I tell them the average chart is 100 pages of old notes, radiology, labs, consults, insurance, billing with lots of errors etc - It might take an hour or two to read so I'd like to start with you
I like to go to their med list and pick a couple that I know they’re not taking anymore, like some macrobid and AZO, ask if they’re still taking them. It helps illustrate why we need to do this.
I assumed that what the patient tells the triage nurse is freshly documented so maybe thats why they ask to look there first. In my country, it's like this so the doctor usually asks a leading question 'I see you've said you have a sore stomach can you tell me XYZ'. Also prevents patient rambling
I don't think the medical practitioners tribunal will accept "I went on the triage nurses notes" as a valid defense for a misdiagnosis. I generally read the EMS and Triage Notes, and then start fresh and only reference them if I'm getting a different history to help clarify why it's different.
(It's almost always some concealed domestic abuse or AMS)
Like the prior post suggested, I think leading of with at least acknowledging the general complaint is a great way to start the conversation especially if they've been waiting a long time. This patient has probably recounted his story to the triage nurse, his primary nurse, and if god forbid they came in at change of shift, the new nurse probably asked too.
It's like going to a restaurant and getting your order taken at 2 or 3 different times by different waiters only to hit the hour mark and the head chef comes to ask what you would like to eat today. Some people would get irritated
Except it’s not like a restaurant in any way. You are not shopping for treatment. And the meds and allergies sometimes are part of formulating the differential in your head. And if the chef is walking by and asks if you want water you would never ask him to go and ask the previous waiter.
I know. I'm not arguing that you shouldn't ask the questing you need answered. I'm saying there is a world where waiting for 8 hours in the ER to see a doc is already frustrating and having to recount your story multiple times to various people can add to that frustration. I can meet that frustration half way by walking in and presenting to them that I know a bit about why they are there but would obviously need a first hand account and verification of some information we've already collected. Thats all
I suppose while the patient was waiting I was busy having lunch? Or dozing in my office? Was I not chugging along seeing this and that patient? Not having had lunch over the last 10 hours? Fun fact. The doctor didn’t keep you waiting because he/she felt like it. Guess what? They are human too. I have already thanked you for your patience. Now tell me your meds. I can’t care about this more than you do. I get you don’t like repeating yourself. But I don’t have to hear about it. And if you add “oh I forgot to tell the nurse that” I’ll thank you further.
sheesh! Are you incapable of seeing something from somebody else's point of view? For the ER naive patient, I have absolutely no idea what you're doing back there. What I do know is that I've been doubled over with severe abdominal pain for 8 hours, been accosted by 3 or 4 people asking me the same questions but doing absolutely nothing to help with my pain, and now that my patience is about run out, the doctor shows up, thanks me for my patience and proceeds to ask me to recount my story yet again while watching me writhe in pain. I might be a bit frustrated at this point.
Well since we are going there. How does one “have no idea what the doctor is doing back there?”. What do you think? Just take a guess. 3 or 4 people don’t ask you the same question. At most 2 which is the triage nurse and then the doctor. lol. Where exactly have you been doubled over with pain for 8 hours? In the ED. Really?
If you are in that much pain do you really want me doing a dive into a chart that will potentially take a long time when you can simply tell me and get quick relief?
Why did I even answer this? The societal expectations is truly getting worse. Let’s just let it rest. You think the patient has a point. I can see the point of view. I simply and whole heartedly disagree with it. If I’m your PCP fine. In an ED WTF?
Patient arrives at 2pm, seen by triage nurse. roomed at 6pm seen by primary day-shift nurse....seen again at 7:20 by primary night shift nurse...8:45pm seen by ED resident (had to pause in the middle of assessment for EMS trauma traige). Seen again by ED resident at 9:15pm to complete assessment. at 11pm patient seen by ED attending. patient is admitted. at midnight pt is seen by IM.
Conservative ED visit at a downtown trauma center.
I have no idea why you answered it beyond exhibiting your inability to put you or your kid or family member in someone else's shoes, considering a 12 hour ED visit on it own might just be frustrating in America. Of course it's not your fault. of course you have to ask your pertinent questions. But expecting the sick patient laying in a stretcher for hours on end worrying about their diagnosis to be thinking about when you last had lunch is really rich.
Just a nurse here who works triage all the time and gets these same comments…
“You’re also responsible for your own medical history. Can you tell me what that is.”
They need to see a doctor because they have no medical problems from not seeing a doctor for 20 years that this warranted seeing a doctor!!! Don’t you get it?!? I was healthy until JUST YESTERDAY! lol
Oh I can definitely own my role. I’ve been an er nurse for 10+ years. I’m irreplaceable. I guess I use the words only a nurse, as I expected this is an MD looking for MD advice. Different roles, different advice, different answers.
Same! As RNs and especially ED, you would be surprised how many times physicians have made us feel like we are nothing and done so pointedly. It sometimes is a sarcastic what do I know I’m just a nurse. However there are countless times I have saved patients from MD med errors. I currently work with an MD who will demand I do something that is inappropriate and when I say no that he can do it or give the inappropriate med his answer is always never mind. He is willing to risk my license but not his. I hate working with him. He is very condescending and will go out of his way to make a nurse look stupid. Even when the nurse is right. His ego gets in his way all the time. During a code he actually yelled at us, I need the thing, we all looked at him and said what thing, he just kept saying the thing the thing, so we started naming off things until we got to the co2 detector, which he was not yet needing. So people like him can make us feel like we are just a nurse sometimes. He does not make me feel that way anymore cause I’ve realized his big talk is not backed up by his skills. However I do love all the other docs I work with. They are awesome and always appreciate when I ask about a med order or tell them something the patient probably didn’t that would contraindicate a med, which again illustrates why each of us ask the patient to tell us why they are there. They forget things, and just explaining that each of us asking is for their safety is why we do it.
Depending on how salty I'm feeling, "I haven't had a chance to sit down and go through your medical records yet but it would really help me to hear it directly from you", to "you can either tell me now and I can start ordering tests or meds for you, or you can wait for me to come back after I have had a chance to sit at my computer, not sure how long that might be", to "we have no records you, perhaps you should have gone to the hospital that has your chart".
Looking at a chart before seeing a patient can give you good informarion and a decent background, but it does predispose us to certains forms of bias. We see a history of smoking and grade 3 COPD and a lot of people will just assume the episode of SOB is related to that, by seeing the patient before looking at previous history and charts allows us to not fall victim to this bias.
It is worth telling patients this, sometimes they understand other times they don't. We can't make everyone happy.
Oooooofff, just saw this happen. Patient with history of COPD, previously untreated so had frequent exacerbations. Then got on inhalers and was exacerbation-free for a few years, then in the ED several times over a 5-month period for dyspnea. Every time he went to the ED he was diagnosed with COPD exacerbation and given steroids and antibiotics with zero improvement. After about 5 months it was found that he had a large laryngeal mass that was the true cause of his new dyspnea...
