Me: What brings you into the ED today?
Patient: I have this bruise on my leg.  It just popped up today.  Do you think I have a blood clot?  I had one once before.
Me: It looks like just a bruise.  But since you have a history of blood clots we'll take a look with an ultrasound.

{time goes by for ultrasound}

Me: Okay - it looks like there's no clot there.  You just have a bruise.  That's good news!
Patient: Oh ok.  Well.  Sometimes my feet swell.  I have to work on my feet all day.  It's really hard to do that.
Me: (Pause) Well ... sometimes when you stand a lot it's normal for your feet to swell.  When you get breaks you can prop your feet up and that will help.
Patient:  But I don't get a lot of breaks.  I have to work 12 hours.
Me: (Pause) Well ... compression stockings are actually great for that.
Patient: (makes a face)
Me: I work 16 hours a day and I'm thinking of getting some compression stockings myself.

{yes, I was getting a little passive-aggressive}

Patient: Can I have a work excuse?
Me: For this morning while you were here?
Patient: No - I have to go in in a couple of hours.
Me: You do not have a medical emergency.  It's just a bruise.  There's no reason you shouldn't be able to go to work.
Patient: But I don't want to go to work.
Me: Well sorry.  I'll write you a note that says you were seen here today and that you can return back to work today.

Good times in the ED!