By: The Musing Medic (@TheMusingMedic)
One Night, While Working Triage…
Most of my professional time is spent in the emergency department, specifically floating on the floor or manning the triage office. Of those two places, my favorite is easily triage. There are a fair number of my colleagues that don’t care for triage for a few reasons. The most commonly cited reasons I have heard are too many patients and fear of missing something. While I can respect and understand both those reasons, I think triage houses prime examples of the patient vs customer debate.
I was covering triage for an entire shift the other day and was seeing patients at a high rate, hovering around eight patients per hour on average. Like most days, the majority of these patients were “fast-track worthy” and didn’t constitute a true medical emergency. In other words, they have an inconvenience-type problem rather than an emergency.
A Dental Pain Patient Complains We’re Not As Fast As Fast Food
So I am triaging one patient after another with a majority going from the triage office to the waiting room. The entire department was full that day and the non-urgent cases were forced to bide their time patiently. At one point, a patient who had presented with the complaint of dental pain became somewhat displeased with the length of time they had been waiting, which by my calculation was just less than an hour. This person started out relatively understanding and pleasant but then progressed to downright rude. But that isn’t unusual. We see this all the time. What really stuck with me was when they compared us to a popular fast food restaurant. They mentioned how they never had to wait as long for their dinner as they did to get a medical examination. How do you respond to this?
There is part of me that wishes I could have seen my facial expressions in response to this ridiculous comment. I think any health care worker would have the same response. My handing of the response was as good as could be expected. I conveyed my understanding but kindly refuted the notion that an ED is similar to a fast-food enterprise.
More importantly, this illustrates what John Q. Public thinks the ED does on a daily basis. We are not open 24/7 for every trivial complaint. (Some dental pain patients are very legitimate, yet this one was well known to use a dental pain complaint to attempt to obtain unnecessary narcotics.) We exist to treat diseases and injuries that are either acute or exacerbations of chronic conditions that could result in loss of life or limb.
The ED Isn’t A Fast Food Restaurant
The ED isn’t a fast food restaurant. Do you know how I know? Most fast restaurants aren’t open 24 hours and serving a burger is very different than working on someone who is near death. I mean, come on.
When did patients think they became customers who are entitled to the same customer service that any fast-food restaurant or retailer extends to those who purchase their goods? Why has it gotten to this point? Who allowed it? And what do we do to curb this mindset? There is an issue of expectations that need adjusting.
Want the same level of speed and customer service you get with your burger at noon? Vote for the government to reimburse us so that, at midnight, we have fresh staff who are just waiting to take your order.
Want outcomes that are perfect? Require us to make only 7 meals instead of caring for hundreds of different conditions that vary by the patient’s age, sex, race, level of non-compliance, and a host of other factors.
…or with every dose of morphine we administer should we ask if they would like fries with that?