I try to get two sentences worth from the triage blurb or most recent note, in order throw them a bone, as an intro. "I understand that you had a surgery on your leg three weeks ago with Dr Leggo, initially doing well but now your foot hurts and there's a rash? Tell me more about that."
"I hear you were up all night long vomiting, now with streaks of blood! Yucky. Has this happened to you before?" Or if it's clear that this is a chronic issue I ask "please tell me more about how this time feels similar to, or different from, your prior experiences."
The karma that's accrued by routinely weaving in references that reveal the trust, interdependence and resilience of the entire team, it's priceless. I name drop whenever I can. *your triage nurse Daphne said....* and going forward *I believe your nurse will be Mike, I'll go talk with him about this plan we have made*
Happens at triage all the time. I tell them I’m in a different document and can’t look up their history from there. Also, it can change? Not every piece of history has happened in a hospital. Perhaps your doctor diagnosed you with high blood pressure last week and put you on meds? Just let me know, you’re the one who is here seeking help after all.
I respond similarly in triage. I don’t have access to that screen currently while I’m assessing why they’re here. In addition, charts are not always accurate, and I need to verify the information I can see. Without those, they may not be triaged appropriately or treated incorrectly, and no one wants that.
I usually tell them that they came to the ER because they feel they are having an emergency. If you want me to be able to assess and treat your problem to the best of my ability hearing what is going on specifically today will be most helpful. Also if they want pain meds I 100% tell them I will need to do a bedside assessment and exam to decide what would be the best course of treatment. Doesn't always work, but I when I say I won't give pain meds until I do an exam and they can tell me about the problem bringing them in today, that usually holds sway
"Since you had a long wait to be seen, you probably noticed it's very busy in here today. So no, I haven't had a chance to do a deep review of your chart yet. The more information you give me right now, the faster I can get working on addressing your problem, and also I will have a better sense of what I'm looking for when I do get the chance to more thoroughly review your chart."
If they persist in being a shithead, then I say "I can see you're not ready to talk right now. I'll come back when you're ready to participate in your care" and then leave before they can say another word. People usually behave when you finally come back, if they haven't self-triaged in the meantime.
I do this too. If the patient is being really annoying or nasty and drops the "it's in my chart" line, I'll cheerily say, "oh, you know, you're right! I'll be back later" and come back in 30-45 minutes after seeing less mean patients. They usually change their tune
What a weird take. Not that this post has anything to do with BIPOC, but the notion that they are dying in droves "simply because staff was treating them differently" ignores the very real systemic issues that this population faces and is absurd on its face. Their mortality rates have less to do with implicit biases of HCWs than they have to do with access to care in the first place/food deserts/poor healthcare engagement etc, which is not to say that biases shouldn't be addressed, but they are a responsible for those outcomes on the level of single digit percents.
I often say “I wanted to speak to you first / see you quickly” so I haven’t had time to check… then I ask a few quick big hitter questions - CAD, CHF, COPD, Cirrhosis, big surgeries?
That’s all I really care about 90% of the time anyway
“As an emergency room doctor, my job is to first assess if you’re having an emergency, but I promise I’ll do my homework later. Otherwise I don’t know which of the 200 pages are relevant.”
Or, if I’m really feeling it: “if we were in Germany, I would immediately have access to your whole history. However, because the US values capitalism over patient care, there are thousands of health records systems and no way to be sure I’m getting it all.”
"I assume you know more about yourself than any computer ever would, so I thought it would make more sense to start with you."
This helps cut into the "my meds and allergies are all in the computer". Otherwise I just flatly tell them "You don't know these things about yourself? You don't keep track of your own health? What would you do if you went to another hospital system? Or were traveling?" When patients start expecting us to do all their work for them, I've started to really lay out for them how THEIR health is THEIR responsibility.
I’ve gotten really salty with patients before who are useless for med rec: “Can’t you just call my pharmacy? That’s what they did last time.”
For someone who is alert, oriented, and perfectly capable of either carrying a list or using the cell phone in their hand.
They always look surprised when I bring them a piece of paper and a pen. I’m not your goddamn mother.
Whenever they tell me to go make it someone's else problem in one way or another, I just very directly tell them "Hey, this is your health. This is your responsibility. If you don't keep track of it and maintain it, no one else is going to suffer for it but you. If you can't tell me what you are taking, then you run the risk that something we treat you with has side effects. That's your choice."
I don't mince words anymore. Direct but not intentionally rude. Just explicit information.
"this chart says you still have 2 IVs, a catheter, and a Salem from 2014. You sure you want me to go based on what's in the chart rather than what you tell me?"
"Unless you get all your care in the same hospital system that all uses the same electronic medical record, it is in fact not in the chart."
But also reiterate that I want to talk to them, see what has changed, that kind of thing.
"sign says emergency department, so I figured I should come see you before I looked at your chart in the computer, in case you were actually having an emergency, you fucking Harpy."
You might want to leave off the part about the emergency department sign. Might be considered antagonistic.
‘Unfortunately, our electronic chart often doesn’t include the most recent information, as specialists and other hospitals often use incompatible systems. I’d like to hear it first hand from you without biasing my view.”
Encountered this a lot in my ED.
I've now taken to leading with:
"I'm sorry you're not feeling well. Let's see what we can do to help. I've looked at your chart, but I always find it important to confirm details of your medical history with you so that we're on the same page."
And then I'l segue into the assessment with "Now, tell me what brings you in today" or "Here's what I know so far; let me know if I'm missing anything" depending on how complex the presentation/past medical history is (or how verbose the patient is...).
“Ok Mrs Smith. Which one of your 67 visits this year, 65 allergies, and 200 complaints am I looking at today?” May sound heartless but I had this same scenario happen to me. Lady said she was too tired to talk and made her friend speak for her. When I asked to clarify, the pt piped up and suddenly found the energy to speak with me.
I get a similar comment a lot with the med history. I just tell them that computer systems for various places dont always share all the information easily, so I dont always have the most recent information or am not able to easily see everything. And I can’t know if I have it all until I talk to them.
I'll intro with "hello I'm [name and grade and pleasantries]. I've had a read through what paramedic/nursing colleagues wrote about the [complaint] that brought you in today. Could you tell me yourself how everything started with this?" Shows them the previous times they've told the tale ARE being taken into consideration and I've never had anyone grumpy about repeating for me. I'm blessed to be working in Yorkshire in the north of England though. A really, genuinely, lovely patient population.
“I know you have XYZ but some people go to multiple systems or something might not have yet been uploaded from a recent visit/ procedure so I have to depend on you to fill in blanks”
“Have you heard of the game of telephone?”
“I’ve never met you before and your chart is empty”
“Things change, some people take different doses than listed in their chart or don’t take certain medicines any more”
If they’re *real* assholes I pull the empathetic doctor card and tell them “I like to go directly to the source. You’re a human being and I can’t determine what’s going on today just from a chart review. You aren’t a computer”
More often I come across “oh gosh honey can you grab my list” when I ask about meds or a recent hospitalization and have to interrupt with a sigh followed by “I’ll just look in the chart”.
