I usually write about this subject once a year. Women will tell you that men are stubborn, and men will tell you that women are.  Really, stubbornness is universal.  How you handle the spouse who refuses help is dependent on sex.  The answer is highly dependent on the severity of the consequences of inaction that could result if care is not sought. What do you do when your loved one needs help but refuses to acknowledge it? I

In the case of chest pain and neurological problems,. a trip to the ER is best:

 You’ve got bad indigestion.  Why not see your doc?  How likely are you to speak to your doc on the first call?  Not very!  If you’re lucky enough to speak with a triage nurse, he/she is most likely going to put you on hold while he/she confers with the doc on call. Forty minutes later the nurse sends you to the ER or makes an appointment for you to be seen in 1-2 weeks.  Medicine is called into your local pharmacy.

Did you know that heartburn and heart attack can be indistinguishable? Yep! One eighth of my patients with indigestion ended up with a diagnosis of heart attack/heart disease.  Mr. X sat in my lobby for 2 hours before he was seen.  He was asked about chest pain multiple times and denied having pain in his chest.  He did have “indigestion” he attributed to spicy Mexican food.  His indigestion was a heart attack.

Had he called the paramedics, he would have been seen immediately.  There is a “golden period” of 4 hours during which the ER can reverse the effects of a heart attack or a stroke. Once you are in an ambulance, you’re really in the ICU.  Assume that this patient did not come to the office but stayed home. 

His wife says, “Darling, I’m going to take you to the hospital.”

 A typical response from her husband would be, “Its just indigestion; do we have TUMS?  I’m not going to the ER!” 

Wife says, “I’m calling the paramedics!”

 Classic response from her husband, “If you call the paramedics, I’ll never talk to you again!” Four hours later, in the cardiac intensive care unit:

I ask the wife, “Did it dawn on you that if he died, he’d never speak to you again?  Better he be mad than dead.”

Unexpectedly, the wife responds, “I did, I thought about it and decided I’d call the paramedics and pray he lives and never talks to me again.”

These days, ER (actually all docs) docs are incentivized to send patients home for out-patient management. The formula for catastrophe is a patient who belittles his indigestion and sees a physician who is tired of being admonished for admitting patients to the hospital.

On the TV show, Dragnet, Detective Joe Friday’s signature line was “The facts, ma’am, just the facts.”  In the ER, the doc needs the facts and more than just the facts.  He/she needs to know everything leading up to and through the present. The ER doc needs an accurate history of prior illness, surgery, medications and allergies.

As a patient, you should have several documents on your computer.  Documents should be entitled past medical history, current medications, allergies, surgical history, family history and review of systems.  If you keep them current, then printing and taking them with becomes a simple task.  

If you are worried about being sent home, pack a suitcase.  It’s hard to send a patient home with a positive suitcase sign.

Here’s your joke- Q: Why was the insurance company refusing to pay after lightning struck the church?

A: Because they said it was an act of God, therefore, deliberate destruction by the owner.

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