An Open Request to Everyone Who Works in an Emergency Room
I hereby call upon all ER physicians, nurses, clerks, aids, receptionists, security and housekeeping staff, along with anyone else who talks to patients to BANISH the following words from your vocabulary:
Why didn't you come in sooner?For starters, it isn't even really a question; it's a poorly disguised way of saying, "You should have come in sooner." Next, it doesn't matter. Science has yet to perfect a working prototype of a time machine, so whatever would have been different if the patient had presented at some time in the past is completely irrelevant. The patient is here now. Not two weeks ago; not two hours ago, but now. This is what you have to deal with, so deal with it.
It just so happens that a great many patients are in fact themselves wondering why they didn't come in sooner. At the same instant you are asking the (non-)question, they are feeling stupid/anxious/upset/other distressing emotions about that very issue. It does no good to intensify those negative feelings when the patient is already struggling with them.
For another thing, there may be a perfectly valid reason for the patient to come in when he or she did. I saw a woman today in follow up who had been to the ER for a pyelonephritis (and told, "Why didn't you come in sooner?") who'd had a respiratory infection preceding the UTI. She was achy; she didn't think anything of it until the pain changed and increased. Then she came in. Other people may have needed a ride (and felt that calling 911 was not appropriate.) Not only might patients have valid reasons for presenting when they did, it might even have been appropriate given the entire clinical picture -- which may not yet be clear to ER personnel.
The appropriate time and way to address the issue is at disposition. Under the guise of "education" it is permissible to say, "You know, if something like this happens again, it would be better to come in sooner."
So cut it out!
I guess I should have said something sooner.