Something for the pain

There are some things that an emergency physician can expect when he goes to work, like the mailman getting chased by the neighborhood dog or a teacher dealing with the problem child. We ED docs know that drug-seakers never cease to disappoint. Their constant lumbar or cervical back pain from falling at work, car accidents that are never their fault, or the rare (but comical) post-coital muscle strain is a daily occurance that we can bank on. Rain or shine, morning or evening, a seeker always finds his or her way through the ED doors (although having an ambulace pick you up i'm sure makes the hike through the cold a bit easier).

The "cry worf" scenario wouldn't be a problem if seven lawyer's offices were not located within 2 blocks of my hospital. I've just started my seventh month in emergency medicine (only three of which have actually been in the ER due to office service rotations) and I already know, almost personally, a handful of patients I can expect to see regularly. The other day I had had enough and practically begged the attending to let me not treat this guy's knee pain because we all knew he was there for his dilaudid and percocet scripts that he could take home and sell. That day I working with one of the more conservative attendings and he told me a story about a patient he once had, a seeker, that came in regularly complaining of the same thing. One day he was in my situation, fed up with the same complaint and he decided to discharge the patient without treating her. She walked out and died.

The lawyers loved it. All they had to do was go to court and say, " you mean to tell us that the now deceased patient came in to your ED complaining of pain and you did nothing to take the pain away, doctor?" That's an instant settlement.

Its easy for me to not want to treat these folks because technically the responsiblity lies with the attending. I may be as conservative three years from now when I'm the one facing the lawyer. So for now I will continue to give these folks something for the pain eventhough they are a major problem in our healthcare system. Everytime he comes in complaining of knee pain I have to be sure it is not going to kill him, and that's not cheap, and, of course, he ain't paying.

The title of this post was borrowed from a book that looks at one MDs life as an ED Doc, very interesting. I highly recommend.