So, some time ago, I had a younger, obese female patient present to the ED. She came with a complaint of a breast lump with skin discoloration. At first, I thought of potential mastitis, could she have a ductal abcess, something bad...right? Nope. This had been present for 2 months duration, and she had done a "lot of research on the internet". That is not usually a good statement to hear from your patient, primarily because there is just so much BAD information out there, and you often spend a great deal of time correcting misinformation, or even more often, MISINTERPRETATION of information. Anyway, she saw her local MD, who referred her to a breast physician locally. She was extremely concerned that she had Invasive Ductal Carcinoma. In fact, she had already staged herself, and was concerned that she had already progressed to stage II. Mind you, she had not seen a breast physician yet. She had been concerned, and had already called our breast clinic, for which she had an appointment in 2 days.
This was unacceptable apparently. The patient wanted an MRI (which we rarely ever do in the ED, and only in the instance of a severe emergency), or to have it biopsied in the ED. I explained to her calmly that I could not offer her either of those options. I explained some alternative ways that she could potentially move up her appointment.
A completely unnecessary visit, which cost hundreds of dollars, and added nothing to her care. I don't blame her. I blame the system in which this is encouraged. This is not even an unusual story, as there are dozens of patients who present every day with complaints that should have likely been seen in an outpatient clinic.