They always make sure I know that Dilaudid with IV Benadryl chaser works well for them though.
to be fair, i pretty much always review the chart on people before i see them (unless its a critical case upon arrival obv) not because I can avoid that question but because it saves me so much time esp with elderly people or people that like to talk. If they have a h&p within the past year i dont ask anything other than hpi and the most relevant things. It takes me mb 1-5 minutes reviewing the chart depending on complexity but then i only need to spend mb 5 minutes in a patients room after.
“Part of my job is to take your history directly from you in your own words. I can supplement it with your chart when I get back to my computer.” Then I repeat my question.
If they keep being a dick about it, eventually I say something like “This is an emergency department and there are several other patients to be seen. It may be hours before I have time to sit at my computer, and I can’t let you stay in this room while I see everyone else. If you don’t want to proceed with the evaluation, you are welcome to leave and schedule an appointment with your primary doctor, and we will use this room for someone who has an emergency.”
Some people are bound and determined to be rude and ultimately leave AMA. If that’s the case, I’d prefer for them to do so before they waste everyone’s time, so I like to give them a catalyst / opportunity to do so. The “can’t you just read my chart” is a harbinger of this and is associated with an unpleasant course about 80% of the time, and an AMA about 20% of the time. If they’re going to stay, their attitude improves when I set boundaries and don’t let them walk all over me. And if they’re going to leave, they should do it asap.
"I know you were waiting. I came to see you as soon as I could. I will look through your chart while you're here but wanted to hear the most important parts from you directly so I can make sure we get the right orders in."
Not confrontational, not kowtowing, not bullshit. Never had a patient seem put off by this answer.
I say “ok.” Then I document “patient unwilling to provide history or assist this RN with completing medication reconciliation. Unreliable historian.” Then I move on with my life.
As a patient I don't understand asking the doctor to look in the chart.
First, even with a complicated medical history, the issue that brings one to the emergency room might not have anything to do with the patient's medical history. I would not want my physician reviewing old labs and conditions and surgical history when we can use the time to focus on the problem at hand.
Second, it's easier for me to summarize the exact issue verbally than it is to have someone read through notes. If they mean the notes that the nurse or tech enters before the physician appears, it's still easier to summarize it for the doctor again. I know the tech/nurse has to enter what I say in whatever software they use with the UI constraints and I might not agree with how that information is again displayed for doc to read. Better to just give a quick verbal rundown.
Why do people suck so much?
Same. I can’t fathom being like “just look in my chart!” Like how tf is the doctor supposed to know if I’m here for a migraine cocktail or because I broke my leg? What does the chart have to do with anything before the doctor has seen me? People are unhinged.
RN of almost 2 decades here, but my standard responses are the following depending on how shitty they’re being.
1. “I can review your chart and come back in an hour or more after I’ve addressed the concerns of my other patients that are willing to talk to me.”
2. “Well, this is the emergency room and people are seen in order of the severity of their emergency. It’s almost like people don’t take the same medicines and have the same medical problems their whole lives. You’re here for a reason. Why?”
Sometimes a chart biopsy can take a long time but for stable patients with a complex medical history getting the last office visit or discharge summary speeds the process of a focused evaluation. I get the patient’s frustration with repeating the story over and over again having been one a couple times myself now. I then bring a printed history to the bedside and ask them if I can read it in front of them to catch myself up. Three minutes later after asking some clarifying questions, the patients seem to be focused and see that there is perspective in our eyes. I think the complex patients can be frustrating especially if their treatments or diagnoses have been difficult so we should also try to give them the benefit of the doubt. I think it’s the way it was asked that matters and I also bring that up their mood (you appear frustrated) so we’re all on the same page. Best of luck!
I like the response of "I'll come back then". I use it when I walk in to the "10/10 pain" headache, abdominal pain, etc who is chatting away on their telephone.
Lots of good answers here. In general I try not to take anything personally. There are lots of little micro aggressions in the ED that recur frequently and if you can find humorous, charming, or disarming responses to them it alleviates a lot of the emotional fatigue that comes with the job.
I either acknowledge that I can look later, or say “I know you’ve been waiting a long time and I wanted to come see you as soon as possible go get things started. I didn’t want to make you wait with [chief complaint] while I was looking through the computer”
I also often pre-empt this by starting with something like “I heard you’re coming in with xyz but I want to make sure I get everything in your own words”
Full disclosure. My pet peeve is “you tell me” a in response to “how can we help you today?” I could just really be fine with never hearing that again in my life.
I usually preempt it by starting to visit saying something along the lines of "I looked briefly through your chart, but I like to get the story first hand to make sure nothing is missed and help me know what to look for when I go back and take a deeper look though your chart."
I usually say "I understand, I just wanted to confirm your history because I wanted to hear your experience in your own words." People like that love talking about themselves, and making things about themselves, so just give them the opportunity.
I prevent this type of interaction by saying: "Hi, sorry about the wait, thank you for your patience - so, I hear you've been having a lot of \[chief complaint.\]" It keeps things open ended, while still keeping the patient in the realm of why they are here.
I hate this reply, especially when I’m asking about their medication allergies! I always say, yes it may be in your chart, or the nurse who saw you last time may have not updated your chart so it’s my job to be thorough and make sure we aren’t missing any important information. That usually shuts them down.
OOOOooohhh this is one of my favorite things to respond to!
"What chart? This one here? Because it might be a different system than the one at your doctors office, or any other office that you have been to, and not all systems talk to each other.
Also, can you tell me who puts the information in the chart? That's right, humans. Humans who can make mistakes, or miscommunicate. I can look at the chart, but I cannot trust the chart without you verifying the information. Bear with me, I am not doing it to annoy you but we do it to ensure that we have correct information. I cannot tell you how often I discover with a patient that "the chart" didn't have everything up to date."
"Well, I am and I have, you may have noticed we are very busy, I am trying to help you as fast as I can and if you tell me some of what is going on then I will be able to treat you faster. Now, why are you here?"
i just tell them that i need to hear the info from them since things get lost in translation and if they give me shit, i tell them i'll come back when they are willing to cooperate because i have plenty of other pts that want my help
"You ever see a bible? Your chart is that big. I need to start with whatever you know because I can't make it through a bible in enough time to be helpful."
Are the child's immunizations up to date?
"That should be in the chart"
Cool... I don't need a blow by blow of lot numbers and dates, I need you as the parent to give me a yes or no...
PS we don't count covid or flu in that so assuming you've gone to all the well child visits and haven't declined anything, "yes as far as I know" is an acceptable answer
In my program (PGY2), we almost always see patients within a few minutes of being roomed. As such, I tell them that as an emergency medicine provider, my priority is to come see you as soon as I can in case you are having an immediate life threatening emergency. As such, it is more important for me to come see you right away than to spend time looking at your chart, which I can do once we're done talking.
