Are you replying to the right post???????? I said exactly what you said and certainly nothing about coming in for that bed, bath and meal that a few patients try on occasion.
Yes. My apology was after I posted, read that you'd said essentially the same thing I did, and had your post jog me into somewhat of a
non sequitir about patients who use the ED as their free Comfort Inn.
And, depending on where you're at, it's more than occassionally that this happens. EMTALA has effectively endorsed this. And, the patients pulling this stunt (saw it a lot in medical school) are really quite adept at acting the part. You know, it's the 11:30 PM "I have crushing chest pain!" with the subsequent EKG, cardiac enzymes, a nice nap, and two passes of the meal cart later when they're signing out AMA, which means "against medical advice" and not the American Medical Association who've done little to advocate for our profession in dealing with such problem patients. Malingerers become quickly well-known, but can usually pull this two or three times before the ED wises up. The real problem is that this steals valuable and crucial resources away from patients who really need it.
Or, my favorite, the "renting" of a medicaid card by uncovereds (i.e., namely illegal immigrants).
So, I see this one patient while pre-rounding on the surgery service (again, in med school) who's got a chart a mile thick. I look through his past medical history, and he's a walking Merck manual. His medication list is a pharmacy.
What's he in for now? Admitted late the previous night for right upper quadrant pain. A quick ultrasound later and we have the diagnosis: cholelithiasis. Scheduled to have his gallbladder out. Problem is, you dig deep enough into the chart and you realize that he already had his gallbladder out in 1992.
Well, I approach said patient and inform him of this, and he tells me, "No, that's a mistake. I never had my gallbladder out before." Being the good-intentioned, trusting medical student that I was at the time, I leave with the chart and notify my senior resident before we start rounds. He agrees that's strange, but we have our recent ultrasound report that shows that he does indeed have a gallbladder and there are indeed stones in it.
So, we start rounding, make our way back around to the room, and PRESTO-CHANGO! The patient has vanished. Chart is referred to administration, and after some fairly quick investigating, it becomes apparent that this patient was one among many engaging in medicare fraud, we have no idea who he was, and I still to this day don't know what happened, if anything, to the actual owner of that card, who if I could venture a guess probably reported that it had been stolen when he was confronted.
Can you begin to understand why it's really hard not to get cynical in this profession?
-Dr. Imago
Thanks!
I know I know, we're getting closer to using some of the self destruct mechanisms embedded in most (every?) cells, but let's try to step down the complete abuse of peniciline.