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68 Laws of the ER

01/15/19 3:43 PM

Every now and then you read a piece about life in the medical trenches that fully hits the mark. Dr. Rada Jones is an Emergency Physician who did precisely that. She penned the 68 Laws of the ER. The best way for me to do it justice is to present it as is without editorial or comment. Enjoy!

1. Murphy’s Law as it applies to the ER: If something can go bad, it will do so in a hurry. If it can’t possibly go bad, it will still find a way.

2. Clock’s First Rule: All the patients will crash at the same time. Usually when the computer system goes down.

3. Clock’s Second Rule: The sickest patients will come just before the shift change.

4. Haste’s Theorem: The healthier the patient is, the more they insist on being seen first. Sick patients are not in a hurry. Lefty’s Corollary: The patient who doesn’t ask: “When is the doctor coming?” is probably dead.

5. McDonald’s Law: The patient who needs sedation will stop at McDonald’s on his way to the hospital.

6. Sweets’ Exception: Unless they are diabetics. Then they didn’t eat for three days, but they did get their insulin.

7. Sandwich’s Principle: All vomiting patients request a sandwich.

8. Mass’s Law: Whenever a non-ambulatory patient needs to be moved, he will weigh at least 300 pounds.

9. Law’s First Rule: Every drunk patient has a lawyer on speed dial.

10. Law’s Second Rule: Alcoholics will start withdrawing before becoming legally sober.

11. Law’s Third Rule: Every lawyer in the ED will be your patient.

12. Law’s Rule on Charting: The one case you documented poorly will turn bad and get you sued.

13. Urine’s First Law: The consultant you paged an hour ago will only call back when you go to the bathroom.

14. Urine’s Second Law: All babies will pee as soon as you remove their diaper — on you.

15. Urine’s Third Law: Whenever you need urine, the patient has just peed.

16. Cutter’s Law of Time: The surgeon who performed the surgery is never the one on-call.

17. Cutter’s Law of Space: The surgery was never done at your hospital.

18. Timer’s Law: Whenever you manage to go see a patient, they just went to radiology.

19. Gyn’s Principle: The pelvic stretcher is always inhabited by a large non-ambulatory male.

20. The Law of Detrimental Location: The trauma victim was just sitting there minding his own business.

21. Bleeder’s Law of Priority: The most important lab will be the first one to clot and the last to result.

22. Bleeder’s Law of Excruciating Challenge: The likelihood that the labs will clot again is directly proportional with the difficulty of getting them.

23. Bleeder’s Inevitability Principle: You can’t stop the bleeding even if the INR clotted on its way to the lab.

24. Home’s Placement Law: Patients will need placement only after case management has left.

25. Hitchcock’s Theorem: The likelihood of a patient having a long QT is directly proportional to the degree of psychosis.

26. Middlesex’s Law on Gender: If you are female, you are a nurse. If you’re male, you are a doctor.

27. Prick’s Principle: The fear of needles is directly proportional to the number of tattoos.

28. Segway’s First Risk Theorem: The likelihood of medical errors increases exponentially in VIPs.

29. Segway’s Second Risk Theorem: The nicer the patient, the worse the disease. Segway’s Corollary: All nice patients will have cancer, a stroke or at least a broken hip.

30. Segway’s Pregnancy Conundrum: Sitting on the toilet or swimming in the pool may get you pregnant.

31. Pain’s First Principle: Patients with a high pain tolerance are allergic to Motrin and Tylenol.

32. Pain’s Second Principle: 95.8 percent of fibromyalgia flares occur on Mondays.

33. Pain’s Rule of Furniture: Chronic back pain patients love to move refrigerators.

34. DeBeer’s Law of Correlation: The likelihood of a patient being suicidal correlates directly with the blood-alcohol level.

35. Fahrenheit’s Law: Parents of unvaccinated kids don’t own thermometers.

36. Poor’s First Law: Smoking is inversely correlated with the ability to afford your antibiotics.

37. Poor’s Second Law: The number of tattoos is inversely correlated with being able to afford dental care. Poor’s Corollary: Beware the tooth to tattoo ratio.

38. Hope’s Law: Being on Chantix negates smoking.

39. Love’s First Law: The patient asking for your phone number is in the ER for an STD.

40. Love’s Second Law: The patient who hugged you before he left has scabies.

41. Love’s Third Law: The patient who shook your hand is positive for C Diff.

42. Pooper’s Rule: Patients with three weeks of diarrhea become constipated as soon as they step in the ER.

43. Cheeto’s Rule: Abdominal pain gets better with Cheetos.

44. Sucker’s Law: When you separate fighting dogs, you’ll be the one who gets the shots.

45. Mattu’s Law: If the patient is so diaphoretic that you can’t stick his EKG leads, just activate the cath lab. They’re having a STEMI.

46. L’Hospitel’s Law: Patients who need admission have pets at home they need to care for. L’Hospitel’s Reciprocal: Patients who don’t need admission have families that can no longer care for them.

47. Tester’s First Law: Whenever you need a CTA, the patient’s GFR is bad. Tester’s Reciprocal: Whenever the GFR is bad, you need a CTA.

48. Tester’s Second Law: D-dimers are positive only if the patient can’t get a CTA. Tester’s Corollary: Then, they are positive every time, and the VQ scan is out of substrate.

