If you are treating someone repeatedly during Emergency Medicine Residency for crises that occur because they won’t modify a certain lifestyle, how would you help this patient?
Repeat patients in an emergency room setting is not an uncommon occurrence and can occur for a variety of reasons. Sometimes, patients prefer to use an emergency setting rather than scheduling appointments to see a primary care provider. In other cases, patients have an unhealthy lifestyle choice that continues to put them in harm's way. Your interviewers need you to understand that as an Emergency Medicine Resident, you will likely see some of these patients, and they expect you to be able to handle them.
"Whether it's substance abuse, smoking, sexual promiscuity, or dietary choices, there are many reasons why people don't get better. Depending on the cause, there is probably a support group or educational platform I would recommend as a part of their therapy. I also know that there are persons for whom none of these efforts will do any good. As an ER doctor, I have to come to terms with the fact that some people can't be helped."
As you answer this question, recognize the different types of patients that can and will be regular visitors to an emergency room. While discussing those types of patients, be sure not to cast judgment. Carefully describe how you would handle a patient who continues to come in for things like alcohol abuse, domestic violence, or smoking. Make sure your interviewers know that you would always take a patient-centered approach in providing the care needed and that you would do all in your power to educate the patient on making healthy lifestyles changes.
"A patient with multiple admissions and medical complexity often requires an interdisciplinary approach. I would try to talk with the rest of the medical team such as a social worker to make sure this patient has a follow up appointment scheduled with their primary care physician. In addition, I would try to see what other resources and education I could provide the patient to set them up for success in the future."
"I think that it's critically important to meet patients where they are and to understand the challenges they face in order to deliver patient-centered- care. In those types of situations, I would try and understand what could be holding the patient back from making such changes. Depending on that, I would try and connect them with resources through the ED- such as through Social Work, Care Managers, or Psychiatric Consultation- to help them address the root problem. I would also try to refer them to an appropriate primary care provider to help manage their long-term conditions more closely in order to avoid ER visits due to exacerbation."
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