Specialist on Paul Nystrom

Distress vs. Disaster

Wed, 25 Mar 2026 00:00:00 +0000

There are two thresholds when it comes to medical complaints in the ER: distress and disaster.

The distress threshold is the point at which patients decide to come to the ER. Whatever is bothering them, they feel it needs medical attention right away.

The disaster threshold is the point at which a patient requires an immediate procedure, specific treatment, medicine, hospital admission, surgery, or specialist intervention.

We in the ER live in the middle.

The Admit Game

Wed, 25 Mar 2026 00:00:00 +0000

At times in my career, my job has become less about actually practicing medicine—especially at a small rural hospital. Instead of seeing patients, I often feel like the quarterback of the transfer game. This is not unique to my hospital or health system. Across the country, providers are doing the same thing on literally every shift. Even at medium-sized hospitals that lack certain specialties, a great deal of patient transferring still occurs. This is simply how the game is played.

Expecting a Specialist

Sun, 15 Mar 2026 00:00:00 +0000

If you go to the ER expecting to see a specialist, go during the day. Your odds are a little better than at night. Very rarely do specialists come to the ER in the middle of the night. The rest of Big Medicine—besides the ER—does not really operate 24/7. Yes, at large hospitals, there are always many specialists on call. But it takes a real emergency for them to actually come to the ER.

I don't know your doctor

Fri, 27 Feb 2026 00:00:00 +0000

Very frequently, when asking patients about their medical problems, they will tell me the name of their specific provider. Sometimes this is a primary care provider; sometimes it’s a specialist. Their tone suggests that they assume I know who they’re talking about.

Me: What other medical problems do you have?

Patient: I see Dr. Johnson—you know, across the street—for my heart stuff. He did my angiogram last year.

Me outloud: OK.