I read the chart of a I6-year-old girl, the complaint was: mother said daughter has some mental problems and she wants her to get her professional help. When I entered the patient room, I greeted both mother and daughter, introduced myself as Dr. Gayao their ER physician, then asking them what I could help them with.
The daughter was standing by the bed, looked younger than her age, had short hair wearing jeans and a t-shirt. She did not respond my greeting, had blank stare and flat affect (emotional expressions don’t show). So, I turned my attention to the mother who said she wanted to get some help for her daughter. Then she related about her daughters’ problem; about getting into trouble at home and at her school. Mother said she had got to a point that she does not know what to do with her.
At that point, without warning, the daughter swung one of her legs and kicked me with her boots on sheen bone of my left leg. Immediately a severe pain shot through my whole leg, but I had to maintain my composure, and summoned security to help control the situation. The girl still had that flat affect as if nothing happened and did not say anything. With the security personnel in that room, I continued the interview with the mother. I then arranged for her to be transferred to a psychiatric facility for evaluation and management.
After that I checked my leg that was hit and it showed a skinned area covered by dried blood. I just cleaned with some saline solution, place an antibiotic ointment and a dressing and went on working.
“In a national survey, 97% of ER assailants were patients according to the American College of Emergency Physicians (ACEP), a majority of the 3,539 doctors polled said they been victims physical assaul. Results of this poll will not surprise any practicing er physician,” says Vidor Friedman, MD. The statistics are staggering. According to surveys by the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA), almost half of emergency physicians reported being physically assaulted at work, while about 70 percent of emergency nurses report being hit and kicked while on the job. When you have to deal with psychiatric patients, people with dementia, alcohol and substance abuse, it just a matter of time that a health care provider becomes a victim of not just verbal but also physical abuse.
In emergency medicine, we have don’t have the luxury of choosing our patients. By law “the Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in 1986 has remained an unfunded mandate.”
Emergency physicians provide the most charity care of all physicians. When I was working full time only about 30% of our total professional fee was paid. That is why the ER has been called the safety net of medicine because people get same quality whither you are able to pay or not. That is why charges are so high because factored into it is to help offset the expense of non-paying patients.
As an emergency physician, the great satisfaction I get from my job is being able to do my best for the patient regardless of his or her ability to pay. As to that verbal and physical abuse directed at us ER personnel, it known hazard that comes with our job.
