The Medical Screening Exam
"I cut my arm on something. I thought it might need stitches."
No, it doesn't need stitches. Just wash it with soap and water and put a BandAid on it.
"Are you sure? I don't want it to get infected or leave a scar."
Yes, I'm sure. It barely broke the skin. I can't make it heal any better than it's going to already.
"Well, it sure bled a lot."
It's not bleeding now. In fact, it's almost healed. When did it happen?
"Yesterday."
Oh. Well, just keep it clean and bandaged, and you'll be fine.
"Can you look at my toenail then?"
Sure...you've got a fungal infection of your toenail. Looks like it's been there for a while. You should see your doctor and he can prescribe some medication for it. That will take months to heal, so it's best treated by your regular physician.
"Is that all? You aren't going to do anything for me?"
I gave you proper medical advice. Sometimes that's all I can do. Good night.
"Can I get a work excuse?"
Labels: patients
posted by scalpel at 10:51 PM
18 Comments:
A friend of mine who works in corporate America and is often in charge of reading such work excuses gets a great kick out of the ones clearly written by ER docs who've been jerked around. "Toe fungus" might provide a few moments of laughter for her, and weeks of jokes as she walks past the patient's cubicle.....
"I cut my arm on something. I thought it might need stitches."
The guy needs something,but its not stitches...
No script for Lortab? I'm sure he was in horrible pain from that life-threatening laceration and the equally life-threatening fungal infection.....
Mean, mean Scalpel.
So, how did you respond to his request for his freakin' work excuse:-)
Classic!
Excuse From Work or School:
Mr. Sensitive was seen in the Emergency Department on this date and may return to work immediately with the following restrictions:
keep wound bandaged.
So, here's an honest question: how does one know if a cut or something needs stitches? Is there some sort of general rule?
(I was in a VERY minor accident, and cut up my elbow. I washed it off, and thought it was okay to just bandage up, but my friend insisted I go to the school clinic. Turned out I needed 8 stitches, so not huge, but... Good friend! But how should I have known?)
I got hauled into the office for unbandaging that same arm on someone. The patient said, "Oh, it looks much better now. I think I'm going to go." I told the patient I agreed, verified that his tetanus was current and he left without being seen. The boss told me I was practicing medicine without a license by not insisting he stay and wait for the doctor. Maybe that's true, but come on.
"How does one know if a cut or something needs stitches? Is there some sort of general rule?"
Good question. Here are some general guidelines. When in doubt, seek medical attention. I would rather you come in and have a quick uncomplicated visit than stay home and not get proper care. Most people don't clean their wounds adequately at home, and at least we will do that for you under anesthetic if required, even if we don't suture your wound.
How did you go about asking him if you could take a picture?
I just ask "Do you mind if I take a picture?"
Hehehe.
Nobody's ever said no.
anon --
Coming from someone with a long history of self-harm:
You will generally know if you *need* stitches.
Most stitching is optional. It reduces scaring and the possibility of infection.
That is, you're probably not going to bleed to death.
Proper use of butterfly/steri-strips will often do the same thing as a few stitches. Just keep the damn thing clean with some soap and guaze.
Scalpel's answer surprises me, since we all know how many uninsured/medicaid folks come into the ER with wounds that really don't need to be sutured. Think of the money!
They always want that work excuse don't they?
Yes, I thought of the injury being self-inflicted, too. I'm sure they wanted both a work excuse AND the Lortab. And the desire for sutures would have provided a nice dramatic touch and given more credence to that work excuse, given them the opportunity for a second work excuse when they returned to the ER for the suture removal....
Bohemian Road Nurse --
Doubtful. Said person would also want a psych eval as well. :) Plus, any SI'er worth their salt would know that you can take out your own stitches with a pair of nail scissors. Duh.
This is a great piece...love it..I am brand new to the world of blogging and was visiting some physician blogs to see wat people write abt...I am finishing up my IM residency in exactly 16 days from tdy (yes cant wait!!!)..I was doing ER last mth and probably for the first time really appreciated ER docs for all the midnight rashes, vaginal bleeds and drunk psychos they have to deal with on a daily basis...so I am kind of glad its not just us...(although fibromyalgia probably beats anythg hands down!)....now i have reached a point where I dont even think I have the energy to fight if some drug seeker is asking for narcs (sure man, as long as you get out of my hair)...anyways this is it for now...check out my blog...and let me know wat u thk!
back in singapore, especially those who have been through the military conscript process, we fondly call it "CHAO KENG".
it means pretending to be sick, faking symptoms, etc, just so that you need not participate in activities that you don't fancy, like a 5km run, or a SOC (standard obstacle course) session, some other physical training, and perhaps some military-related exercises (like field camps, etc.)
it turns out that we as commanders play important roles in reducing "CHAO KENG" conscripts and hence their "REPORT SICK" rates at the medical centre. Soldier contentment and sense of purpose in a mandatory 2 year period of military service, depriving them of additional income outside, or delaying their further education, are common issues. They are not easily dealt with.
While there are classifications to how sick you are, and military laws to guard against malingering, it has not deterred the CHAO-KENG-ers.
And this CHAO-KENG syndrome can be applied to many cases outside the military as well! Sometimes people just want to take a break from work. While there may not be a pressing medical problem, perhaps when we consider the psycho-social aspect, the patient could have discontentment at work, signs of depression, and maybe even self-inflicted injury to get a work certificate.
Just to add a little social view to this discussion.
Remember the key word:
CHAO KENG.
(it's Hokkien, one of the dialects of the Chinese language)
funny
nicely written..or quoted:)
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