Tuesday, August 16, 2005

Oh, the Games People Play

I never knew this game existed until I did a web search for the character! There are actually pristine, unopened Cherry Ames games on eBay.
No, I didn't buy one. Seventy-five dollars is a wee bit too much to pay, although I did spend that much on a vintage Barbie outfit about ten years ago. Hey, it came with the original shoes and Barbie fans know it's all about the shoes!

Those who study human behavior should spend a shift in the emergency department. The games played in the ER make the Olympics look like a tetherball tournament. Some of the participants are patients and some are staff. Some are gold-medalists in their specialty and some arrive a few feet short of a full balance beam. Let's take a look at "The Emergency Olympic Games":

"The Suck-Up"
Usually the player is suffering from an acute lack of an opiate prescription for chronic pain symptoms with a nebulous origin for which they have not been evaluated by a doctor but they have an appointment with a specialist next week but they ran out of their Vicodin and they just cannot bear it. Said patient is overwhelmingly complimentary to Team Nursing . The targeted nurse is SO much nicer than any other nurse anywhere in the whole world and gee, that other nurse was so rude they wish ALL nurses were just like you! These compliments are dispensed within 3.5 seconds of spotting the nurse, often making said RN feel an acute need for a shower. The player realizes she is out of medal contention when the targeted nurse responds with, "Gee, thanks, but I just came in to get a Betadine swab...."

" Mean Medical Matchup"

This game is closely related to the Suck-Up, utilizing the same team. Player has been evaluated by the ER doctor, who, having the audacity to disbelieve their story, has gone for the gold and verbalized his lack of belief to the patient. Bottom line: no prescription. The patient prepares for this event with the "Which Doctor is On Tonight?" drill, using a telephone to assess the playing field before engaging the opponent.

"Peek-a-Boo Bypass"
This event requires a large team that converges on the patient's playing field soon after the patients arrival. Anyone can make the Peek-a-Boo team, although it is usually composed of family members and friends of many generations. Upon arrival, Team Nursing announces the event rule: only two members of the Peek-a-Boo team on the field at a time. This is met with a courteous response and extraneous members go to the bench in the waiting room, where the goal is getting back onto the playing field without Team Nursing noticing. This is accomplished by one Peek-a-Boo team member returning to the patient at a time until the bedside number has quadrupled. Stealth and dexterity are assets to this goal. Occasionally Team Security will act as referee.

"The Two Guy Offense"
The preliminaries for this event take place off the Emergency Stadium grounds. The player reports a spontaneous assault by Team Two Guys. The members of this team are always unknown to the patient and the initiation of contact always unprovoked. The goal of Team Patient is to obtain care from Team Medical with minimal disclosure of the playbook. The involvement of Team Police is always declined as so as not to incur a penalty. Team Two Guys apparently has many expansion franchises.

"The Two Beer Defense"
Team Patient enters the arena via Team Paramedic, having received a report of "player down" on the sidelines of a local Team Seven-Eleven. Team Patient arrives supine on a movable gamepiece.Upon arrival in ER Stadium, body fluids are released for assessment by Team Nursing who immediately take defensive positions. Performance-enhancing ETOH is suspected as the characterisic Odor Offense is noted. Team Medical waits for the Designated Cleaners and takes the field. Minimal interaction takes place between the teams for many hours at which point Team Patient verbalizes that he only had "two beers". Team Medical knows to multiply this number by 58. Team Patient is taken out of the medals race on a credibility technicality.

"The Decible Debate"
Team Patient attempts to propel themselves off the bench and onto the playing field by increasing their verbal intensity. Team Nursing counters with internal auditory blocking mechanisms. The goal: Team Patient enters playing field at appropriate interval. Team Patient rarely medals in this event.

"The Titanic Panic"
Team Patient arrives, usually via Team Paramedic, complaining of numbness, chest pain, shortness of breath and near-syncope occurring at the preliminary event at Home Arena which involved a "Decible Debate" with another member of Team Family. The Peek-a-Boo team arrives to act as cheerleaders for the event. No medal is awarded, as the full cardiac work-up that ensues turns out to be negative. An Acadamy Award nomination, however, would be appropriate.

