Sometimes it seems like the emergency room at my hospital is a wormhole between two universes: one where I and the other medical professionals live, and one where the patients live. Some of the differences between these two were unsurprising to me: I already knew that our patient population tends to visit the ER for situations where I’d just pop some Tylenol, for example. (And there are a lot of reasons for that; if you don’t know much about medical issues you might not have any way of knowing whether something’s life-threatening, and if you don’t have access to a primary doctor there’s no one to call when you’re not sure whether to come in, nor is there any way you can just go see your doctor in a week if it doesn’t get better.)
One of the differences I saw this month really struck me, though. I saw quite a few young women with complaints of nausea, vomiting, abdominal pain, tiredness, missed periods, etc. Many of them received a diagnosis of “normal pregnancy.” What got me was that none of these teenagers seemed upset to find out they were pregnant! If I had turned up pregnant at 16, I would have thought my life was over. Apparently (I didn’t see any with their moms there) the mothers are excited to find out that their daughters are pregnant, too. Again, if this had happened to me, I know my mom would have still loved and supported me, but her first word would not have been “Congratulations!” (Of course, my mom did not have me when she was 16, either.)
This is the first thing in med school that has made me feel naive and idealistic. I thought that education was key, and if young people knew about their bodies and their options for preventing pregnancy, and birth control was made available, the teenage birth rate would decline. Now I’m not so sure - if pregnancy is seen as a *happy* thing for high school kids, if they don’t see it as a huge roadblock on their paths in life, what’s the motivation to abstain or use condoms? I guess it’s good that girls who become pregnant aren’t ostracized, but I think this might be a little too far in the other direction!
The other day, I saw another interesting and weird aspect of this. I went in to see a patient whose chief complaint was “nausea/vomiting/need pregnancy test”. She’d been waiting for a few hours in the waiting room, then maybe 20 minutes in the exam room, which really isn’t bad for people who show up with non-urgent complaints. During those 20 minutes she’d been out to the nurses’ station multiple times asking for food (so apparently her nausea wasn’t so bad) and to use the phone. So I went in to see her with the thought that we’d do her pregnancy test, let her know what was going on (at least she wasn’t going to be too surprised if it was positive), and send her out.
ME: [Introduce myself.] So, what’s been going on?
PATIENT: I need a pregnancy test.
ME: OK, we can do that here. When was your last period?
PATIENT: The beginning of August. I’m healthy, I’m 20 years old, I weigh 160 pounds, what else do you need to know, can we just do the pregnancy test and get me out of here?
ME: Well, we can do that, but whenever somebody comes in to the hospital we have to talk to them and examine them to make sure we aren’t missing anything serious.
PATIENT: Fine. Can I have something to eat? I’m hungry.
ME: So your nausea and vomiting is better?
PATIENT: Yeah I just throw up in the mornings. And I’m tired and hungry the rest of the time and my nipples hurt. I’m pregnant, OK? I took a home test.
ME: Oh, you did? What did it say?
PATIENT: It was positive. Three of them.
ME: So… are you expecting this one to be different? [probably not an example of good doctor-patient communication skills, but I was just really confused about why she'd be there if she already knew she was pregnant.]
PATIENT: No, I just need a paper that says I’m pregnant so I can go on WIC.
So I finished examining her, counseled her to stop smoking, told her about getting prenatal care, etc. She ended up being pregnant (surprise!) and very unhappy that she’d had to wait another hour or so to see the doctor to get discharged. I don’t know what the actual WIC requirements are, but it seems like it would be cheaper for them to accept the results of a home pregnancy test with verification in the WIC office, than having the taxpayers pay for emergency room visits for pregnancy tests.
[As always when I post about patients, some details have been changed.]