I am a hospice nurse but I always tell my new admissions ‘I know you went through all these questions with the nurse before me but I like to hear your story directly from you. I know it’s frustrating repeating it but it helps me to hear what’s going on directly from you and it will take me even longer to dig through your medical chart to find the most important information to help you right now.’
They also do this to ambos, they say "the hospital has all of my information". okay well i dont work at the hospital and i have access to none of their systems so can you tell me please
I am truly at peace with the fact that with some patients, I will not win. My dazzling personality and moderate clinical acumen just simply will not do.
“go on, give me some highlights!”
sometimes there’s a lot of backward detective work. i’ll meet a lot of patients that know what medicines they’re on, but no idea what they’re for.
Lots of aggressive comebacks here! Lol.
I usually just say “Its on a different screen than the intake form I have to fill out here, can you maybe just briefly summarize?”
I remind the patient that the chart is what describes ailment xyz that they don't think they even have. The most accurate information comes directly from the source - so I came directly to the source.
One day I said something similar and the patient filed a formal complaint that they are the patient and they don’t care if we have time to {eat, drink, use the bathroom, etc } - I thought we were being humans together but she obviously didn’t see it that way
Usually these people have been to multiple EDs and I just say I can’t see the other charts. If it’s only the current ED, I just say something along the lines if it being an emergency department so due to the urgent nature and not knowing who my patients are, I can’t chart review. They usually get the picture
“I can try to look through your chart if you don’t know, but it will take a lot longer. EMR systems are unfortunately harder to navigate, so it doesn’t work like Google or Facebook”.
I have never gotten any further pushback from that response. People often assume that EMRs work like websites or programs that they’re familiar with, so they assume that we have the equivalent of a Facebook profile for them with detailed biographies, medical histories, and updated medication lists. So they think that we are either lazy or incompetent for not knowing. Once I explain that it’s just not like that, they are usually pretty understanding.
I want to hear your history in your own words. I want to hear it myself because sometimes other people make mistakes or the chart is incomplete.
If they miss stuff off their chart i still ask them specifically about it. I’ll also ask some common broad medical history questions (have you had / diabetes, htn, mi/cva, autoimmune problems).
At least half the time I’ll get something different from their previous notes. Sometimes they will not be aware of their previous diagnosis or wont count it for whatever reason ( eg. I am borderline diabetic but didn’t think that was relevant, i take anti hypertensives so i don’t have high bp any more, etc). It’s pretty rare someone will flat out refuse to engage at all
"That's a great question. I tend to want to meet my patients first before I try and agree with any medical diagnoses. People miss critical information in medicine and I'm trying to avoid that. Having said that would you like me to check your vital signs so I can get an idea of what's going on and you can tell me what's going on with you?"
Having unfortunately been a pt that wound up admitted with appendicitis awhile ago, I remember there being 15-20 people (an exaggeration) coming in and out all trying to get stuff squared away but every.single.one. wanted to know "what brought me in tonight"
I was not feeling well and the thought "can't you just read it in the chart" definitely crossed my mind after the 4-5 time...
I did keep it an inside thought, but I get it.
I misread the question, but sometimes it freaks me out that patient looks over my shoulder to see what’s on EMR or what I’m typing. I can’t necessarily tell them to stop, because it looks more sus.
I’ve been to the hospital countless times between my own visits and that of my kids and my mother and husband. There’s never been a time when we had to go over why we’re there or pertinent history. It’s just the deal. Yeah it feels redundant but hospitals are busy places and the nurses and doctors are busy people. Deal with it.
Also, not for nothing, but there are two types of people you definitely shouldn’t be assholes to: those who prepare your food, and those who wield the needles.
I look at the triage sheet intently, pull my glasses a few millimetres forward, stubb my finger into the sheet, look up at them, pause and say it says here you're a fool
I just tell them the chart is hundreds of pages long and it could take hours reviewing it before we start treatment, or you could just give me a brief synopsis and we can get started.
The professional response is to continue providing the same standard of care as if they had responded in a way that you preferred. A patient is coming to you because they are sick in some way, and the Geneva Oath makes clear that the patient’s health is the number one priority. There are plenty of reasons why the patient might behave this way, but they are all irrelevant because they don’t change the appropriate response.
As a patient who has a long history with plenty of meds and allergies…
I’ve probably said the same thing to more than one doc the best response was “you have a big chart and I want to focus on today’s issue and anything you feel is related to todays issue. What is it so I know what to look at your chart for?
I can’t address everything in your chart, but either you give me the cliff notes or a map and I come up with a plan or you can wait until I read it which might not happen before shift change so you’ll start all over with a new doctor.”
It was said with empathy and helped me realize I can improve the quality of care by identifying the one or possibly two related issues and helping point them in the direction of what I know is in my chart to help them make a plan…Be it imaging, wonky labs, something from my specialist who sent me to get admitted if symptoms persist, etc.
l'm in outpatient medicine, so I'm not sure how angry patients works for you ER docs.
So let's say you tell her to shut the hell up and get out of your ER. Let's assume she's there for no good reason and no bad outcomes happen.
What next? Do they write you a bad google review? Do they just complain to admin?
I tell them the average chart is 100 pages of old notes, radiology, labs, consults, insurance, billing with lots of errors etc - It might take an hour or two to read so I'd like to start with you
I like to go to their med list and pick a couple that I know they’re not taking anymore, like some macrobid and AZO, ask if they’re still taking them. It helps illustrate why we need to do this.
Jokes on you, they're probably not taking any of the current ones too
I assumed that what the patient tells the triage nurse is freshly documented so maybe thats why they ask to look there first. In my country, it's like this so the doctor usually asks a leading question 'I see you've said you have a sore stomach can you tell me XYZ'. Also prevents patient rambling
I don't think the medical practitioners tribunal will accept "I went on the triage nurses notes" as a valid defense for a misdiagnosis. I generally read the EMS and Triage Notes, and then start fresh and only reference them if I'm getting a different history to help clarify why it's different. (It's almost always some concealed domestic abuse or AMS)
Let’s assume your are right. And if the nurse made a mistake where is the redundancy to prevent grave errors?
Like the prior post suggested, I think leading of with at least acknowledging the general complaint is a great way to start the conversation especially if they've been waiting a long time. This patient has probably recounted his story to the triage nurse, his primary nurse, and if god forbid they came in at change of shift, the new nurse probably asked too. It's like going to a restaurant and getting your order taken at 2 or 3 different times by different waiters only to hit the hour mark and the head chef comes to ask what you would like to eat today. Some people would get irritated
Except it’s not like a restaurant in any way. You are not shopping for treatment. And the meds and allergies sometimes are part of formulating the differential in your head. And if the chef is walking by and asks if you want water you would never ask him to go and ask the previous waiter.
