We have a process in our ED called Rapid Assessment and Discharge.
Basically you examine the patient and decide:
a.) this patient can be discharged with just a script
b.) this patient can be discharged after some simple intervention, lab or x-ray
c.) this patient just needs some labs or x-ray and then might need something else
d.) this patient is going to need a LOT of work
Today, I was the Doc in the Box making the decisions.
I actually enjoy working in triage.
You have to think fast on your feet. Make decisions with a small amount of information.
You then order what you think is necessary so someone else can come along and complete the workup, or the disposition (deciding if a patient is admitted or discharged to home.)
Sometimes the problem is obvious; like poison oak rash, or medication refill.
You write up the chart and discharge the patient.
Other times, you have to figure out not what is wrong with the patient, but what their true intent was in coming to the emergency department. One of my residency instructors used to say that everyone coming to the ED had an agenda. My challenge was to find out what it was. For some, unfortunately, it comes down to seeking pain medication. For others, they just need someone who will listen to their problems and reassure them that everything will be ok. Some, I will never figure out...
But, there's the true challenge... to keep trying... or just write a prescription for Vicodin...