The medical student presented the case of an infant with nasal congestion for 2 days. Based on the history and exam findings, it sounded like a baby with a mild cold. “So why did they come to the ER?” I asked. Perhaps assuming that, like so many emergency department veterans, I meant this as an indication of irritation with an abuse of the system, he replied, “I don’t know. It does seem pretty unnecessary.”
“No,” I answered, “they have a reason. Everyone on the planet has something better to do than to come to the Children’s Hospital ER. If it doesn’t make sense to you, then you need to dig harder. Our job is to find out why they are here and to make sure we address that reason. Go back and see if you can find out more.”
The student returned a few minutes later, a bit exasperated. “I tried to get some more details, but couldn’t really sort it out. The mom isn’t a great historian.”
“Actually,” I said, “the mother is the primary source. We are the historians. Never blame the patient or family for our inability to interpret the facts.”
I will never forget my experience as a fourth-year medical student. On medicine rounds, we were discussing a patient who was not responding as expected to the prescribed treatment. The attending physician asked me how I would explain that. “I suppose he could be non-compliant with his medications,” I ventured. The intern and senior resident nodded. “Congratulations,” the attending said. “You’re clearly ready to be a doctor – your first reaction is to blame the patient.” We were all embarrassed into a prolonged and uncomfortable silence.
People always have a reason for seeking our services. Contrary to what some of the most jaded people say, it’s never to get a free popsicle or to watch our TV. Neither is worth a 2-3 hour wait. Sometimes it’s simply a matter of knowledge. Most people who bring their child to an ER believe it’s an emergency. Those of us with specific expertise and training can’t apply our standards to judge whether someone “needed” to come in. (I hope my car mechanic doesn’t roll his eyes at me for bringing in my car for what turns out to be a benign noise, when I thought for sure the brakes were about to fail.) In that case, a little education can go a long way toward helping both the child and the parents.
Other times, the physical complaints are not the real motivation for seeking help. In the case of the baby with the cold, it turned out that the mother had run out of money and couldn’t afford to buy the bulb syringe that her doctor had recommended over the phone. In my years of working in the emergency department, I’ve seen parents who were out of food for their child, who were victims of domestic violence, who were suffering from schizophrenia. No one asks to be in those situations. What they are asking for is help. Living our value of purpose means finding out what our patients’ needs are and working to meet them. Without judging.