I don’t understand patients who find it necessary to come to the ED and then reject the professional advice you give. In particular…remember the lady who stabbed herself in the groin? She didn’t want to be admitted for her near fatal wound, she wanted to go home to see her kids. How can they not understand the BIG PICTURE???? That had she aimed a little further left, her kids would have no mother???
Or last night, the fellow who came in after taking a “handful” of tylenol for a headache. A handful ended up being about 50 extra stregth…an easily fatal dose if the antidote is not started in time. I started treatment immediately, and then checked his level, which sure enough was high. He didn’t want to stay in the hospital for treatment. NOrmally, if patient’s wish to leave the hospital “against medical advice”, we don’t stop them, but do make 100% certain that they understand the consequences of leaving, which is usually death or permanant disability. This only works, though, for people who are cabable of understanding and demonstrating that they understand.
I had to be as blunt as possible…”Sir, you could die if you go home. By the time you come back with abdominal pain, it will be too late, your liver will fail, you’ll turn yellow, vomit your insides out and bleed from your nose, mouth, eyeballs and pe-nis.”
OK, I wasn’t quite that blunt, but I did question his ability to comprehend the consequences and therefore his ability to make a decision about his health…and thus told him that if he tried to leave, I would send the police to his house to bring him back to the hospital. He decided to stay.
Finally, there was the woman, third trimester pregnancy, whose significant other had pushed her into the stairs, and she came in with abdominal pain, back pain and spotting. She did not want to stay for the recommended 4 hours of fetal monitoring. She was at risk for going into pre-term labor, she understood what this meant, but still did not want to stay. I convinced her to at least go to L&D to have the monitors put on, and she could then leave if she wanted to.
Why do they even come to see us if they’d rather put their lives in danger? Just stay home then!