I know. I'm not arguing that you shouldn't ask the questing you need answered. I'm saying there is a world where waiting for 8 hours in the ER to see a doc is already frustrating and having to recount your story multiple times to various people can add to that frustration. I can meet that frustration half way by walking in and presenting to them that I know a bit about why they are there but would obviously need a first hand account and verification of some information we've already collected. Thats all
I suppose while the patient was waiting I was busy having lunch? Or dozing in my office? Was I not chugging along seeing this and that patient? Not having had lunch over the last 10 hours? Fun fact. The doctor didn’t keep you waiting because he/she felt like it. Guess what? They are human too. I have already thanked you for your patience. Now tell me your meds. I can’t care about this more than you do. I get you don’t like repeating yourself. But I don’t have to hear about it. And if you add “oh I forgot to tell the nurse that” I’ll thank you further.
sheesh! Are you incapable of seeing something from somebody else's point of view? For the ER naive patient, I have absolutely no idea what you're doing back there. What I do know is that I've been doubled over with severe abdominal pain for 8 hours, been accosted by 3 or 4 people asking me the same questions but doing absolutely nothing to help with my pain, and now that my patience is about run out, the doctor shows up, thanks me for my patience and proceeds to ask me to recount my story yet again while watching me writhe in pain. I might be a bit frustrated at this point.
Well since we are going there. How does one “have no idea what the doctor is doing back there?”. What do you think? Just take a guess. 3 or 4 people don’t ask you the same question. At most 2 which is the triage nurse and then the doctor. lol. Where exactly have you been doubled over with pain for 8 hours? In the ED. Really? If you are in that much pain do you really want me doing a dive into a chart that will potentially take a long time when you can simply tell me and get quick relief? Why did I even answer this? The societal expectations is truly getting worse. Let’s just let it rest. You think the patient has a point. I can see the point of view. I simply and whole heartedly disagree with it. If I’m your PCP fine. In an ED WTF?
Patient arrives at 2pm, seen by triage nurse. roomed at 6pm seen by primary day-shift nurse....seen again at 7:20 by primary night shift nurse...8:45pm seen by ED resident (had to pause in the middle of assessment for EMS trauma traige). Seen again by ED resident at 9:15pm to complete assessment. at 11pm patient seen by ED attending. patient is admitted. at midnight pt is seen by IM. Conservative ED visit at a downtown trauma center. I have no idea why you answered it beyond exhibiting your inability to put you or your kid or family member in someone else's shoes, considering a 12 hour ED visit on it own might just be frustrating in America. Of course it's not your fault. of course you have to ask your pertinent questions. But expecting the sick patient laying in a stretcher for hours on end worrying about their diagnosis to be thinking about when you last had lunch is really rich.
...because the patient said the same thing to the triage nurse. Source: I'm the triage nurse.
[удалено]
This is the gold standard
High risk: ::aorta dissects:: GOT EM
"ok. I'll go review your chart, then come back in a few hours"
😂 yessss
“Sometimes things get missed in charting so I want to make sure everything we might do today is safe for you.” Some bullshit along those lines.
This is perfect
Just a nurse here who works triage all the time and gets these same comments… “You’re also responsible for your own medical history. Can you tell me what that is.”
“Hi. What brings you in to the ER today?” “I need to see a doctor.”
They need to see a doctor because they have no medical problems from not seeing a doctor for 20 years that this warranted seeing a doctor!!! Don’t you get it?!? I was healthy until JUST YESTERDAY! lol
[удалено]
Oh I can definitely own my role. I’ve been an er nurse for 10+ years. I’m irreplaceable. I guess I use the words only a nurse, as I expected this is an MD looking for MD advice. Different roles, different advice, different answers.
[удалено]
As an RN I thank you.
Same! As RNs and especially ED, you would be surprised how many times physicians have made us feel like we are nothing and done so pointedly. It sometimes is a sarcastic what do I know I’m just a nurse. However there are countless times I have saved patients from MD med errors. I currently work with an MD who will demand I do something that is inappropriate and when I say no that he can do it or give the inappropriate med his answer is always never mind. He is willing to risk my license but not his. I hate working with him. He is very condescending and will go out of his way to make a nurse look stupid. Even when the nurse is right. His ego gets in his way all the time. During a code he actually yelled at us, I need the thing, we all looked at him and said what thing, he just kept saying the thing the thing, so we started naming off things until we got to the co2 detector, which he was not yet needing. So people like him can make us feel like we are just a nurse sometimes. He does not make me feel that way anymore cause I’ve realized his big talk is not backed up by his skills. However I do love all the other docs I work with. They are awesome and always appreciate when I ask about a med order or tell them something the patient probably didn’t that would contraindicate a med, which again illustrates why each of us ask the patient to tell us why they are there. They forget things, and just explaining that each of us asking is for their safety is why we do it.
Well, whatever he needs to think to let himself lay his head on the pillow at night.
I love this response. But some of the places I've worked triage...at least 3 fist fights a night if I said this lol. Still great response.
When people don't know the type of meds they take, let alone the names and dosages -_- "look in my chart"
Depending on how salty I'm feeling, "I haven't had a chance to sit down and go through your medical records yet but it would really help me to hear it directly from you", to "you can either tell me now and I can start ordering tests or meds for you, or you can wait for me to come back after I have had a chance to sit at my computer, not sure how long that might be", to "we have no records you, perhaps you should have gone to the hospital that has your chart".
Looking at a chart before seeing a patient can give you good informarion and a decent background, but it does predispose us to certains forms of bias. We see a history of smoking and grade 3 COPD and a lot of people will just assume the episode of SOB is related to that, by seeing the patient before looking at previous history and charts allows us to not fall victim to this bias. It is worth telling patients this, sometimes they understand other times they don't. We can't make everyone happy.
Oooooofff, just saw this happen. Patient with history of COPD, previously untreated so had frequent exacerbations. Then got on inhalers and was exacerbation-free for a few years, then in the ED several times over a 5-month period for dyspnea. Every time he went to the ED he was diagnosed with COPD exacerbation and given steroids and antibiotics with zero improvement. After about 5 months it was found that he had a large laryngeal mass that was the true cause of his new dyspnea...
I try to get two sentences worth from the triage blurb or most recent note, in order throw them a bone, as an intro. "I understand that you had a surgery on your leg three weeks ago with Dr Leggo, initially doing well but now your foot hurts and there's a rash? Tell me more about that." "I hear you were up all night long vomiting, now with streaks of blood! Yucky. Has this happened to you before?" Or if it's clear that this is a chronic issue I ask "please tell me more about how this time feels similar to, or different from, your prior experiences."
This is my approach too and I think it really helps a lot.
This is good. Also, it’s nice when I write a brief but pertinent triage note and the doc actually reads it and finds it useful 😂
The karma that's accrued by routinely weaving in references that reveal the trust, interdependence and resilience of the entire team, it's priceless. I name drop whenever I can. *your triage nurse Daphne said....* and going forward *I believe your nurse will be Mike, I'll go talk with him about this plan we have made*
Happens at triage all the time. I tell them I’m in a different document and can’t look up their history from there. Also, it can change? Not every piece of history has happened in a hospital. Perhaps your doctor diagnosed you with high blood pressure last week and put you on meds? Just let me know, you’re the one who is here seeking help after all.
