During quieter nights and when there's not much going on, the charge nurse will sometimes let me do the triage thing. Even though I am not yet at a point where I can be the triage nurse, it's a great experience for me because it helps me practice on how to get triage information, patient histories, and all that. Usually, the charge nurse or someone more experienced will be there with me initially to make sure the patient is stable enough to hang out with me in the triage room for a short time.

I've noticed an interesting trend in patients who come to the ED for particular complaints. More often than not they don't want to tell out outright why they're there. I've started calling this the "by the way" syndrome.

Here's a typical scenario:

Me: Hi, how are you today
Pt: Doing okay, I guess
Me: So what's going on today?
Pt: I'm having pain in my belly
Me: Can you describe this pain?
Pt: {pointing to some vague location} ...ummmm here?
Me: You don't sound sure. Is the pain just there or does it radiate elsewhere? Any nausea or vomitting?
Pt: ummm... not really

Interview continues for sometime ascertaining other patient factors. Finally, after I have completed triage and put the triage impression as Abdominal Pain, and specified in my detailed triage note that there is no dysuria or back pain, no nausea or vomitting, and patient does not complain of any chills and fevers, etc etc., I walk the patient back to the treatment area.

I hand him/her the requisitie urine cup and gown, and as I'm closing the curtain, here comes the "by the way"

Pt: Nurse... ummm, by the way...
Me: Yes
Pt: I have this ummmm... discharge... like... it itches too, do you think they could look at that?
Me: What kind of discharge? Itches where?
Pt: In my private area
Me: {trying hard not to sigh, now that I know what's coming} How long have you had this discharge?
Pt: For a week now
Me: OK, did you have unprotected sex before you noticed the discharge?
Pt: Ummm... yes, but it's not an STD is it?
Me: That's for the doc to determine. Do you have any abdominal pain?
Pt: {getting animated} No, but this discharge and the itching is driving me crazy! I had to come in!
Me: OK, well, give me a urine sample and get undressed and into the gown.

I walk back to the computer, update my triage notes, and then let the charge nurse and the doc know that this is probably a Gyn Eval.

I've wised up now and I ask every abdominal pain at 2am if they are having any foul or unusual discharge from their "private area". So far it's saved me the wrong triage impression more than a few times.

This is not the only instance of the "by the way" syndrome, but the most common one I've experienced so far.