Everyone knows that patients are asked to rate their pain on a scale of 1-10. Lesser known is the ER doc pain scale, laid out below.
–8.5: An empty department
-Like the first time you had sex: amazing and you wonder how long it can possibly last
–6.8: A thank you note from a patient
-We appreciate being appreciated
–4.75: Birthday cake
-50/50 chance it’s cut with a tongue depressor
–2.8: Best parking space is open
-It’s life’s little things
–1.2: Running late, but hit all the lights
-I knew I’d make it all along
0.41: Respirations out of triage always 16
-20 patients in a row? Really?
0.64: Coffee machine’s broken
-Can usually scrounge some up from another department
0.82: Gown on backwards
-Hello saggers, let’s get you covered up
0.96: The drive home after a night shift
-Slapping face, windows rolled down, radio blaring
1.01: Bed not locked
-Lean up against bed to examine, awkwardly stumble forward
1.15: Spider bite
-It’s not
1.21: Otoscope light doesn’t work
-Check plug, smack in hand, decide how bad do I really want to look in these ears
1.32: Pharmacy call-backs for zofran prescriptions
-My esteemed colleagues: lots of ER patients can’t afford a $300 med
1.36: Outside hospital says they’ll fax old records, never do
-Are there medical record/DMV mixers?
1.44: Patient won’t get off cell phone
-See you in an hour
1.61: Nurses withholding blankets because of fever
-We’ve been over this
1.66: Waking up groggily, asking for more pain meds
-No
1.71: Calmly reporting 10/10 pain
-Uh huh
1.72: Calmly reporting 12/10 pain
-Bonus points for ignoring the scale
1.77: Missing vital signs out of triage
-Helpful to know if this belly painer has a fever
1.79: Patient brought back from xray, never hooked back up to the monitor
-Meh, it’s just a bunch of squiggly lines and numbers
1.81: Whiny consultants
-Should I send you a motivational poster?
1.84: Patient can’t remember meds
-Do people go to H&R Block without their W2’s?
1.88: “Wow, you don’t look old enough to be a doctor!”
- x1,000,000 and counting
1.94: Hand sanitizer bottle empty
-pump pump pump pump pump pump pump…walk over to sink
1.99: “Can I go smoke can I go smoke can I go smoke?”
-Why am I bargaining with you?
2.04: Mysterious fake swelling
-”You see how this part of my stomach is swollen?” Um, no
2.07: Antibiotic seekers
- Antibiotics don’t work against viruses
2.08: Ultrasound seekers
-Well child checks begin earlier than you think
2.09: Drug seekers
-7 allergies and something that starts with the letter D huh
2.16: Press Gainey Reports
-80 returned patient surveys out of 5,000 handed out? That sounds like solid reliable data.
2.27: Construction
-Don’t (WHAM!) worry ma’am (WHAM!) we most certainly (WHAM!) can help you with your headache (WHAM!)
2.30: Lose pen
-Anyone got a spare? Anyone?
2.32: Fully dressed patients
-Knee and hip pain? Of course
2.36: Soda fridge almost empty
-But I don’t want peach citrus fresca
2.37: Nazi nurse JACHO enforcers
-OMG! IS THAT AN OPEN SODA AT YOUR DESK?!? (I dunno, does peach citrus fresca count?)
2.40: Working on a beautiful Saturday afternoon
-Job hazard
2.43: 3fers
-Medicaider: This one’s sick, while I’m here just wanna get the other two checked out
2.44: 4fers
- +1
2.51: Forget stethoscope
-Here’s a spare, it’s glitter filled and has a care bears scrunchie
2.54: Culture followups
-Sir, it turns out you do in fact have gonorrhea
2.55: Radiology overreads
-Sorry about missing that broken bone
2.64: Hemolyzed blood samples
-Patients love getting stuck again and sitting around for an extra hour. How many hemolyzed samples are from lab ineptness? I say 80/20
2.68: Overbearing, high stress parents
-A whole day without pooping, wow
2.92: Can’t get an IV started
-Timesuck
3.38: Pelvic Exams
-If I had known how many of these I’d be stuck doing, I probably would have gone into anesthesia
3.40: Speculum light lost/doesn’t work
-Nurse get the crazy-looking bendy-armed light out and look into how long an anesthesia residency is
3.47: Specialities fighting each other to not admit
-Pregnant PE — Internal Medicine: Call OB, OB: Call Internal Medicine
3.62: Six ambulances crammed into bay as you show up for work
-Trend setter
3.64: Taking in ambulance diverts from everywhere else
-Enjoy your stay in our hallway
4.14: On call doc won’t call back
-Passive aggressive
4.53: Police bringing in patients for medical clearance
-Drunk guy, would you like to go to jail or the ER?
