Agraphia Medical Tragicomedy

28Aug/07Off

Being Cynical

Well, after all the talk of "professionalism"...

Mr. G was a 45 year old who presented last week to the ED. He's a rather unpleasant guy with over 50 prior ED visits and multiple notes in his chart about being "uncooperative" and "noncompliant". We were consulted because he complained of right arm tingling and weakness that was present when we examined him, but mysteriously disappeared when we left the room. His exam was nonfocal (neuro code for "nothing wrong").

There was nothing else in the history that would have clued you in to any diagnosis, except his abuse of the emergency room. No trauma, no vascular disease, nothing. He's a deadbeat dad who is currently remiss on his child support (recently documented on his chart). He hinted that he's currently homeless. In the hospital he gets a warm bed and free meals.

This guy is faking it.

We still ordered an MRI of the head to rule out the slim possibility of stroke - only to find that he actually crawled out of the MRI machine, yelling at the tech that he was uncomfortable. We finally convinced him to get the MRI, and on a whim, got images all the way down his neck. Just in case.

- Radiology Report -
MRI Head : normal, no stroke seen.
MRI Neck : acutely herniated C5, C6 disks impinging on the right neural foramina. Correlates anatomically with pattern of right arm weakness and tingling.

Oops.

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  1. I’m glad you posted this. I read so many, “What a HORRIBLE person this AWFUL NON-COMPLIANT patient is. He is TOTALLY a drug seeker and ABUSING the system,” that it’s nice to see that occasionally there are actual physical findings that he probably didn’t cause himself.

  2. You cant scare me! Drug seekers are drug seekers and ED abusers are that only! If we are willing to allow in the idea that some of these people may have real medical conditions, then we are going to have to freaking check EVERYONE out! Do you have any idea how long that is going to take?

  3. I found your blog while googling for the StudentMed ‘Things I Learned’ thread. I needed that thread today to remind myself what jerks ER doctors have to put up with all the time, so that I could cut the doctor I had today some slack.

    I have AIP and had an attack yesterday, the first in over a year and a half. When gutloading carbs, potassium, sodium and glucose didn’t stop the pain, I went to the ER today. It’s well documented in my history at that ER, which basically reads ‘If she shows up, give her dextrose and demerol and if that doesn’t stop the pain, give her Hematin.’ I had a poor intern who didn’t know what to do refer me to the worst attending I’ve ever met in my life. If it hadn’t been for the intercession of another attending who’s treated me before, it might have made the news, because I was very close to strangling Attending Asshole.

    Being treated like a drug seeking hypochondriac did nothing to improve my already crappy day. So I had to go find the blogs to remind myself that there’s a reason a doctor unfamiliar with my case would be suspicious of someone presenting with very bad abdominal pain that has no apparent cause whatsoever, requesting narcotics and antinausea drugs – especially when I learned oxycontin is now prescribed for nausea. I had to specify that I wanted my happy, non-addictive Zofran.

    Anyway. Thank you for writing this blog. I’m going to be stuck in bed for the next couple days, so it’s given me new reading material as well as another reminder that doctors have to deal with crappy people and I shouldn’t take it personally this time.
    -T


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