nothing more.</p>https://paulnystrom.com/posts/middle-man/Sat, 06 Sep 2025 00:00:00 +0000https://paulnystrom.com/posts/middle-man/<p>Besides employers placing ER doctors in the middle of decisions about a patient’s return to work, we also get caught between divorced parents and between parents and their children. This includes parents with minor children as well as parents of adult children. I can tell you that no ER doctor wants to be in the middle of these situations.</p> <p>In high-conflict situations, it’s tempting to want someone else to solve the problem for you. In high-conflict divorce cases, this often involves one parent bringing the child to the ER for a very minor complaint. The story typically begins with, “Well, they just came back from their dad’s…” or “Mom had them for the weekend…” When I hear that, I know where this is going. The child usually has a minor issue, such as a cough, a stomach bug, a bug bite, mild upper respiratory infection (URI) symptoms, or vague pain. Almost never does the child have a significant medical complaint that warrants an ER visit.</p>