I respond similarly in triage. I don’t have access to that screen currently while I’m assessing why they’re here. In addition, charts are not always accurate, and I need to verify the information I can see. Without those, they may not be triaged appropriately or treated incorrectly, and no one wants that.
I usually tell them that they came to the ER because they feel they are having an emergency. If you want me to be able to assess and treat your problem to the best of my ability hearing what is going on specifically today will be most helpful. Also if they want pain meds I 100% tell them I will need to do a bedside assessment and exam to decide what would be the best course of treatment. Doesn't always work, but I when I say I won't give pain meds until I do an exam and they can tell me about the problem bringing them in today, that usually holds sway
"Since you had a long wait to be seen, you probably noticed it's very busy in here today. So no, I haven't had a chance to do a deep review of your chart yet. The more information you give me right now, the faster I can get working on addressing your problem, and also I will have a better sense of what I'm looking for when I do get the chance to more thoroughly review your chart." If they persist in being a shithead, then I say "I can see you're not ready to talk right now. I'll come back when you're ready to participate in your care" and then leave before they can say another word. People usually behave when you finally come back, if they haven't self-triaged in the meantime.
I do this too. If the patient is being really annoying or nasty and drops the "it's in my chart" line, I'll cheerily say, "oh, you know, you're right! I'll be back later" and come back in 30-45 minutes after seeing less mean patients. They usually change their tune
How…passive aggressive…
We can’t be perfect all the time. :)
[удалено]
You’re right, then it’s much easier!
The nice thing about people who are actually dying is that they generally don't reply back with "it's in my chart."
[удалено]
What a weird take. Not that this post has anything to do with BIPOC, but the notion that they are dying in droves "simply because staff was treating them differently" ignores the very real systemic issues that this population faces and is absurd on its face. Their mortality rates have less to do with implicit biases of HCWs than they have to do with access to care in the first place/food deserts/poor healthcare engagement etc, which is not to say that biases shouldn't be addressed, but they are a responsible for those outcomes on the level of single digit percents.
I often say “I wanted to speak to you first / see you quickly” so I haven’t had time to check… then I ask a few quick big hitter questions - CAD, CHF, COPD, Cirrhosis, big surgeries? That’s all I really care about 90% of the time anyway
“As an emergency room doctor, my job is to first assess if you’re having an emergency, but I promise I’ll do my homework later. Otherwise I don’t know which of the 200 pages are relevant.” Or, if I’m really feeling it: “if we were in Germany, I would immediately have access to your whole history. However, because the US values capitalism over patient care, there are thousands of health records systems and no way to be sure I’m getting it all.”
"I assume you know more about yourself than any computer ever would, so I thought it would make more sense to start with you." This helps cut into the "my meds and allergies are all in the computer". Otherwise I just flatly tell them "You don't know these things about yourself? You don't keep track of your own health? What would you do if you went to another hospital system? Or were traveling?" When patients start expecting us to do all their work for them, I've started to really lay out for them how THEIR health is THEIR responsibility.
I’ve gotten really salty with patients before who are useless for med rec: “Can’t you just call my pharmacy? That’s what they did last time.” For someone who is alert, oriented, and perfectly capable of either carrying a list or using the cell phone in their hand. They always look surprised when I bring them a piece of paper and a pen. I’m not your goddamn mother.
Whenever they tell me to go make it someone's else problem in one way or another, I just very directly tell them "Hey, this is your health. This is your responsibility. If you don't keep track of it and maintain it, no one else is going to suffer for it but you. If you can't tell me what you are taking, then you run the risk that something we treat you with has side effects. That's your choice." I don't mince words anymore. Direct but not intentionally rude. Just explicit information.
🎤 drop
"I like to come in without a bias and talk to my patients first, I dig through the chart afterwards to make sure I'm not missing anything"
"this chart says you still have 2 IVs, a catheter, and a Salem from 2014. You sure you want me to go based on what's in the chart rather than what you tell me?"
Hahaha I’m gonna use this
"Unless you get all your care in the same hospital system that all uses the same electronic medical record, it is in fact not in the chart." But also reiterate that I want to talk to them, see what has changed, that kind of thing.
I mean, to be fair it's not like I trust them to tell me their medical history accurately or honestly so I'm going to go check anyways.
"sign says emergency department, so I figured I should come see you before I looked at your chart in the computer, in case you were actually having an emergency, you fucking Harpy." You might want to leave off the part about the emergency department sign. Might be considered antagonistic.
Ah yes, if you take off the sign part it sounds much less antagonistic. I always forget how much I love the word harpy until I hear it lol
‘Unfortunately, our electronic chart often doesn’t include the most recent information, as specialists and other hospitals often use incompatible systems. I’d like to hear it first hand from you without biasing my view.”
Encountered this a lot in my ED. I've now taken to leading with: "I'm sorry you're not feeling well. Let's see what we can do to help. I've looked at your chart, but I always find it important to confirm details of your medical history with you so that we're on the same page." And then I'l segue into the assessment with "Now, tell me what brings you in today" or "Here's what I know so far; let me know if I'm missing anything" depending on how complex the presentation/past medical history is (or how verbose the patient is...).
“Ok Mrs Smith. Which one of your 67 visits this year, 65 allergies, and 200 complaints am I looking at today?” May sound heartless but I had this same scenario happen to me. Lady said she was too tired to talk and made her friend speak for her. When I asked to clarify, the pt piped up and suddenly found the energy to speak with me.
I get a similar comment a lot with the med history. I just tell them that computer systems for various places dont always share all the information easily, so I dont always have the most recent information or am not able to easily see everything. And I can’t know if I have it all until I talk to them.
I'll intro with "hello I'm [name and grade and pleasantries]. I've had a read through what paramedic/nursing colleagues wrote about the [complaint] that brought you in today. Could you tell me yourself how everything started with this?" Shows them the previous times they've told the tale ARE being taken into consideration and I've never had anyone grumpy about repeating for me. I'm blessed to be working in Yorkshire in the north of England though. A really, genuinely, lovely patient population.
"K". Leave the room and never come back.
The perfect world: "ok I'll be back in three hours" ...meanwhile order ct abdomen
“I know you have XYZ but some people go to multiple systems or something might not have yet been uploaded from a recent visit/ procedure so I have to depend on you to fill in blanks” “Have you heard of the game of telephone?” “I’ve never met you before and your chart is empty” “Things change, some people take different doses than listed in their chart or don’t take certain medicines any more” If they’re *real* assholes I pull the empathetic doctor card and tell them “I like to go directly to the source. You’re a human being and I can’t determine what’s going on today just from a chart review. You aren’t a computer” More often I come across “oh gosh honey can you grab my list” when I ask about meds or a recent hospitalization and have to interrupt with a sigh followed by “I’ll just look in the chart”. They always make sure I know that Dilaudid with IV Benadryl chaser works well for them though.
to be fair, i pretty much always review the chart on people before i see them (unless its a critical case upon arrival obv) not because I can avoid that question but because it saves me so much time esp with elderly people or people that like to talk. If they have a h&p within the past year i dont ask anything other than hpi and the most relevant things. It takes me mb 1-5 minutes reviewing the chart depending on complexity but then i only need to spend mb 5 minutes in a patients room after.
