Dr. Zac's Rule of Twofers

This guest post is very special to me, as it is written by Dr. Zac, an Emergency Medicine physician, who blogs at AgraphiaDr. Zac is one of my blogger heroes, and a major reason I started The Hero Complex. If you haven't already, I suggest going through Agraphia's archives. If you don't laugh out loud, feel some profound sadness, and fall in love with his writing style, than something is wrong with you. Enjoy his post.  When you get ready to examine a patient, there are a few clues you can use beforehand to determine how sick they are. There are some quick ones, such as how many visits they've had in the past 30 days for the same back pain, or whether or not they have any vital sign abnormalities. Sometimes you're in luck and labs or xrays have already been performed.

But all of these methods pale in comparison to Dr. Zac's Rule of Twofers. Now, I don't mean to talk myself up, but this formula is genius. Allow me to demonstrate:




Where the total sickness of your patient is equal to a coefficient (δ) times the total possible sickness of any given patient divided by the number of patients in the room. Please note, there is a separate but directly related theorem when multiple people from one family check into different rooms in the ER.

You may ask yourself, "What exactly is δ, Dr. Zac?" Quite simple. It's the Coefficient of Chief Complaint, goes from 1-10, and it is used to scale the importance of certain chief complaints. Usually it equals 1, but if the chief complaint is, say, "horrific car wreck on the interstate," it allows us to overpower the denominator.

A few examples:

  1. Mom checks in her four children at the same time, all who have "Fever x 1 Day" listed as a chief complaint. Fever has a δ coefficient of 1. Thus, the maximal sickness per patient is divided by four, leaving us with an essentially social visit. Make your pleasantries, crack a joke or two, look in the kids' ears, no antibiotics necessary.
  2. Dad, drunk, lights the house on fire. He and his 8 illegitimate children are brought in as well as his mistress. "House Was On Fire," naturally, carries a δ of 10. Thus, 10 divided by 10 patients gives us 1, leaving us with a maximal potential sick value equivalent to that of any other patient in the ER.
  3. A friend sitting in the room with your patient mentions offhandedly that she coughed once earlier today. Unfortunately, all the sick in the room has already been used up by your patient, leaving the friend with a δ = 0. This is a special case, also known as the "convenience coefficient" and occurs when someone is so far from being sick they couldn't even be bothered to check in at triage.

There you have it, folks. Dr. Zac's Rule Of Twofers. It's bulletproof.