Playing Doctor

Initial Visit?

Tuesday, January 4

Up Yours, Reader’s Digest

About once a year Reader’s Digest does this nightmare article on how to manipulate your health care providers. When I have a rash of senior patients behaving in a truly bizarre fashion, I flip through the recent editions and sure enough, there is some article giving horrid advice.

A few years ago, they did a great piece on ‘How to See a Physician in Less Than 20 Minutes in the Emergency Room.’ I am going to leave alone the whole subject of people who hang out in emergency departments with such frequency to make this an issue. With a few exceptions, if it is taking longer than an hour to see a physician, it’s likely because you don’t belong in an emergency room: you belong at home and calling the next morning to get an appointment to your family doctor. But whatever.

Reader’s Digest advised people to tell the triage nurse that they were having crushing pain in their chest that radiating down their arm. I have no idea how many of these fools were screened out by the ED, but those that actually had cardiac risk factors got admitted to the hospital for a day or two.

Now, once you tell a physician that you have a problem; it is usually incumbent on the physician to decide if it needs further work up. Even if you tell the doctor your original complaint was a lie, at that point you are saying that you are a liar, and the physician has to decide which statement has more credibility, the ‘lie’ or the admission of lying. Because people can go home and die from heart attacks but not from being morally bankrupt, physicians tend to treat them as if they had the former and then send them home if they turn out to be the latter.

What really brought these people to the ED? Here are the ones I remember:

1) Stomach upset

2) The Sniffles

3) Blood pressure medication refills needed

4) One guy had been scheduled for surgical repair of his hernia, but it had been scheduled four weeks away and he was hoping to have it moved up. Unfortunately, his faking a heart attack made the surgeon delay the surgery until the patient could get clearance from a cardiologist who didn’t have an available appointment for over nine weeks.

5) One deserved a special prize. When he was found to have lied and had only a trivial complaint, he was discharged and told to report to his family physician the following week. He left the hospital, walked across the street and called Fire-Rescue from McDonalds. When they brought him back to the ED, he was recognized and then arrested for making a false 911 call.

Several wanted to leave the hospital ‘Against Medical Advice.’ This means the physician does not feel the work up has been completed and it is not reasonably safe for the patient to leave the hospital. For patients who have no insurance, no credit score, and no intention of ever paying any medical bill they receive, it is meaningless. They can sign a piece of paper after someone explains to them that leaving the hospital could result in their death or permanent disability and then walk out. But if you have insurance or Medicare, signing that piece of paper will absolve the carrier from paying for any of the hospital expenses accrued, which leaves the patient to foot the $10,000-$25,000 hospital bill themselves.
Most people who scour Reader Digest have insurance, so they got stuck with staying in the hospital until the cardiac workup was complete. Usually it only took 18-24 hours to perform, but for people who were willing to lie to speed up an ED visit, they were a particularly upset and pissed off bunch.


Blogger hot babe writes:

People really lie about that stuff? I don't have the balls to lie about something like that. But if my doc scolds me again for asking for STD tests because there may have been a slip-up during the year, then I'll lie & say there were no slip-ups but I want the tests as a precaution. No need to lecture me with my feet in the stir-ups, ass hanging off the table & a bright light shining on my bad side. At least do the lecture while I'm still sitting upright & not so vulnerable (take note of this if you have to do a pelvic in the near future- never lecture when we're vulnerable as it just pisses us off & encourages us to be less honest in the future). But that's the extent of a lie I'd tell to my doc. Nothing about fake chest pains. I don't want to be stuck there for hours... or DAYS.


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