ER Doctors and nurses: at what point after a patient arrives do you start to wonder more about how they got there? Do you get time to think about that kind of stuff?

Like physically how they got there? Or existentially how they got there?

If you mean physically, it's part of the registration process that they indicate how the patient arrived and if someone else is with them. At some point, particularly with patients who came by EMS, there's a discussion of how they're planning to get home and telling them to start thinking about making arrangements.

If you mean on an existential level, I don't often find it to be relevant to their hospital stay and treatment beyond how they got sick or injured and their ability to be discharged home. There are so many things going on that the idea of sitting around and pondering a patient's life story is just not a good use of my time and brain power. In regards to discharge planning, it can be more relevant for elderly or disabled patients, such as who cares for them, what is their home like, can they do their basic ADLs, how they manage their medications, etc.

For example, had a patient whose family didn't want to acknowledge she had dementia, but knew she couldn't care for herself. She had a new diabetes diagnosis and the daughter came in and got all the education to help her mom manage the condition. One week they came in almost every day for high sugar and low sugar levels and when asked what they did about it, they said they called 911. I explained that diabetes is chronic and not necessarily an emergency and calling 911 to have EMS check her blood sugar when they have the equipment isn't really appropriate. I used their monitor and talked to them about how to use it and saw it had barely been used. I talked about how they clearly aren't doing what they're supposed to do to manage her blood sugar and tried to determine what was going wrong. First, their mom (who had about a 10 minute memory) said she took her meds and they just took her word for it even though she couldn't tell them what day it was or couldn't be sure if she actually did. Second, the son living with the mom to help her was illiterate and not only couldn't read the directions but hadn't received any of the education from the hospital or the sister who was trained. I spent a ridiculous amount of my day educating them and getting case management and social work involved in this woman's care because the family wasn't meeting her needs, wasn't able to care for her, and she clearly was not safe at home.

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