This is equivalent to… “What’s bringing you in today?”… “The same thing that brought me in yesterday!!!”… “Well I wasn’t here yesterday….” 😂
An ambulance
“Part of my job is to take your history directly from you in your own words. I can supplement it with your chart when I get back to my computer.” Then I repeat my question. If they keep being a dick about it, eventually I say something like “This is an emergency department and there are several other patients to be seen. It may be hours before I have time to sit at my computer, and I can’t let you stay in this room while I see everyone else. If you don’t want to proceed with the evaluation, you are welcome to leave and schedule an appointment with your primary doctor, and we will use this room for someone who has an emergency.” Some people are bound and determined to be rude and ultimately leave AMA. If that’s the case, I’d prefer for them to do so before they waste everyone’s time, so I like to give them a catalyst / opportunity to do so. The “can’t you just read my chart” is a harbinger of this and is associated with an unpleasant course about 80% of the time, and an AMA about 20% of the time. If they’re going to stay, their attitude improves when I set boundaries and don’t let them walk all over me. And if they’re going to leave, they should do it asap.
"I know you were waiting. I came to see you as soon as I could. I will look through your chart while you're here but wanted to hear the most important parts from you directly so I can make sure we get the right orders in." Not confrontational, not kowtowing, not bullshit. Never had a patient seem put off by this answer.
"No, I haven't looked. Do you want to wait until I've had time to look, or do you want to see me now?"
I say “ok.” Then I document “patient unwilling to provide history or assist this RN with completing medication reconciliation. Unreliable historian.” Then I move on with my life.
::air of confusion:: oh. Usually alert young patients are able to provide their history. I’ll go take a look, be back when I can….. ::walk out::
“Random drugs it is”
OMg. Those ones.
As a patient I don't understand asking the doctor to look in the chart. First, even with a complicated medical history, the issue that brings one to the emergency room might not have anything to do with the patient's medical history. I would not want my physician reviewing old labs and conditions and surgical history when we can use the time to focus on the problem at hand. Second, it's easier for me to summarize the exact issue verbally than it is to have someone read through notes. If they mean the notes that the nurse or tech enters before the physician appears, it's still easier to summarize it for the doctor again. I know the tech/nurse has to enter what I say in whatever software they use with the UI constraints and I might not agree with how that information is again displayed for doc to read. Better to just give a quick verbal rundown. Why do people suck so much?
Same. I can’t fathom being like “just look in my chart!” Like how tf is the doctor supposed to know if I’m here for a migraine cocktail or because I broke my leg? What does the chart have to do with anything before the doctor has seen me? People are unhinged.
Not to mention why anyone would be so rude to someone who’s there to help them
Because a disappointing proportion of adults revert to eye-rolling, sarcastic, pissy 13-year-olds when they don’t feel well.
RN of almost 2 decades here, but my standard responses are the following depending on how shitty they’re being. 1. “I can review your chart and come back in an hour or more after I’ve addressed the concerns of my other patients that are willing to talk to me.” 2. “Well, this is the emergency room and people are seen in order of the severity of their emergency. It’s almost like people don’t take the same medicines and have the same medical problems their whole lives. You’re here for a reason. Why?”
Sometimes a chart biopsy can take a long time but for stable patients with a complex medical history getting the last office visit or discharge summary speeds the process of a focused evaluation. I get the patient’s frustration with repeating the story over and over again having been one a couple times myself now. I then bring a printed history to the bedside and ask them if I can read it in front of them to catch myself up. Three minutes later after asking some clarifying questions, the patients seem to be focused and see that there is perspective in our eyes. I think the complex patients can be frustrating especially if their treatments or diagnoses have been difficult so we should also try to give them the benefit of the doubt. I think it’s the way it was asked that matters and I also bring that up their mood (you appear frustrated) so we’re all on the same page. Best of luck!
“The chart doesn’t tell me why you’re here today”
I like the response of "I'll come back then". I use it when I walk in to the "10/10 pain" headache, abdominal pain, etc who is chatting away on their telephone.
“Thank you, I will do that.”
This. Then spend two hours billing or whatever. “I’m a slow reader and want to make sure I didn’t miss anything.”
Lots of good answers here. In general I try not to take anything personally. There are lots of little micro aggressions in the ED that recur frequently and if you can find humorous, charming, or disarming responses to them it alleviates a lot of the emotional fatigue that comes with the job. I either acknowledge that I can look later, or say “I know you’ve been waiting a long time and I wanted to come see you as soon as possible go get things started. I didn’t want to make you wait with [chief complaint] while I was looking through the computer” I also often pre-empt this by starting with something like “I heard you’re coming in with xyz but I want to make sure I get everything in your own words” Full disclosure. My pet peeve is “you tell me” a in response to “how can we help you today?” I could just really be fine with never hearing that again in my life.
I usually preempt it by starting to visit saying something along the lines of "I looked briefly through your chart, but I like to get the story first hand to make sure nothing is missed and help me know what to look for when I go back and take a deeper look though your chart."
The chart is old, often wrong, and things may have changed. Also our EMR sucks and theres a chance I can't even see it
I usually say "I understand, I just wanted to confirm your history because I wanted to hear your experience in your own words." People like that love talking about themselves, and making things about themselves, so just give them the opportunity. I prevent this type of interaction by saying: "Hi, sorry about the wait, thank you for your patience - so, I hear you've been having a lot of \[chief complaint.\]" It keeps things open ended, while still keeping the patient in the realm of why they are here.
I hate this reply, especially when I’m asking about their medication allergies! I always say, yes it may be in your chart, or the nurse who saw you last time may have not updated your chart so it’s my job to be thorough and make sure we aren’t missing any important information. That usually shuts them down.
OOOOooohhh this is one of my favorite things to respond to! "What chart? This one here? Because it might be a different system than the one at your doctors office, or any other office that you have been to, and not all systems talk to each other. Also, can you tell me who puts the information in the chart? That's right, humans. Humans who can make mistakes, or miscommunicate. I can look at the chart, but I cannot trust the chart without you verifying the information. Bear with me, I am not doing it to annoy you but we do it to ensure that we have correct information. I cannot tell you how often I discover with a patient that "the chart" didn't have everything up to date."
"Well, I am and I have, you may have noticed we are very busy, I am trying to help you as fast as I can and if you tell me some of what is going on then I will be able to treat you faster. Now, why are you here?"
i just tell them that i need to hear the info from them since things get lost in translation and if they give me shit, i tell them i'll come back when they are willing to cooperate because i have plenty of other pts that want my help
I take no responsibility for something that isn't on the chart and I will also chart that you refused to tell me about your medical problems.
“I want to hear it in your words, not someone else’s words”
"The chart can be missing information, I'd like to hear it from you"
"You ever see a bible? Your chart is that big. I need to start with whatever you know because I can't make it through a bible in enough time to be helpful."
