But why did you come today!?!?!

So...my patience for patients continues to dwindle. Working in an inner city emergency department is challenging in so many ways: emotionally, physically, mentally, and flabergasterdly (probably not a word, but it suits how the last few shifts have made me feel).

"Hi, I'm Dr. Pheysey, how can I help you today"
"Why are you all up in my business?"
"Because if you don't tell me what's wrong I can't help you."
"I don't need your help. Do you think I'm stupid or something?"
"That's not relevant right now. If you won't tell me why you are here I'm going to have to ask you to leave. I've got many other patients that are willing to let me help them. If you don't want my help that is fine. I'll respect your wishes."
"F$#k you. I'm leaving."
"OK, please sign this form that you are leaving against medical advice and understand that I was not able to evaluate or treat you and you take full responsibilty for your actions and those actions could lead to permanent disability or death."
"I'm not signing nothing."
"So then how can I help you?"

And so the loop begins again.

I consider myself fortunate to never have required the services of an emergency department. I dislike going to the doctor and understand how vulnerable it can make you feel. I am lucky to be there for so many (usually feels like too many) people at a time of crisis. I just wish that the definition of crisis for downtown Detroiters was the same as mine.

Today my shift ran the gamut from: "I had a cold last week and need a work note."; a cardiac arrest from smoke inhalation during a fire in a crack house; to telling a parent that his son was in critical condition with a depressed skull fracture and bleeding in his brain from getting pistol whipped. The family members of the patient who died in the fire and those of the critically ill 19 year old were much more appreciative and understanding then the fussy patient who I would only give tylenol for their headache or the sickle cell patient that comes twice a day that I refused to give narcotics too.

I often wonder what emergency medicine is like in suburbia. All of my training in medical school and residency has been in underserved urban areas where drugs, violence, and lack of education rule. I try to teach each patient the importance of taking care of themselves but it never feels like it sinks in. I find myself asking almost every patient "but why did you come in today" and "if you refuse to take care of yourself everyday, what can I do for you in only one visit today?" Am I becoming more bold in my attempt to educate, or just a calloused jerk? I would hope for the first but often feel like the last.