Tuesday, January 17, 2012

Candy, Toys, or Recess?

I have been thinking about these three things frequently since my emergency medicine rotation over a year ago.  I may have commented on it at that time...  I don't recall and don't want to sort through a host of old posts to find it.  Suffice it to say that a wise preceptor of mine once told me that people who go to an ER or Urgent Care want one of three things: they either want candy (medicine), toys (protective equipment/braces/ace wraps, etc), or recess (time off from work/school).  I spent my day today doing urgent care (aka minor care) and it was evident that the desire to receive one of these things is present in nearly everybody.

I had a patient today who basically came in because of cramps.  As it turns out, the patient had not been drinking any water to speak of...  at all.  For days.  But this simple explanation was not sufficient.  This person was sick, according to relatives, and it had to be something worse than a water deficit.  For almost everyone else, there was medicine or bracing or just a day or two off from work that helped them leave happy as clams.  But for the one person who didn't get one of the three, there was little closure - little apparent relief given my assessment and treatment planning as well as the counseling on nutrition and hydration guidelines.

Several of my preceptors discussed with me the importance of "reassurance" as part of a treatment plan and counseling of my patients.  This works well for a few patients, but mostly only those who schedule routine office visits and yearly exams on a regular basis.  Reassurance for the "worried well" works fine in most cases...  For those who are convinced that they are emergently or urgently sick, a little "reassurance" is much more difficult to make sufficient.  At the same time, that should never keep us from trying. 

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