4.77: Post-operative complications from some other hospital
-Advice: if there are problems go back to the hospital where the person who operated on you works
4.84: Nursing change of shift
-Twice the nurses, yet zero work done
5.02: Wrong doc listed as on-call
-Hours to sort out, usually as I’m trying to leave
5.34: “Sick” nurses leave department short staffed
-It’s a big middle finger to everyone who showed up to work
5.83: Vomited on
-Can the genius bar help get the puke out of my iphone?
6.11: Unannounced shadowers
-Hi, this is the student doctor who’ll be standing 5 feet from you for the next 10 hours
6.39: Patient influx 1.5 hours before leaving
-But I’m lazy and want to get home on time
6.67: Computer’s down
-We know where the downtime forms are all to well
6.72: Computer’s slow
-Slamming the mouse against the desk doesn’t seem to speed things up, but it does feel good
7.18: VIP’s
-Get in line
7.45: No beds upstairs
-Welcome to our ER, your home for the next 48 hours
7.84: Next doc on oversleeps
-So hard to ramp back up when you thought you could start winding down
8.13: Can’t find a hospital to accept a patient in transfer
-Would it help if I, say, threw in a starbucks gift card?
8.57: Laryngoscope light goes out
-Ok I’ve got the cords…and suddenly it all goes dark
9.16: Needle stick
-Can you expound on this “free love compound” that you list as your residence?
9.37: Summons in mailbox
-So I’ve heard knock on wood
9.45: Hospital administrators who double sneakily toss your contract
-So I know
9.72: Telling family their loved one is dead
-I’m so sorry
9.83: Unsuccessful pediatric code
-Always leaves a heaviness over the entire department
9.98: Living with your mistakes
-We’d all like a few do-overs
May 21, 2009 at 5:39 pm
Пора переименовать блог, присвоив название связанное с доменами
может хватит про них?
May 21, 2009 at 5:40 pm
RE: Birthday cake. If it’s a clean tongue depressor, who cares? Lol.
And doc, your scale stops before 10. We all know it goes much higher.
May 21, 2009 at 5:49 pm
ABSOLUTELY PRICELESS!!!!!!
May 21, 2009 at 6:22 pm
Ultrasound seekers. Heh.
“Mysterious Fake Swelling” on an obese person where you know it’s just fat and really want to tell them this = 2.05
May 22, 2009 at 4:32 am
Ultrasound seekers, hmm seems like I’ve heard that someplace else before.
May 22, 2009 at 10:45 am
Obviously, I knew that was a little shout-out to me.
/blushes
May 21, 2009 at 7:19 pm
Re: pain level 1.32. You have to shop around for that zofran, as prices vary tremendously, at least on the generic ondansetron. Some pharmacies will quote you $350 for ten tablets, others $18.99 … and they’re the same damn tablets. If they charge more than 3 or 4 dollars each, they’re ripping you off. (The oral dissolving tablets are a bit higher, but still within reason.)
I do have one question to ask about the definition of the (real) pain scale, though. First time any provider asked me to rate my pain level on a scale of 1 to 10, I asked him, so is the scale linear, exponential or logarithmic? He thought I was cracking wise, but how was I supposed to answer unless I know if each increment makes it twice as bad, ten times as bad, or what? Once he realized I was serious, he didn’t have an answer, and neither has anyone else I asked. How say you?
(I can’t be the first person to have thought of that question, and it’s bothering me.)
May 25, 2009 at 6:23 am
= 8.6
June 7, 2009 at 10:52 am
The pain scale really bugs me too. I have asked this exact same question (linear, exponential or logarithmic?) many times and I have never received an answer. I do not know how to answer the question without this piece of information. My guess is that it must be logarithmic as we can perceive small changes in pain level more easily at the lower levels.
May 21, 2009 at 9:36 pm
Classic!
May 21, 2009 at 11:28 pm
Linear, clearly!
May 21, 2009 at 11:28 pm
1.84: Patient can’t remember meds
-Do people go to H&R Block without their W2’s?
As a matter of fact, some do. You’d be surprised at the number of times that I’ve had to tell people that I can’t do their taxes without their tax documents.
May 22, 2009 at 4:40 am
Unfortunately, I wouldn’t.
May 22, 2009 at 2:35 am
Pain scale:
You always ask pain on a scale of 1 to 10 with 10 being the worst you ever had. The question is what if the worst you ever had was being crushed by a car and having twelve reconstructive surgeries. But this time you are here for a broken arm. Would the current fracture be just a 2 ??? Need a better instrument to determine pain.
May 22, 2009 at 2:46 am
Bob:
No actually it IS that simple.
If your fracture pain only feels like 1/5 of the pain you experienced being crushed by a car… then yes… your pain is a 2.
