A patient who was on “The List” came to the ED for another bout of “kidney stones.”
She had been through several staff physicians before they had discovered that she was gaming the system. The problem with the patient was that she was addicted to Vicodin, but that she also had real medical problems. CT after CT would show stones in the kidneys. Sometimes she really would be passing a stone. Most of the time she wasn’t. She had enough CT scans to treat a tumor, but she’d always come to the ED squirming in pain. She got so good at it that it became a coin flip as to whether her pain was legitimate. Eventually when she had burned enough physicians, she was cut off from the narcotics list.
Then she made her way to other hospitals.
She had just started seeing a urologist at another hospital for her kidney stones when her pain struck again. She was out of Vicodins and needed more. She called the on-call physician and asked for a refill. He told her to go to the ED for evaluation. So she showed up grabbing her stomach in pain. Based on her history at our hospital, she didn’t get a lot of sympathy at first. Sure, she received IV fluids, Toradol, steroids, and Flomax. But she didn’t get any narcotics. While she was getting her medications, I had the on-call urologist from the other hospital paged.
About 10 minutes later, the secretary announced over the intercom that Dr. Bladder was on the phone.
I picked it up and gave him the patient’s presenting complaints. He told me to do a CT and if she had passed a stone to give her thirty Vicodins and to have her follow up in the office.
“You don’t know her very well, do you?”
“No. I don’t know her at all.”
“She’s been in our ED 27 times in the past year and has been at multiple other EDs supposedly passing kidney stones as well. She’s always asking for Vicodins just to hold her over until she sees her doctor. Sometimes she has legitimate stones. More often than not, there are cortical stones but she’s not passing anything. I’m not aware of anyone that can pass 27+ kidney stones in a year, are you?”
“Very interesting. Thanks for the head’s up. I’ll let my partners know, too.”
“No problem. I’ll send her home on some NSAIDs and have her follow up in the office tomorrow.”
“Sounds like a plan. Thanks.”
A few seconds after we hung up, we heard stuff being thrown the patient’s room. A chair hit the wall. Then the door flew open and the patient had ripped her IV out and wanted to leave. Turns out she picked up the phone in the room when she heard that the urologist was on the line and listened to our whole phone conversation.
“I heard them kibbitzing on the phone like a couple of little old ladies. That’s a bunch of bullshit! I have NOT been in this hospital 27 times in the past year.”
I was stunned for a second. Then I regained my composure and told her “I could show you the charts if you want. It would just take me a couple of hours to print them all out. As for now, you’re going to be discharged on anti inflammatory medications. You need to see Dr. Ureter tomorrow.”
“Don’t bother. I’ll just go to another hospital where they care about their patients.”
Oooh. That one hurt.
My mother always used to say “be careful what you look for … you may find it.”
This patient’s little eavesdropping stint will probably just be the source of another complaint about a “rude” physician who defamed her good name. I still have this glimmer of hope that maybe what she heard would be a wake-up call.
After all, she hasn’t been back to the ED in three days.