To recap …
Don’t call it the “emergency room” or the “ER” to my face, in the comments, or anywhere else. Period. It is the emergency department. “ER” is a TV show that was canceled. We don’t need to dredge up old drama. I’ll politely correct you once, then I’ll get DeNiro on you the second time. And we’re emergency physicians. We’re not “ER docs”.
If you use a cell phone while I’m examining you, talking to you, or treating you, that’s like spraying me with pepper spray.
Baby talk will probably cause me to have little twitching episodes. If I hear it, I might say something like “Hey, I speak ‘Fudd’ too” and talk back to you in the same manner. Don’t be offended.
Then there’s pain transference.
Wait. What is pain transference, you ask? Let me describe a typical experience in detail for you.
Consider a patient with a complaint of pain who comes to the emergency department accompanied by another person. The patient dons a gown and the accompanying person sits in a chair next to the stretcher.
Your thorough exam leads you to the area of the body in which the patient is having pain. You press around gently on the area … not even on the area where the patient is reporting to have pain … and then it happens. You hear a “reverse hiss” from across the bed.
Imagine making a hissing sound with your mouth. Now imagine sucking air in through your clenched teeth instead of blowing air out. The “reverse hiss” is the first sign that pain transference has occurred.
If you’ve not had this happen before, you think to yourself “what was that”?
You look up and the other person in the room invariably has a frightened look on her face.
You look at the patient.
The patient looks back at you and shrugs his shoulders.
You lightly touch near the painful area again. The patient doesn’t flinch, but you hear another reverse hiss from across the bed.
You look across the bed out of the corner of your eye. Now the person across the bed has her mouth open and is tensing those muscles that make all the skin on the neck stick out. In severe cases of pain transference, the other person in the room will even yell at you because you’re “hurting” the patient.
You look back at the patient.
“Does that hurt?”
“Ummm. I guess …”
You gently press around a little more and you hear a series of short reverse hisses. You see if you can get the person across the bed to signal “SOS” in reverse hiss Morse Code. “S … O … U” SOU? No no no. The last hiss was supposed to be short, not long. Aaahhh forget this. Didn’t work.
But to cinch the diagnosis of pain transference, you have to perform a confirmatory maneuver:
You have to lift up the sheet so that the person across the bed cannot see where or when you are touching the patient. This act of defiance interrupts the visuo-spacial pain continuum, causing immediate anger in the person across the bed, ceasing any additional reverse hissing, but also causing the patient to experience much worse pain in the same spot that wasn’t hurting only a few seconds before.
“Oooooowwwww” moans the patient.
“Why are you trying to hurt him?” Yells the advocate.
“But I just touched there a second ago and it didn’t hurt at all.”
Doesn’t matter where you touch. Doesn’t matter how hard you touch. You have now become a victim of pain transference. Studies clearly show that there is now a 24% chance of a call to an administrator and a 97% chance of Press Ganey badness.
You should have excused yourself from the room at the first “reverse hiss.”