Emergency Department Treatment of Cyclic Vomiting Syndrome

A recent medical article describes a patient’s frustration dealing with her local Emergency Department Sickle Cell Disease painful crisis. The patient declares “My relationship with the emergency room is that there is no relationship” [1]. It is not unusual for a chronic disease patient to become frustrated by their inability to obtain predictable Emergency Department Care. As a physician caring for Cyclic Vomiting Syndrome patients, I thought it would be relatively simple to provide patients with, a letter identifying the best form of treatment for their condition. During follow-up clinic visits, I was surprised to learn that these letters were often ignored. In some cases, these letters were thrust back at the patient’s family with a gesture that declared “We’re not doing that”. A survey of US patients using Emergency Department confirmed that directive letters are ignored in approximately 50% of visits [2].