These are just some of the Emergency Olympic events to which I have a front row seat and perpetual season tickets......


At 8/17/2005 08:36:00 PM, Blogger Gypsybobocowgirl said...

Loved it!

You forgot the Fall Down Patient that arrives with a minimum of a black eye and anxious spouse (who moonlights as a member of the Two Guy's team).

At 8/17/2005 08:37:00 PM, Blogger Gypsybobocowgirl said...

And, you are featured on today's grand rounds :)

At 8/17/2005 09:08:00 PM, Blogger kenju said...

Too funny! Sometimes I wish I still worked in a hospital, so I could be privy to these games first-hand!

At 8/17/2005 10:54:00 PM, Blogger Kim said...

My goodness - I never expected to get "featured" anywhere and Circadiana is such a great site! Whoo Hoo! And I did forget the Fall Down Patient - we could call that game "The Horizontal Challenge"

At 8/18/2005 04:34:00 AM, Anonymous Anonymous said...

It seems a bit harsh to decide that the patient who presents with chest pains and shortness of breath is merely faking it. There are genuine medical problems with those symptoms that don't involve cardiac trace abnormalities. There's also the good old panic attack, which - contrary to your assertion - is not faked, is not voluntary, and is genuinely terrifying to the sufferer. I hope that you don't allow your callousness to negatively affect your professional duty to your patients.

At 8/18/2005 10:09:00 AM, Blogger Kim said...

I was concerned that some of my posts might seem callous to someone who may be outside the profession. I'm using extreme exaggeration for the purpose of humor. Thank you for giving me a chance to clarify. I love my job and my patients and I think this will become apparent with subsequent posting.

At 8/18/2005 12:17:00 PM, Blogger Third Degree Nurse said...

Good stuff! I love nurses who tell the truth about how it is. Mind if I link?

At 8/18/2005 01:10:00 PM, Blogger Kim said...

Not at all! Thanks!

At 8/24/2005 05:00:00 AM, Anonymous Catherine said...

Here's a game as seen from the patients in the ER waiting room. I call it:

ER Cash Cow

Team Administration discontinues the Urgent Care clinic, which sees patients with non-emergency problems . . . and whose co-pay is only $5-$10. This closure forces the non-emergency patients to seek treatment in the ER. Upon entering the ER waiting room, the non-emergency patient checks in at the desk, then is whisked back to the triage area. Within 5-10 minutes, said patient is sent back out into the waiting room. S/he no sooner sits down, when s/he is called back up to the ER front counter, at which time Team ER Clerk requests immediate payment of a $50 ER visit co-pay (which is only refunded if the patient is admitted to the hospital). Said patient pays, then sits back down to wait . . . and wait . . . and wait. But because her/his illness is deemed a non-emergency, s/he never gets called to see a doctor and ends up leaving (in the hospital's viewpoint) AMA, with their $50 co-pay non-refundable.

Tinkling MUZAK can be heard playing in the background: Cha-ching, cha-ching, cha-ching . . .

I witnessed this phenomenon first hand one evening during a four-hour wait in the ER. Not ONE person was called back to be seen by a doctor. Every hour, the crowd in the waiting room seemed to turn over by about 25% as people just got tired of waiting and left, only to be replaced by other poor snooks who would be fleeced out of their hard-earned money.

I fully understand and support the concept of ER triage, with the most ill patients being seen first, regardless of the time they enter the ER system, but there must be a better way for HMOs to handle non-emergency patients.

Sorry for the long rant, but patients have a side, too.

P.S. Love your blog! Keep up the good work!

At 8/24/2005 03:26:00 PM, Blogger Kim said...

Catherine, that was great - you hit it right on the head. I'm fortunate to work in an ER that is noted for short waiting times, but when it does get bad, the triage nurse should be keeping the folks in the waiting room informed about how long the wait will be and why. And I can't believe you don't get the co-pay back if you aren't seen!!! That is not right. In our hospital, if you leave before seeing the doctor, it isn't "AMA", we designate it "Left Without Being Seen". I'll be doing some posting from the patient's point of view; after all, we're all patients at one time or another.


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