Don't tell lies

There is of course another side of the coin when it comes to my last post. I like to think that omitting information (or flat out refusing to give it) is more of a deficit of honesty more so than lying, so I bundled some of those examples into that post. Some people, however, just flat out lie. Not through omission, not to save their skin - they just lie.

Several cases in point; at a recent festival a member of the public came to my post and reported an unconscious male locked in a bathroom cubicle. On goes the response gear - a giant pack filled with Oxygen, breathing apparatus and other gear on me with a response kit complete with trauma gear and defib for my partner. Not the easiest gear to carry but we do it without complaint or question - it's the gear we need to do our job. We make our way around the corner to the bathrooms and I check every damn cubicle - all of them in use and filled with an angry male wanting to know why I was banging on the doors. Nobody else had seen our supposed unconscious male, and some patrons had been waiting for a cubicle for quite some time.

Now, I'm not afraid to go on a wild goose chase ('That's what wild geese are for.' - Anon), because I'm fearful of that one time we don't go when we are needed. But why would someone make up a story like that? It got the reporter about three seconds attention from us but wasted about fifteen minutes of our time. Time that we had to mark ourselves as a response crew as 'responding and unavailable'. At this event we had a rather large amount of drug OD's - and they wasted our time on this? But sometimes it's not the reporting of a patient that's the lie... Sometimes we have something much more fun in store.

And these are the cases that really irritate me - people who have nothing wrong with them, but they insist on treatment. These are the teenage girls who've 'fainted' at concerts, the patrons who travel around first aid posts at large events getting paracetamol from each post (we usually catch them out, but unfortunately they can get as much as 3mg before the flags get raised), the hypochondriacs who insist on us calling an ambulance for their 'broken leg' despite walking in with no problems only to find out this post doesn't stock penthrane.

It's the active lie that can do much more damage to our patients, ourselves and our work. I can understand sometimes why people might lie - the elderly or homeless sometimes just want someone to talk to, youths often just want attention and sympathy, addicts might want to score a pain killer when they have no money - and this is one of the things that worries me most about emergency medicine. You see, the problem with medicine outside the hospital (and even in many cases inside) is that we have little in the way of diagnostic equipment. For this reason EMS is rarely allowed to diagnose patients - but it's still a big part of what we do. So how do we go about doing this without said equipment? We have to depend on the patients complaints and symptoms to guide us.

For this reason the homeless will get their night in A&E in the warm bed, youths will get their attention and yes, addicts do score free pain killers - because we have to trust them and their word, because some times there is little else we can do.

Rule 1 of Emergency Medicine is everybody lies.
Rule 2 is supposed to be 'Never forget Rule 1'.

I sometimes think a much more appropriate rule 2 would be 'Know when to forget rule 1'.