Sleepless

It's 5am and I've been awake for two hours obsessing about my patients. And that's one of the downsides of being an Emergency Physician- they're really not MY patients. Except for the few patients who routinely visit the ED, either because of lack of a family doctor or surplus of chronic diseases, most of the patients I see are unfamiliar to me. I don't have a file with each person's medical history, medications and allergies, and the patients often don't know their own information. We don't do the same kinds of testing from the ED that one can do from a primary care office. Most tests and procedures need to be scheduled ahead of time, but patients walk in with the expectation that anything they need done can be done right away. After all, it's a hospital. I saw one woman the other day who asked me if she could get a hysterectomy (which she pronounced hystamectomy) that day, since she was already there.

But back to why I can't sleep. I saw a patient the other day who had chronic nausea and had a fairly substantial workup for it. She was scheduled for a special test as an outpatient the next day, but called her doctor that morning and said she was still nauseaus. He told her to come to the ED to be admitted. I can't admit someone for nausea. To top it off, it was her third visit to the ED in 48 hours for the same thing. I never order this particular test that she was scheduled for. It's just not something that we order, since it is not an emergency test. But I called radiology and they were able to fit her in that morning. I was so proud of myself and felt like I was doing a real service for this woman. The test was read as normal. I called her doctor who asked about a specific portion of it. When I spoke to the radiologist, he told me that I had to order that other part specifically or they didn't do it, and that now it was too late. Now the patient and her specialist are furious at me. What can I do? She'll get it again as an outpatient like she should have the first time. But I hate when people are mad at me.

I've become less obsessive over the years of my practice, but I have many nights awake thinking about what I could have or should have done, despite the fact that it usually doesn't make any difference in patient outcome. I guess that the day I stop worrying, I should quit medicine, because I will have stopped caring.