Sometimes the Best Emergency Medicine is No Medicine at All

I was recently reminded by a patient experience that the best medicine sometimes is no medicine at all. I cared for a young woman who had been seen the last few nights complaining of shortness of breath. When it was obvious that she had normal breath sounds, no wheezing and normal oxygen level I started to wonder if there were other things that may be bothering her. After she returned with similar complaints I decided to sit with her for a moment and talk to her about what was going on. 

I asked about her family. She said was a single mom who took care of her four children. I then asked the nurse to take her young child out of the room so I could speak to her privately. Her eyes rarely met mine as she was gazing down at the floor. I thought perhaps this could be a situation of domestic violence or abuse so I calmly and quietly asked her if anyone was harming her or if she felt threatened. She said no and that she felt safe.

I then asked about her routine. She said her days were filled with taking care of her children and making sure they were fed and clothed and she had little time for herself. I asked if she thinks that this could be due to anxiety and whether the frequent ER visits could be a sign that she was becoming more anxious. She mentioned that she was in fact concerned about this. I then asked if she would mind speaking to our counselor to see if there were some outpatient resources to help her.

The crisis counselor evaluating her determined that she was no immediate danger to herself or her children and gave her some outpatient resources with which to follow up. I want back in the room and talked to her a little bit more. She appreciated the resources and advised that she would follow-up with them and thanked me for speaking with her.

Often, we want to fix something as emergency physicians. We want to give a treatment, medicine or therapy for making people better. With experience and sensitivity you realize that sometimes there are no medicines but simply listening to the patient often leads you to where you need to go. I have no doubt that this woman would have continued coming to the emergency department complaining about shortness of breath and difficulty breathing until someone realized that there was something else going on. I was fortunate enough to have seen her the night before knowing that there may have been something more.

One of my attendings in training always used to say, “Ang, you’ve got to figure out the patient’s agenda.” Sometimes that agenda is simple. I need an antibiotic because I think I have pneumonia. Sometimes it’s a work excuse to go back to (or stay out of) work. Sometimes it’s a worry about cancer that her mother had the same age and she needs only reassurance. Sometimes patients need someone just to listen to tease apart what they’re trying to tell you. I was fortunate enough to figure that out and hopefully help her to help herself. As physicians isn’t that what we are ultimately supposed to do?