I have learned that Emergency medicine often has a hefty amount of psychiatry in every single shift. True psychiatric illness is devastating. Fake psychiatric illness pisses me off.
For example, of all of the patients I saw this evening, over 75% of my patients had psychiatric problems, even if they were not listed in the primary chief complaint.
One patient had a GI bleed, which partially stemmed from his many years of alcoholism and very poor life choices (crack, heroine, alcohol, and paint-thinner seems to add up after a while).
Another three had suicidal thoughts, though all these fine young citizens also enjoyed drinking 2 beers (all only had two, how weird, since my blood alcohol after two beers does not normally go to seven times the legal driving limit after two beers).
However, the difficult ones are those that have amazingly obvious, painfully obtrusive personality disorders that everyone can see but the patient. I don’t like to generalize (this is of course a lie, but it’s a nice thing to say), but every single one of these patients is a 30 year old obese female who comes in holding some sort of lovie (teddy bear, blanket, soft rabbit), who has a family member who continuously reinforces their helplessness. They all have about 200 different vague complaints that can never be confirmed and all their labs come back negative since they never have anything wrong with them. Oh, and 98% have fibromyalgia, always fibromyalgia. I’m starting to think that it might be contagious, and that possibly one side effect of fibromylagia is an immediate and precipitous decline in the patients IQ.
Me (looking like a stud): What seems to be the problem?
Her (stroking a dilapidated one-eyed teddy bear): I’m having a panic attack and seizures.
Me (appearing concerned): Oh? When did it start?
Her (seemingly calm): It started about two years ago. Oh, wait, here comes one now (she then blinks rapidly for two seconds) Whew!, OK, I made it. I need help.
Me (flag down on the field): So you are here for the, uh, seizures or the panic attacks?
Her: Both. And my allergy to aspartame is acting up. It’s so bad that I can’t even let my sister sleep, I have to keep waking her up.
Sister (seemingly also concerned): She sure is anxious, you need to fix it.
Me: So what is different today?
Her: What do you mean?
Sister: Uh oh! There goes another seizure.
Her: Oh, you’re right, I’m having another seizure (she wiggles her fingers for ten seconds). Whew, OK, I’m better now, aren’t I?
Her: Can you fix me?
Me: I’m pretty sure I can fix you. But the therapy involves living in Antarctica for 40 years. It has done wonders for my other patients.
I think I know what bothers me the most. Patients that have true psychiatric disorders requiring help cause me little frustration. I can empathize and always help them to the best of my abilities. However, when a patient’s problem stems from their own attention seeking behavior, it irks me.
I can’t fix the choices you make.
I can’t fix whininess.