49. Luck’s Theorems: The likelihood of the computer crashing is directly proportional to the number of patients in the department. Multiply by five if it’s Monday night. Add 10 if it’s a full moon. If you’re red-haired and have at least one stepparent, divide by 0.25.

50. Schift’s First Law: The Joint Commission only comes during your shift.

51. Schift’s Second Law: The other doctor has fewer patients.

52. Lavoisier’s Principle on Medication Errors: They always got too much. If it was too little, it would be easy to fix.

53. Lavoisier’s Theorem: Tylenol allergy is a risk factor for fibromyalgia, IBS, and anxiety.

54. Lavoisier’s Rule of Anticoagulation: Every patient who has a sloped porch must be on coumadin.

55. Lavoisier’s Dictum: When the patient comes to the ER, the med list stays home.

56. Child’s Principle: Toddlers can’t swallow pills. Unless they are grandma’s. Then, they’ll swallow the whole bottle.

57. Child’s Law of Location: Bleach must be stored under the sink in a Coke bottle.

58. Snow’s Method: The best way to unclog a snowblower is sticking your hand in it.

59. Needy’s First Rule: Your patient will need you as soon as you leave the room.

60. Needy’s Second Rule: Your consultant always needs the one test you didn’t order.

61. Margarita’s Law: The ER goes to shambles as soon as the pizza arrives. Margarita’s Corollary: Never order pizza in the ED. Margarita’s Conclusion: To eat hot pizza, you need to retire.

62. Bell’s Rule: Patients who are hard of hearing don’t have their hearing aids. If they do, the battery is dead. If it’s not, the family will take them home, together with their watch, their jewelry, and their glasses.

63. Bell’s Axiom: If the patient doesn’t speak English, the translation phone is not working. In the unlikely event that the phone is working, the patient will speak the only language that the phone does not.

64. Sage’s First Advice: Skip the CT if the patient with abdominal pain is eating McDonald’s.

65. Sage’s Second Advice: Whenever a patient tells you: “You took care of my mom,” don’t ask how she is. She’s dead.

66. Sage’s Third Advice: The family member looking like the patient’s mother is his wife. Don’t ask.

67. Sage’s Unavoidable Error: You should have called the other consultant first.

68. Sage’s Chest Pain Rule: Every patient with chest pain, elevated troponin and cardiac risk factors has GERD. Just ask your cardiologist.

What do you think?


ABOUT THE AUTHOR

Rada Jones is an emergency physician and can be reached at her self-titled site, RadaJonesMD. She is the author of Overdose.

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Addison Tarjanyi
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Addison Tarjanyi

brilliant.

RADA JONES
Guest

Thank you!

Jon
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Jon

When radiology is holding for you, it’s never good.

RADA JONES
Guest

Still waiting for one to call with good news…

sapphire
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sapphire

1. If they’re not walking or they’re not talking, they’re not going home.

2. Beware the return visit.

RADA JONES
Guest

Agree.

retired
Guest
retired

Surgical Friday rule: There is a direct proportion to the closeness of the weekend and the sickness of the patient consulting surgery from the medical ward.
Surgical Friday Corollary: The sickest patients transferred on Friday afternoon to a surgeon’s care, have been in the hospital the longest.
Surgical Friday Corollary II: The sickest patients transferred from the medical ward to the surgeon on Friday afternoon, are also the most likely to have their medical admitting physician gone for the weekend, and the covering physician knows nothing about the patient.

retired
Guest
retired

Super Bowl Sunday rule: When no other anesthesia team members are around on Super Bowl Sunday, there will be an emergency call for a long surgical procedure.
Super Bowl Sunday corollary: Checking with OB to make sure that it is okay to start a long surgical procedure on Super Bowl Sunday, results in an all clear, that is reversed with a call for an emergency C section, 5 minutes after the surgical incision is made.

RADA JONES
Guest

Murphy rules everywhere, ER and OR alike.

Joe Horton
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Joe Horton

In addition to the Laws of the House of God (from the book, House of God, by Samuel Shem), there’s Steed’s law (David Steed, vascular surgeon at U. Pitt): A strange presentation of a common disease is much more likely than a textbook presentation of a rare disease. So: the most classical case of Tsutsugamushi fever you will ever see will be the wildest case of diabetes mellitus you will ever see. Horton’s first law: Bleeding always stops. [For some reason, people always seem to feel an irresistible urge to add words to this law. I don’t know why.] Horton’s… Read more »

Erin Alonso
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Erin Alonso

Hilarious!

Barbara Hummel
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Barbara Hummel

Fantastic. Makes me remember why I left ER for Family Practice where some things are predictable and the pizza is occasionally hot.

RADA JONES
Guest

lucky you!

Jacksonrdmd
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Jacksonrdmd

Cynic’s rule: if it comes out of the ED it was penned by a cynic.
Cynic’s corallary: ED docs are cynics for good reason. The good acumen and judgement they bring to work every day are challenged by patients and on call specialists alike

RADA JONES
Guest

I agree.

john
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john

Kerr’s corollary- the vehemence of the request for everything to be done asap for Mom/Dad is directly proportional to this offspring’s distance from the situation-
Kerr’s axiom- the local family member giving care knows you have done everything in your power to fix the hopeless situation and asks for you to be merciful to their loved one

RADA JONES
Guest

Well said!

ABQ Slim
Guest
ABQ Slim

Just about the best summary of ED life ever!