(Don't) Dial-a-Nurse

One of the most frustrating aspects of working in an ER is fielding calls from people who want to discuss their symptoms over the phone and expect a diagnosis, home treatment plan, or advice about whether or not to seek emergency treatment. Sometimes these individuals are calling about themselves, but most often it is a parent calling about a child's symptoms.

Ostensibly, my hospital does not permit ER nurses to give advice over the phone. The reason for this is liability. If I gave advice to someone about symptoms I cannot properly assess in person, I run the risk of misdiagnosis or mistreatment or both.

Similarly, I have a 50/50 chance of recommending correctly whether or not someone needs to seek emergency treatment. If I tell them to come to the ER and they do and, in fact, they have an emergent condition, then I might be their hero. But when they are stuck with a bill for an unnecessary ER visit, I'm the villian.

And, worse, if I suggest that they do not have an emergent condition when in fact they do, perhaps life-threatening, and they don't come in, well...

The belief that it is easy to distinguish emergent or life-threatening conditions over the phone is the subject of this short (and scary, to an ER nurse) article.

www.nytimes.com/2008/02/12/health/12magn.html?_r=1&th&emc=th&oref=slogin


Regardless of my hospital's policy, the administration continues to publish the ER's phone number against our requests and will not allow us to have a phone message to answer as many other businesses, doctors' offices, and health care agencies do (a message that usually begins, "If you have an emergency, hang up and dial 911..."), claiming that such a message is too impersonal.

(Ironically, the only department in our hospital that has such a messaging service is Human Resources!)

How do I negotiate this mine-field?

I try to put myself in the caller's place and tell them what I would do if I were experiencing or witnessing the symptoms they are relating to me. Telling them what I would do if I were them or if it was my child strikes me as offering an informed opinion, not advice, and is a reasonable way to communicate what I think but ultimately leave the decision up to the caller.

They should just be happy I don't give them my mother's stock advice: "It'll be better in the morning."