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On "unnecessary" ED visits: background reading

Here are a bunch of very informative pieces on why trying to blame excessive costs or busy-ness on low acuity patients in the ED is, at be...

April 9, 2014

"Don't Be an Idiot"

This is exactly one of the best lessons I learned in med school was from a young attending neurologist (who also used to cite studies in her patients' charts). I forget exactly which precise neurologic phenomena she was referring to, basically the lesson is to not use jargon when you don't need to.

For example, if you say "dysphagia" and you really mean "odynophagia" (which people do all the time), you are flat out wrong. The person you're talking to will a) think you're an idiot or b) get the wrong message from you. And even if you are right, they might c) misinterpret what you say, because jargon.

But if you say "it hurts when he swallows" then everyone knows what you're talking about.

Similarly, in actual clinical ED care*, I was taught to not use GCS numbers. Instead, give a narrative: "he's intubated, not opening his eyes, and extending from stimuli." Avoids misremembering the scale, miscounting, miscalculating, and miscommunication. And in most cases when we're talking about GCS, people on both side of the conversation are under some level of stress, so it's 15 fewer things to worry about.

*but not on exams