But the pain with the fracture is probably more like HALF the pain of the car crushing, putting you in the 5+ range. Its not the severity of the injury scale, its the pain scale.
May 22, 2009 at 4:25 am
Bob, here ya go
May 24, 2009 at 12:41 pm
Reminds me of a friend of mine – she’s had ridiculously bad luck healthwise, so she’s had a crapton of procedures and various painful life events. When she got appendicitis, she declared the pain a six – and thus the damn idiot doctors left it to rupture because appendicitis was never that low on the scale.
Kind of makes me understand why people exaggerate! (But then, most doctors aren’t that stupid, I imagine.)
May 22, 2009 at 2:48 am
2.64: Hemolyzed blood samples
-Patients love getting stuck again and sitting around for an extra hour. How many hemolyzed samples are from lab ineptness? I say 80/20
The majority of hemolyzed blood samples are from IV placements, not venipuncture*. This means that unless your laboratory is placing IVs, perhaps you should be looking elsewhere to blame.
* [Authors Omitted] Nursing Blood Specimen Collection Techniques and Hemolysis Rates in an Emergency Department: Analysis of Venipuncture Versus Intravenous Catheter Collection Techniques. Journal of Emergency Nursing. 34(1):26-32, February 2008.
May 22, 2009 at 4:35 am
I like blaming the lab for everything way too much to be swayed by something like logic.
May 22, 2009 at 11:39 am
Our hospital instituted a policy saying nurses couldn’t draw labs off IVs. We STILL get hemolyzed samples. Hm….
May 25, 2009 at 6:17 am
I find it is usually inexperience in blood drawing that causes the most hemolyzed samples, whether from an iv or not.
In our hospital a dedicated phlebotomy team draws most of the bloodwork, and a very small percentage of their samples come back hemolyzed.
I’m not trying to knock nurses–they have a lot to know. But in general I find it will be a nurses inexperience or lack of practice with venipunture that will cause a lot of hemolyzed samples.
May 29, 2009 at 10:15 am
as a medical technologist working in the blood bank, the two areas of the hospital known for their hemolyzed specimens are the ER and L & D. It seems these two areas don’t know how to draw blood properly and don’t realize that red blood cells are not happy when they get pushed hard through a needle into a empty vacutainer tube. I must admit after working 30 years in the lab i am sick and tired of everyone blaming us for the rest of the hospital’s errors. just because we can’t defend ourselves doesn’t give everyone else the right to blame us!
May 31, 2009 at 10:19 am
Anybody who has ever worked in a lab will tell you that the average doc or nurse knows approximately jack shit about the lab. We are a convenient scapegoat, that’s all.
June 3, 2009 at 2:01 pm
Unless the patient is hemolyzing his own cells the hemolysis happened during the blood draw. Short of freezing or cooking the sample there’s nothing we could do to the sample that will cause hemolysis. And what you MDs and RNs don’t seem to understand is that it’s more work for us to cancel the hemolyzed sample, reorder it, and call for redraw than it is if we just run your crappy hemolyzed sample and report out inaccurate results.
I don’t really want the patient to be stuck again either, but I’m pretty sure you don’t want me reporting a K of 7.5 unless unless it’s real.
June 6, 2009 at 10:49 am
You all seem like hard working, conscientious individuals and it is clear that you don’t work at my hospital
May 22, 2009 at 2:49 am
Bob, in that case, maybe they should have gone with the faces pain scale and you could have picked the face that best describes you.
And Shalom, I think the US needs to work out what they’re doing with medicine. In Australia, odansetron is $31.30 or $5.30 for pt’s on a pension. Unless the Dr. prescribes a strange amount, then they have to pay full price…
Hilarious list.
May 22, 2009 at 4:38 am
re: backwards gown
But the backwards gown makes doing your exam so much easier!
May 22, 2009 at 5:57 am
I love these – Great work!
May 22, 2009 at 8:35 am
hilarious
1.79: Patient brought back from xray, never hooked back up to the monitor
-Meh, it’s just a bunch of squiggly lines and numbers
I always figure the ED techs need something to do, so I leave it for them…
May 22, 2009 at 10:42 am
You unhook, you re-hook. Super annoying. If they code in that 10 minutes it takes for us to realize they’re back, it’s your fault.
May 22, 2009 at 3:01 pm
awesome post
May 22, 2009 at 5:38 pm
I LOLed, and I feel your pain.
When I was the unannounced shadow, I always brought spare (cheap but nice) pens. To mitigate the pain in the ass.
