This is What We Do

Abdominal pain.  Seriously.  Pick up the chart from the rack and read, “Abdominal pain,” and I can almost guarantee that I want to just put it back and skip to the next chart.  But, as a single provider, eventually I will have to see the patient, so why put off the inevitable?

What makes abdominal pain such a, well, pain?  Sure it can be due to an infinite number of reasons.  But, what I find so frustrating is that some patients can’t accept it when we tell them we can’t find a cause.
“But I have pain.”
I nod, “I acknowledge that you feel pain.  It’s just that your physical exam, labs, abdominal series, ultrasound, and Cat Scan don’t identify a reason for your need for Q 1 hour Dilaudid and Zofran/Phenergan.”
“But nothing else works, and it’s been going on for 6 months now.”
“Well, I can tell you I don’t see: an ectopic, an ovarian cyst, ovarian torsion, a hernia, free fluid in the pelvis, a small or large bowel obstruction, constipation, volvulus, diverticulosis, diverticulitis, colitis, appendicitis, cholecystitis, gastritis, or malignancy.  Oh, and you don’t have a bladder infection.”
“Well, I can’t go home like this.  Why can’t you tell me what’s wrong with me?”
” This is what emergency medicine doctors do.  We make sure there is nothing acute, ie. an emergency, that needs to be taken care of right now.  The rest of the work-up needs to be done by your primary care physician.”
“Well, he didn’t find anything on the upper GI, ERCP, colonoscopy, or Cat Scan he did last week.  Which I didn’t mention because I thought you might suggest something different.”
Deep inside a small part of me dies while I start to contemplate becoming a professional underwater basket weaver….
**as a small pat on the back to myself, my video on Incision and Loop Drainage for abscesses was included in the article in EMRA entitled, ” 2011 Clinical Advances:  The Five Developments That Could Change How Emergency Physicians Care for Patients in 2011 and Beyond.”  Feel free to email me if you have any questions.
  1. #1 by Ryan - April 19th, 2011 at 15:02

    Thanks for the information, I will make sure to pass this along to my good friend who can benefit from this.

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