TGIF

It's Friday!!!!!!!!!!!!!!

Friday, if I'm working in clinic, (Which is where I'm supposed to be seeing people with chronic heart conditions by! the! way!!, like heart failure, angina, vascular disease, etc), it is like I'm a magnet for Walk Ins.

Walk Ins are people who could've called, should've called, but don't. They just decide to drive the 10 minutes or 55 miles to walk into your clinic and demand to be seen for their problem.

These problems are very rarely heart related.
Examples to follow. Not all included.

8:10 AM:
74 year old female. Claims she is having a stroke and NEEDS A NURSE RIGHT NOW. Receptionist freaking out. Talk with the patient over counter in lobby, she drove herself in, she walks to the desk with no limp, she talks in a perfect snobby Connecticut accent, she states she noticed her right eye drooping yesterday. (I do not note any eye drooping.) She saw her family doctor for this yeseterday. He advised something she didn't want to hear. She demands I work her up for a stroke. I told her I didn't have a CT scanner and she would have to go elsewhere. I do a neuro exam anyway just for kicks, completely normal.

8:50 AM:
Male, 40s. Walked in stating he needs his lab results NOW because he feels sick and wants to know if they show any. He did not have labs done at our office. He has not seen a doctor here for a year. He has a cough and runny nose and feels "fatigued".

10:00 AM:
Female, 60s. Complains of extreme, unbearable pain at her cardiac cath entry site (femoral artery). Evaluate, check for bruits, everything I do "HURTS AHH! HURTS!!" Use ultrasound to check for pseudoaneurysm. Nothing there. A small bruise. Oh, the cath was two weeks ago. Oh, after all this, she demands narcotics. Bye bye patient.

12:30 (get called from break room interrupting my sandwich time):
Male, 80s. Demanding to speak with a nurse regarding a "SERIOUS" medication reaction. He feels tired. He has for years. He's been on the same heart medication for 5 years without a dosage change. He is always hypertensive. He is noncompliant. He has decided his heart medication is the cause of all his problems in the whole world. He wants to spend 25 minutes talking about.

2:00 PM:
Female, younger patient, demands receptionist let her speak to her doctor now because she is "very ill". Instead she gets me to triage her. She wants antibiotics because she has a sinus infection. I explain this is why there is a walk in clinic next door or her family doctor. She flips a lid in the lobby for 30 minutes because we won't "take good care of me! you won't!!"

4:00 PM
Male, older patient, having chest pain. Diaphoretic. Cold extremities. Sulken eyes. Shortness of breath at rest. Arm numbness. Ongoing with these symptoms for two days "and it just keeps getting worse". History of stent to LAD, stent to circ, stent to etc. etc. etc. History of small MI prior to stents. Noncompliant with blood thinners and other meds. Immediately start nitro, aspirin and ACS protocol. In cath lab within minutes.
My question for this patient is:
-why not go to ER when you first have the signs of a heart attack?
-how was he NOT dead yet????

4:50 PM (and mind you, clinic ends at 4:00 PM, doors are locked at 5:00 PM):
Pt walks in complaining of a lump in his chest. Sure enough, there is a lump there. I'm not a doctor. The doctors went home or elsewhere. I don't know what the lump is or why it's there. I shake patient's hand, thank him for letting me feel the lump, and send him to the walk in clinic.