Feb
17
Circus of Chief Complaints (Your Tax Dollars at Work): Part 2
February 17, 2008 | Leave a Comment
(In reponse to some nervous emails, yes, every patient mentioned had a complete history, review of systems, and physical exam. I’m just distilling the salient elements of the conversation. Okay? -PB)
Actual Patient Interaction Number Six:
“So Mr. Smith, what brings you to the Emergency Department, a place where we handle medical emergencies, at 3AM.”
“My mom is up in the ICU and I just thought I’d come down to get myself checked out.”
“Anything in particular bothering you or is it just a general malaise?”
“Well, my back has been hurting me a lot lately.”
“Is it your usual back pain?”
“Yeah. I’m supposed to see my doctor about it on Tuesday.”
“Does he write you your prescriptions for pain medication?”
“Yeah, but he was out of town last month.”
“Okay, I’ll give you some Tylenol. You need to call him tomorrow to get a prescription for your regular pain meds.”
“I’m allergic to Tylenol, he usually gives me Vicodin.”
“You know that Vicodin has Tylenol in it, right?”
“I’m having chest pain too.”
Actual Patient Interaction Number Seven:
“You need to stop smoking, Mr. Brown.”
“That’s what my doctor says, but he smokes so I don’t see why I should listen to him.”
“You mean a couple of years from now when you’re sucking on oxygen twenty-four hours a day you’re going to take comfort in the fact that your doctor is a hypocrite?”
“Well, he should practice what he preaches.”
“Look, I know your doctor, he’s a fit guy and he smokes, maybe, a pack a week if that.”
“He’s a hypocrite.”
“Yeah, but he’s not coughing up blood like you are.”
“Well, I can’t afford the nicotine patches.”
“Where do you get the money for your cigarettes?”
“My sister gives it me.”
“Why can’t you use the money to buy nicotine patches.”
“Uh…”
“So you get the patches instead of the cigarettes. In medicine we call this killing two birds with one stone.”
Actual Patient Interaction Number Eight:
“My dog ate my pain medication.”
“What kind of dog is it?”
“Uh…I don’t know, it’s a dog, man.”
“is it a big dog? A little dog?”
“It’s just a dog. A German Shepard…Okay?”
“Did you take it to the vet?”
“Huh?”
“Well, it says here that you’re on 180 milligrams of MS-Contin every day. That dose would kill a normal human being if he wasn’t used to it and your dog ate a whole bottle, 30 day’s worth. That’s enough to drop a herd of elephants. So I’m asking you if you took your dog to the vet in respiratory arrest…or maybe he’s just laying dead under the porch…or something?”
“Oh man, I ain’t got a goddamn dog, okay? My fucking roommate stole them.”
“I hope he’s not laying under the porch…”
Actual Patient Interaction Number Nine:
“I don’t know if you’ve talked to the trauma surgeons yet, Miss Green, but they tell me everything’s fine, no internal organs were injured, and they’ll probably discharge you tomorrow after they observe you for a while. You were very lucky.”
“Where’s my boyfriend?”
“He’s talking to the police.”
“Do you think he’ll go to jail?”
“Probably.”
“Do you think he’s still mad at me?”
“I have no idea. Listen, Miss Green, I have two daughters. In fact, you’re young enough to be one of them so I hope you don’t take this as anything other than a sincere concern for you but have you ever considered that you’d be better off without this guy? I mean, you’re young, bright, and obviously very intelligent. You’ve got your whole life ahead of you, completely wide open, and I’d hate to see you end up saddled with a couple of this guy’s kids, without any support, living in some dump, and struggling through life when you could be a real success.”
“But he loves me.”
“I don’t think so.”
“How can you say that?”
“Well, he did shoot you in the vagina….”
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