May 23, 2009 at 3:26 am
What about the patient whose states during the HPI, “My doctor told me you would be expecting me and that I’d be admitted. When do I go upstairs?” (+/- suitcase sign)
May 23, 2009 at 6:56 am
Thanks for giving us smile
I like this one
No beds upstairs
-Welcome to our ER, your home for the next 48 hours
May 23, 2009 at 3:28 pm
Спасибо. Добавлено в закладки
May 23, 2009 at 3:49 pm
The otoscope and soap dispenser ones are classic and totally true.
Great post.
May 23, 2009 at 6:19 pm
[...] Pain Scale Everyone knows that patients are asked to rate their pain on a scale of 1-10. Lesser known is the ER doc pain scale, [...] [...]
May 23, 2009 at 8:22 pm
This is Great!! I shared these with some of my friends that are ER Doc’s and they almost spilt a gut.. I love your Blog
May 25, 2009 at 10:40 am
0.82: Gown on backwards
So which is the correct way for gowns? Is open part in back or front?
May 27, 2009 at 8:16 am
Tie in back please.
May 25, 2009 at 4:00 pm
From the ER doc that’s reading over my shoulder:
“First, E, it’s ED. Are you really typing this, oh good god. Ok, tell him that he needs to come work in our ED. He seems funny. And then I won’t be the smallest guy in our ED anymore. Or the funniest, oh well. You really are typing this? Geez.”
May 27, 2009 at 8:14 am
Not so fast, I’m making big time strides with the “her first weight set” I bought.
May 27, 2009 at 12:28 pm
HAHA, I love it.
May 25, 2009 at 9:34 pm
Great post 10/10, as usual!
May 26, 2009 at 11:26 pm
Excellent post. It’s the little things that get me most: the unlocked stretcher, the empty hand sanitizer, the slow computer. And the ungowned patient for whom you helpfully find a gown, only to get the kind with like a dozen little ties that must be matched up correctly. I hate those gowns.
May 27, 2009 at 12:28 pm
“only to get the kind with like a dozen little ties that must be matched up correctly. I hate those gowns.”
Those are teh suck.
May 27, 2009 at 2:02 pm
But to those of us in imaging, the snaps are a nightmare, always right in the middle of the anatomy of interest.
May 27, 2009 at 6:35 am
your posts always crack me up and i am inspired to blog more about medico-related stuff. your lists are fabulous!
May 27, 2009 at 11:39 am
just remember, ED nurses have their own pain scale, and you guys are on it more than once:
9.5: Medicine Resident
-can you please make up your mind and order ALL of you labs at once so I don’t have to draw blood from this patient SIX TIMES? yes, I know he has a line…it’s called TIME MANAGEMENT, buddy. And FYI, the lab doesn’t run half of these studies on weekends anyway.
May 27, 2009 at 12:50 pm
Bravo, this is going in the office.
May 28, 2009 at 6:03 pm
2.55: Radiology overreads
-Sorry about missing that broken bone
ARGH to this one. Also add that pt with Ankylosing Spondylitis and prior xrays showing moderate ankylosis does NOT suddenly have a normal xray today. Look again or doublecheck you’re looking at the right films. (Happened to me, still mad.) Obviously didn’t happen in the ED, however.
June 6, 2009 at 3:59 am
6.11: Unannounced shadower.
I’m in 2nd year. In the beginning I had reservations about rocking up without notice and tagging along rounds with the residents on the wards, but have really enjoyed them when the opportunities pop up. Most residents don’t seem to mind if I asked them before they start, and slip in pearls now and again (it probably helps that it’s a teaching hospital, and my school encourages it).
A 6.11? Any tips on how to make it less painful? I don’t want to just be a tolerated presence. Cheers!
June 6, 2009 at 10:48 am
Find docs who don’t mind shadowers. There are plenty out there, especially at teaching hospitals.
June 8, 2009 at 4:40 am
BTW, great blog!
June 30, 2009 at 7:01 pm
[...] out of Ten — If nothing else, check out this ER doctor’s ER doc pain scale for a good [...]
August 31, 2009 at 7:21 pm
Funny, a lot of these are the same painful things that happen in my outpatient community clinic! Except I’d add this one: Patient shows up for an “urgent visit” with complaint of left-sided chest pain, diaphoresis and nausea. When informed that we will be calling an ambulance for them, they insist that they “don’t need to go to the ER!”
September 8, 2009 at 6:13 am
[...] all three). Recent favorites: the widely read (and if you click one link, click this one) Pain Scale, and Proposition [...]
November 3, 2009 at 6:22 pm
Все замечательно: и по стилю изложения, и по содержимому. Так держать!
November 6, 2009 at 7:32 pm
I love 2.51 — the reason my stethoscope not only has a name plate, but is a pleasing shade of raspberry pink. I’d rather have black or blue, but was told early on to go girly to avoid it walking off!