Why ER Visits Need To Be Appropriate

Here is an example sent in by a reader.   If patients don’t understand or abuse our healthcare system then these types of visits happen. 

EMERGENCY DEPARTMENT CLINICAL COURSE AND DECISION MAKING: This is an 18-year-old female who presents to the emergency department with headache. After I have spoke to her for a while, she says that yesterday she took an ibuproven when she had a headache and it got better. She reports that she has run out of ibuprofen and reportedly has no money to buy more ibuprofen. She says that this is because she just bought a new truck and she does not have any money to spend at the pharmacy. She says the she has therefore come to the emergency department to obtain some ibuprofen. She does not feel that she needs anything stronger than this. She is requesting some ibuprofen and some to go home with. I certainly do not feel that the patient has any acute infectious symptoms. I do not have any concern for meningitis. Rather, I feel that this is a simple headache. I have advised her to return to the emergency department for any acute concerns and she does agree to these plans.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  15 comments for “Why ER Visits Need To Be Appropriate

  1. C. McVea
    January 20, 2012 at 7:15 pm

    This is why I love corrections medicine. If someone pulls a stunt like that, I get to lock him up for malingering.

  2. Dr. Jay
    January 18, 2012 at 5:52 pm

    I saw a 25 year old guy the other who hit a dresser with his fist, and came in because he wanted a bandaid for his hand. It happens.


  3. George Jacobs, M.D.
    January 7, 2012 at 12:55 pm

    When I was an intern doing a peds rotation at the local children’s hospital a woman brought her child in by ambulance. The reason: he vomited. Why the ambulance? He had never vomited before.

  4. Allen Dennison
    January 4, 2012 at 11:16 pm

    Did you know that the Motto of Harvard’s Brigham and Women’s Hospital OB-GYN Department is:


    (40 years old but still worth repeating)

  5. andrew eisenberg
    January 4, 2012 at 9:31 am

    The real tragedy is that these patients will be called the following day by the third party consultants and determine that the patients were unhappy with their care and better ‘patient relations protocols’ need to be instituted!

  6. George Voigtlander
    January 2, 2012 at 9:04 pm

    I saw a woman who called for an ambulance for an unspecified “emergency”. The EMTs brought the woman to the ED. She was furious because she wanted to be taken to her hairdresser and she felt lights and sirens were warranted since she was late for her permanent. She left AMA. What is the ICD9 for lack of curls?

    • Doug Farrago
      January 3, 2012 at 5:08 am

      That can’t be a serious? Did that really happen?

      • George Voigtlander
        January 4, 2012 at 1:50 pm

        Really happened.

      • scott
        January 4, 2012 at 11:08 pm

        happens all the time. The problem is that WE don’t the healthcare system. If tylenol costs $3-4 at the pharmacy, but you can get it for free with a prescription and a medicaid card, why would you ever pay for it? More egregious, but no less financially sound is a person who has no ready means of transport, but wants to visit her friend on the other side of town. A taxi costs $10 (or more at night) while calling an ambulance is faster and free.

        • Geoff
          January 5, 2012 at 6:56 pm

          This mode of of arrival is known as a “Cabulance.” Wish I’d made that word up, but I got it from Medics I worked with in South Bend.

    • Karen Heljula
      January 4, 2012 at 9:00 am

      There probably IS an ICD10 for lack of curls

    • Jim Bradley
      January 4, 2012 at 10:17 pm

      I think that someone that pulls that sort of stunt deserves to have a 48 hour psych evaluation. She was obviously delusional.

  7. December 31, 2011 at 6:59 pm

    How many examples like this does it take until the government agencies with all of these bright ideas of how to make the system more effective and efficient start to listen to Emergency Medicine doctors and nurses, who could provide a lot of input about how to cap our spiraling health care costs without hurting people!

  8. Kris Morin
    December 31, 2011 at 9:07 am

    This is not uncommon. I’ve had a young woman come to the ER by ambulance for acetaminophen. Another patient was rushed in by EMS for “acute asthma attack.” Upon arrival she told me that she was smoking while bicycling and had forgotten her inhaler. The worst of these was a patient rushed to the ER for “acute kidney pain.” She had been walking in the woods and called EMS on her cellular saying that her her kidneys were “gonna explode!” Upon arrival she lept off the stretcher and ran into the bathroom to relieve her full bladder.

  9. Rusty Shackleford
    December 30, 2011 at 11:05 pm

    Wow. What a professional.

    Our ED docs would have been paging the hospitalist service to admit her.

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