The Tag-A-Long
Occasionally, two people will arrive together to be evaluated in the ER. Unless the chief complaint is "S/P MVA" (status post motor vehicle accident) or "fever," then one of these patients will usually have some sort of acute medical problem and the other patient will be what I call the tag-a-long.
The tag-a-long patient would not usually seek medical attention at all for their minor ailment, much less in an Emergency Department. But their daughter was vomiting or their friend got cut with a beer bottle or their father was having chest pain, so they figure they might as well sign in to get checked out for that nagging tickle in their throat they have had for the last couple of weeks. Or their discharge. Or their diarrhea.
I like to know when two people arrive together with unrelated complaints, because if one of them signs in with a laceration, then I can usually afford to adjust the sensitivity of my life-threaten-o-meter for the other patient a little bit. Not that diarrhea is usually life-threatening anyway, but if you are a tag-a-long, you're more likely to get the medical screening exam sort of workup than the full-meal deal.
Because I hate tag-a-longs.
Sometimes it's hard to decide which is the "sick" patient and which is the tag-a-long, so I'll ask them. Let's see... you have a migraine, and your sister here has chest pain. Did your sister initially decide to seek care, and since you were going to be here for a while anyway, you decided your migraine was finally bad enough to require emergency treatment? Or was your sister just keeping you company while you were treated for your migraine, so while she was here she decided to get her chest pain checked out just for the heck of it too? What are the chances that you have an intracranial hemorrhage and your sister has a pulmonary embolism at the same time? That would be freaky, wouldn't it?
The tag-a-long patient would not usually seek medical attention at all for their minor ailment, much less in an Emergency Department. But their daughter was vomiting or their friend got cut with a beer bottle or their father was having chest pain, so they figure they might as well sign in to get checked out for that nagging tickle in their throat they have had for the last couple of weeks. Or their discharge. Or their diarrhea.
I like to know when two people arrive together with unrelated complaints, because if one of them signs in with a laceration, then I can usually afford to adjust the sensitivity of my life-threaten-o-meter for the other patient a little bit. Not that diarrhea is usually life-threatening anyway, but if you are a tag-a-long, you're more likely to get the medical screening exam sort of workup than the full-meal deal.
Because I hate tag-a-longs.
Sometimes it's hard to decide which is the "sick" patient and which is the tag-a-long, so I'll ask them. Let's see... you have a migraine, and your sister here has chest pain. Did your sister initially decide to seek care, and since you were going to be here for a while anyway, you decided your migraine was finally bad enough to require emergency treatment? Or was your sister just keeping you company while you were treated for your migraine, so while she was here she decided to get her chest pain checked out just for the heck of it too? What are the chances that you have an intracranial hemorrhage and your sister has a pulmonary embolism at the same time? That would be freaky, wouldn't it?
posted by scalpel at 6:55 AM
9 Comments:
I hate tag-a-longs too. Tag-a-longs are almost worst than "I have three problems tonight," "No, no" I want to scream - "one problem, that is the limit". But at least tag-a-longs sign in as a patient and are there legitamately - not like the "two for ones" who try to get some advise for the wife about her knee while you are sewing up hubby"
Not to be confused with Tagalog, which is the language spoken by most of your nurses.
BTW, check the registration time stamped on the demographic page, or just ask whoever's at the triage desk which one was first.
Oh, and one more thing: be sure to put them in separate rooms as far apart as possible, and make the less emergent one wait forever. Never let them think that just because they came in together they'll be seen together. They'll get the point...or not.
Good Monday morning Scalpel,
Playpus said it well...
The probability of *any* patient having an acute medical problem varies inversely with the number of patients checking in together.
This is a fundamental Law of Emergency medicine.
scalpel, i hope you don't mind a little self-promotion here but i posted on this before and have a mathematical formula that i'm hoping to validate in a large meta-analysis. the link to my theormen is here, please let me know what you think. i know you will share my pain.
911doc
http://docsontheweb.blogspot.com/2007/03/family-plan-inverse-proportionality.html
I believe your theory is correct.
Tag-alongs are slightly different than family plans, but your theory no doubt applies to them as well.
Ahhh, the family plan. Mom with vaginal discharge brings in her 6 satan-like children and decides to sign them in for sniffles. How are you supposed to do a pelvic on mom with all her kids in the room? and they spend all their time in the ER running up and down the halls and going through the doors and cupboards in the room.
I've got a similar theory about multipe unrelated complaints...abdominal pain/knee pain, etc
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