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Monday, March 25, 2013

Oh, No. . . Please Stop. . .

. . . talking, that is.

I really don't need to hear all about your day in order for you to tell me what is wrong right now.  Please, for the love of all that is Holy, please just get to the point.

Usually, when triaging, patients are fairly cooperative.  They answer questions.  If I need more information, then I ask them further questions.  It's a simple system, really.  I ask.  You answer.  I walk out of room (we use a "pull 'til full" system).  Simple.

Usually, when I go in to a room to triage, I introduce myself, explain what I'm doing (triage process), then start with the question, "So, what brings you in today?"

The answer is usually, "I'm seeking drugs."  Ok, that's not usually the answer they say, but it is usually short and sweet like that.  "My leg hurts."  Or, "I've been throwing up."  You get the point.

Sometimes, though, the patient starts with what they ate for breakfast, what route they took to work today, why they were fifteen minutes late, who they had messages from on their desk phone, etc.  Finally, they get to the point.  It's an art as an emergency nurse or doc to get past all this crap and get the person to get to the point without threatening our beloved Press-Ganey scores.  Most, I think, are pretty decent at doing this.  However, every now and then, there is that one guy.

The one that no matter how much you hold up your hand and say, "Sir, so please tell me what brought you in today," they continue down their rabbit hole.  On and on and on.  The guy that causes the doc, lab tech, or x-ray tech to give you a pleading look as you walk by, hoping that you can please just bail them out from this conversation.  The guy who causes you to, prior to starting an IV or other procedure, ask the unit clerk to page you over the intercom a few minutes into you entering the room.

The point of all this?  Please, please, please just answer the questions.  I have others to triage. . .


  1. "Sir/Ma'am,

    I'm sorry to interrupt you, but we're really busy tonight. So I'm going to ask you, in the next ten seconds, to tell me what you came here to have us address/fix. At 11 seconds, you're going back outside, and I'm calling the next patient, and you'll be waiting until I'm not busy to be called back in. We usually stop being busy around 4 AM. It's 8 PM now. So, last chance, why are you here tonight?"

    I've gotten the actual reason 75% of the time, and the other 25% of the time, I've ended the torture, with that approach. I highly recommend it. Great blog!

  2. Lol. Love the approach. Unfortunately, with such a focus on Press-Ganey scores these days, I'd be out on my ass in a heartbeat.

  3. May i ask why vomiting would be drug seeking? I am not gonna go off on a tantrum saying why severe stomach disease is looked at like drug seeking behavior. Or why do people with documented illness are treated so bad?