Makes Me Wonder

Sometimes I have a hard time trying to separate fact from fiction; especially when patients start giving me a back story to explain why they haven’t had follow up for a medical problem, or how their narcotics got stolen/lost/misplaced, etc. I sometimes think, seriously? Is that really how bad your life is? Come on…

I know times are hard for a lot of people, but when you’re a 30-something, insulin-dependent, right AKA with non-healing wounds who social work bent over backward following your last admission to get you a clean place to live, home health care visits and arranged for a primary care physician so that you could regularly get medical care and, more importantly, your prescriptions, it’s poor form to miss appointments and get dropped from the practice.

Yes, I know it’s easy to get kicked out of your place within a month for having a dog which wasn’t allowed in the first place and which you acquired AFTER you moved in. What home isn’t complete without a loving pet? And, since you couldn’t afford a place before because of your limited SSI, I am sure adding vet bills, dog feed, and vaccinations to your budget will be no problem at all. And, sure, having a significant other who doesn’t work and who smokes despite the no-smoking policy of the building management is a problem especially when they’re not supposed to be on the property either. Yes, darn those apartment landlords and their stupid rules.

Now, I understand that you had previously been living in your car and had been lucky to have a nice place to live, but why couldn’t you drive that car to the appointment again? I’m sorry, you’re now having to live in it again… is it in working order? How did you get here again? What? It’s a legitimate question since you came 20 miles out of your way from your hometown to our E.D. Sure, yes, well, you’re in luck, we have no beds and are having to send all of our admissions north to our sister hospital. So, you’ll be closer to, um, home… and, besides, those social workers already know you and have done all of the leg work already, so there’s that too.

Then there’s the “I need a drug refill because my meds were stolen after I moved out from the last place I was in.” My answer is simply “drugs and scripts are like money, if you lose it, it’s gone and there’s no replacing it.” Besides, we have pain contracts with the local primary care M.D.’s, and they say, “No.” I still get some interesting stories, though, of backpacks being left “for just a second,” or of drugs disappearing “while I was taking a nap” or of pills in a lockbox in someone else’s house that mysteriously disappear when the person with the key leaves the house to go out to get some smokes. My favorite is the “I left them at my ex’s house, and now I can’t get them back.” “Did you file a police report?” “Well, um, yeah.” “Ok, let me talk to the police department and confirm the report number.” “Yeah, well, um.” “So, which police officer was it again..?” “Um, well, yeah it’s kinda like this…”

Mark Twain once said, “Truth is stranger than fiction, but it is because Fiction is obliged to stick to possibilities; Truth isn’t.” Twain must have worked in an E.D.

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  1. #1 by Simon - August 21st, 2012 at 09:13

    Mark Twain does come out with some good quotes doesn’t he!

  2. #2 by Dr. Suzanne Johnson - January 8th, 2013 at 02:28

    I empathize with patients in chronic pain. But quite simply stated, we are NOT qualified to be dispensing narcotic medications to patients with acute on chronic pain. WHAT?? Say you? But I place chest tubes, intubate patients, save lives…why can’t I write a refill for Norco? Because, my dear friend and colleague, the American Academy of Pain Management has very clear guidelines on what questions should be asked before dispensing these deadly drugs. Furthermore, we are not equipped to follow these patients routinely nor do we have any way of assuring that they are not being diverted.

    I am the Medical Director for a company called Rational Pain Care. We are in multiple states and many sites and we have as our goal nothing short of changing the practice of Emergency Medicine with regards to ‘frequent fliers’.

    Please check out the interview with Mel Herbet on EMRAP Jan 2012. Visit our website at for more information, and spread the word! For a very minimal cost, your ED physicians can stop struggling and arguing with these patients and treat them compassionately and appropriately.

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