I don't work in an ER anymore

It is getting to the point of ridiculousness with the tests that are ordered in the emergency departments.  I mean for shits sake PET scans, stress tests, CT cardiac angios.  MRIs are commonplace.  Its like the hospital purchased all this shit so it has to be  used.  Here's the thing, when you are ordering all these sophisticated tests, people stay for hours on end in the ER, taking up beds.

Don't even get me started on the 20 fricking orders for every patient that comes in.  I mean seriously if you have a stubbed toe you get an IV and dilaudid and maybe a little zofran for your probable nausea.  We are no longer an ER but a outpatient high acuity med/surg/tele/neuro diagnostic unit.

These days there are 3 groups of people who use ERs on a regular basis:

1) elderly people
2) poor people who use us as a clinic
3) the chronically ill

The other people are going elsewhere, either to their doctors or urgent care.  Urgent cares are popping up left and right.  It seems like we are not getting much of the smaller trauma like fractures, lacerations, minor MVAs anymore.

I mean lets just call this what it is.  It isn't emergency medicine anymore

an ER nurses advice about the approaching cold and flu season..

welcome to triage....

Jus' when you think you seen it all...

Yup. Seen it all..nope. Patient presents accompanied by their own home literally. I shit you not. My patient presents because everybody is against them and cruel to them and life ain't fair, etc etc etc. And my living situation has not worked out and NOWYOUHAVETOHELPME and SAVEME and GIVEMEABEDANDMEALS because EVERYBODYISOUTTOGETME.

Did I mention the patient came by ambulance? Did I mention that they came with all their worldly possessions? We are talking suitcases and boxes and animal paraphanalia and other assorted junk that is so much it has to be put out in the triage area along a wall and is probably 10 feet wide and five feet high worth of stuff. It could have fit in a small moving van.

Now I have seen people bring in some shit - especially those of the mental health persuasion - they pack a couple of suitcases, a 24 pack of diet pepsi..but this was one for the records books.

My question is: How did they fit it all in the ambulance? Never got a chance to ask. Was patient admitted? I dunno. I left before that happened.

am I dreaming?

"One person dies every 19 minutes from a prescription drug overdose in the United States." "Approximately 80% of the world's pain pills are consumed in the United States, according to 2011 congressional testimony...."  This from an article on CNN today. 

The article talks about a proposal by the FDA to tighten control of our old friend Vicodin (aka Lortab, hydrocodone).  It would no longer be possible for docs to prescribe the drug and refills for months.  The patient would have to go back to the doctor for refills.  Wow...what a concept.  It also moves it from schedule 3 drug to schedule 2 drug which would put more restrictions on its use. 

Its funny, because a couple of months ago I was having this very discussion with one of our docs about this problem and what could be done about it.  Her answer:  "Who am I to judge whether someone is having pain or not?" The typical cop out. So I told her that the only way this problem will slow down is for the government to regulate it.  An lo and behold...its happening. 

How will this affect the ER? Who knows.  Might not change much.  Docs only give out a small amount by prescription anyway.  However, they may be less apt to prescribe it now with the restrictions 

What a pathetic commentary on doctors in this country who are responsible for this epidemic (Ain't no one else writing those scripts).  They couldn't regulate themselves so the government has to regulate them.