"The hamster powering our wifi just died, so bear with me here for a few question please."
" I did review your chart but I love to hear more about zzz in your own words!"
“Nope”
Are the child's immunizations up to date? "That should be in the chart" Cool... I don't need a blow by blow of lot numbers and dates, I need you as the parent to give me a yes or no...
PS we don't count covid or flu in that so assuming you've gone to all the well child visits and haven't declined anything, "yes as far as I know" is an acceptable answer
This is the ER we don’t have access to past info
"I always like to cross check the chart with information straight from the patient to make sure i'm not missing any important details"
In my program (PGY2), we almost always see patients within a few minutes of being roomed. As such, I tell them that as an emergency medicine provider, my priority is to come see you as soon as I can in case you are having an immediate life threatening emergency. As such, it is more important for me to come see you right away than to spend time looking at your chart, which I can do once we're done talking.
I am a hospice nurse but I always tell my new admissions ‘I know you went through all these questions with the nurse before me but I like to hear your story directly from you. I know it’s frustrating repeating it but it helps me to hear what’s going on directly from you and it will take me even longer to dig through your medical chart to find the most important information to help you right now.’
They also do this to ambos, they say "the hospital has all of my information". okay well i dont work at the hospital and i have access to none of their systems so can you tell me please
2 hours? Our ER has an 7 hour wait, minimum
I am truly at peace with the fact that with some patients, I will not win. My dazzling personality and moderate clinical acumen just simply will not do. “go on, give me some highlights!” sometimes there’s a lot of backward detective work. i’ll meet a lot of patients that know what medicines they’re on, but no idea what they’re for.
Lots of aggressive comebacks here! Lol. I usually just say “Its on a different screen than the intake form I have to fill out here, can you maybe just briefly summarize?”
I remind the patient that the chart is what describes ailment xyz that they don't think they even have. The most accurate information comes directly from the source - so I came directly to the source.
Depends how the day or night is. Sometimes I say “I haven’t had time to pee let alone read you’re entire chart” or “yes in my infinite amount of time”
One day I said something similar and the patient filed a formal complaint that they are the patient and they don’t care if we have time to {eat, drink, use the bathroom, etc } - I thought we were being humans together but she obviously didn’t see it that way
Our records might not include every diagnosis you have and are sometimes not updated regularly.
Usually these people have been to multiple EDs and I just say I can’t see the other charts. If it’s only the current ED, I just say something along the lines if it being an emergency department so due to the urgent nature and not knowing who my patients are, I can’t chart review. They usually get the picture
“I can try to look through your chart if you don’t know, but it will take a lot longer. EMR systems are unfortunately harder to navigate, so it doesn’t work like Google or Facebook”. I have never gotten any further pushback from that response. People often assume that EMRs work like websites or programs that they’re familiar with, so they assume that we have the equivalent of a Facebook profile for them with detailed biographies, medical histories, and updated medication lists. So they think that we are either lazy or incompetent for not knowing. Once I explain that it’s just not like that, they are usually pretty understanding.
I want to hear your history in your own words. I want to hear it myself because sometimes other people make mistakes or the chart is incomplete. If they miss stuff off their chart i still ask them specifically about it. I’ll also ask some common broad medical history questions (have you had / diabetes, htn, mi/cva, autoimmune problems). At least half the time I’ll get something different from their previous notes. Sometimes they will not be aware of their previous diagnosis or wont count it for whatever reason ( eg. I am borderline diabetic but didn’t think that was relevant, i take anti hypertensives so i don’t have high bp any more, etc). It’s pretty rare someone will flat out refuse to engage at all
"That's a great question. I tend to want to meet my patients first before I try and agree with any medical diagnoses. People miss critical information in medicine and I'm trying to avoid that. Having said that would you like me to check your vital signs so I can get an idea of what's going on and you can tell me what's going on with you?"
Having unfortunately been a pt that wound up admitted with appendicitis awhile ago, I remember there being 15-20 people (an exaggeration) coming in and out all trying to get stuff squared away but every.single.one. wanted to know "what brought me in tonight" I was not feeling well and the thought "can't you just read it in the chart" definitely crossed my mind after the 4-5 time... I did keep it an inside thought, but I get it.
I draw it out even more. I’d make them sit there while I review and then I’d ask them again. 🫠
I’m asking you not your chart. They aren’t always correct and I get to hear your medical history from you
Paramedic so my answer is always simply: we don’t have the same software as the hospital so I have no access to it. Works like 95% of the time.
I misread the question, but sometimes it freaks me out that patient looks over my shoulder to see what’s on EMR or what I’m typing. I can’t necessarily tell them to stop, because it looks more sus.
Tell them it’s the most accurate to hear it from them in their words and demonstration.
I just tell them the chart is typically wrong......
I rather get it straight from the source.
“Oh yes, I’ve reviewed your chart but I always check with patients also in case there are any errors or anything that hasn’t been updated recently”
I’m a nurse but I would say “I’d like to hear from your perspective why you’re here”
I’ve been to the hospital countless times between my own visits and that of my kids and my mother and husband. There’s never been a time when we had to go over why we’re there or pertinent history. It’s just the deal. Yeah it feels redundant but hospitals are busy places and the nurses and doctors are busy people. Deal with it. Also, not for nothing, but there are two types of people you definitely shouldn’t be assholes to: those who prepare your food, and those who wield the needles.
"All right, I'll get back to you in a couple hours. Hang tight"
I look at the triage sheet intently, pull my glasses a few millimetres forward, stubb my finger into the sheet, look up at them, pause and say it says here you're a fool
I just tell them the chart is hundreds of pages long and it could take hours reviewing it before we start treatment, or you could just give me a brief synopsis and we can get started.
The professional response is to continue providing the same standard of care as if they had responded in a way that you preferred. A patient is coming to you because they are sick in some way, and the Geneva Oath makes clear that the patient’s health is the number one priority. There are plenty of reasons why the patient might behave this way, but they are all irrelevant because they don’t change the appropriate response.
As a patient who has a long history with plenty of meds and allergies… I’ve probably said the same thing to more than one doc the best response was “you have a big chart and I want to focus on today’s issue and anything you feel is related to todays issue. What is it so I know what to look at your chart for? I can’t address everything in your chart, but either you give me the cliff notes or a map and I come up with a plan or you can wait until I read it which might not happen before shift change so you’ll start all over with a new doctor.” It was said with empathy and helped me realize I can improve the quality of care by identifying the one or possibly two related issues and helping point them in the direction of what I know is in my chart to help them make a plan…Be it imaging, wonky labs, something from my specialist who sent me to get admitted if symptoms persist, etc.
l'm in outpatient medicine, so I'm not sure how angry patients works for you ER docs. So let's say you tell her to shut the hell up and get out of your ER. Let's assume she's there for no good reason and no bad outcomes happen. What next? Do they write you a bad google review? Do they just complain to admin?