WhiteCoat

Be Careful What You Listen For …

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.

23 Responses to “Be Careful What You Listen For …”

  1. rlbates says:

    Wow, it’s also important for us to be careful who might overhear the conversations we have.

  2. Wiserun says:

    After all, she hasn’t been back to the ED in three days

    Shouldn’t there be a “our” in there, just after “the” and before “ED”?

  3. Hyper Al says:

    I’m surprised you did not use your “Tylenol #3 Trick” on this one. Then again she sounds like a pro and knows how to play the system already.

    This case is a good wake-up call not only for the patient as you hoped, but for all of us and the hospitals. If a patient can pick up a line and listen in to conversations as easily as this case showed, that could easily mean a brand new BMW or a Mercedes Benz to a lawyer looking for a new ride.

  4. ERnursey says:

    What amazes me is that these people who are so adept at scamming the system aren’t smart enough to realize that we keep records of all their visits, what do they think we do- toss the chart in the trash after they are discharged.

  5. Alban Berg says:

    You know everytime I read about some doctor who thinks he’s freekin’ g-d for keeping a substance away from a person who will be made happier for it. Let’s get rid of prescription drugs . . . ah but then who would ever go to doctors?

  6. joe blow says:

    Yeah ALBAN BERG, I got an idea — lets give out free narcotics to your daughter, and then when she’s strung out on crack row prostituting herself for opiates you can laud the “no prescription needed” mantra.

  7. SarahW says:

    How about we charge for the narcotics? but take away the gatekeeper role for physicians? Sensible people will still want doctors to help manage painful conditions. Addicts with real health issues can get around a doctor who thinks they cry wolf for pills that make them feel better. Addicts without real health issues stay out of your ER.

    The teenager thing is a bit overdone, don’t you think? Teenagers do not stay free of drug abuse with current law, and the population of abusers is as likely to remain steady, even if the types of substance abuse changes.

  8. NBrown says:

    This is hilarious on so many levels. First, the truth hurts. Second, her ‘roid rage paints a picture of her turning green with yellow eyes while her big muscles rip through her tattered clothes as she throws the furniture around. You: “I’m sorry you can’t have narcs. Oh wait a sec, you’re going to turn into the Hulk and throw stuff? All right since you put it that way, you can have some more Vicodin.” Third, you’re awesome even if you don’t “care” about her and her “pain” (maybe it is pain and then again maybe not-let the bets begin!). It is worth the complaint.

  9. Tex says:

    What I find interesting is how her pain vanished and she suddenly had the strength to throw chairs and walk/stomp upright.

  10. mottsapplesauce says:

    My thoughts exactly, Tex. It sounds like the phones in your ED need re-wired, WhiteCoat. I’m actually glad she heard the ‘kibbitzing’ though. Truth hurts, eh?

  11. TK says:

    What I really hate is when the patient who hears something nasty said about them is really sick or not a malingering piece of work.

  12. MHA says:

    Good for you for GOMERing this one. As a med student and a migraneur, I would just say this: please don’t approach every patient as though he/she is a drug-seeker. This kind of person is the reason that the few times I’ve been in the ED for migraine I have been treated like a junkie. It makes feeling bad feel even worse…

  13. SeaSpray says:

    Dr Bladder and Dr Ureter and “Oooh that one hurt” has me laughing over here. Too funny!

    She was probably just a tad angry with you for preventing her from getting those vicodin.

    Maybe she’ll get the message but not likely.

    Does anyone explain the risks of CT radiation with her? Sad too that someone’s life comes down to this.

    I’m floored that she actually picked up the phone to listen.

    I agree with you TK. I have seen that happen and I cringe and sometimes feel really upset for the patient. Staff should be careful about how their voices carry sometimes. Then again…I have seen attitudes/comments right in front of the patients. What is WRONG with people that should know better when they do that? Fortunately, it wasn’t that often. I am talking about patients that were misjudged because of the frequency of their visits or appearance, or that they were self pays-mdcd ptatients,etc.

    The absolute worst (I probably said it here) was when an ED doc made fun of an elderly lady brought in from the nursing home who was out of it. Tears actually came out the sides of her closed eyes. This doc was a really good doc and I liked him but what got into him that night… I don’t know. That really disturbed me but I didn’t say anything and I should have I guess. I didn’t laugh.

  14. ArkieRN says:

    I’m sorry if she does happen to have pain on some of her future visits that won’t be managed. But, seriously, does no one teach the story of THE BOY WHO CRIED WOLF anymore? Actions have consequences and people tend to want to conveniently forget that.

  15. SeaSpray says:

    I actually told that story to our boys to make a point. :)

    I forgot about an incident where I was treated horribly by a doctor in a private practice. It was the most humiliating experience, but I was so ill and in so much pain and I wouldn’t have spoken up back then anyway. When I told the ED staff I worked with …they were appalled and the ED doc said if he was going to with hold treatment then he is surprised he didn’t call an ambulance. He was my doc 17 years earlier and I just happened to go into that office because it was the 1st available building. I was on the road and would have stopped anywhere there were humans and a bathroom. We had a good rapport too so I was shocked at how he treated me. Even his nurse was hesitant and surprised at his actions.

    Anyway…being on the wrongful end of that from someone who has taken an oath to help people really hurt, added to how bad I was already feeling and prolonged my suffering unnecessarily.

    I wish I had gone back to see him after I was better just to kindly say I didn’t appreciate it but I was afraid to and I just wanted to forget about it. I forgot about posting this story.

  16. Osler says:

    Think about this women the next time you are complaining about a rise in you insurance premium or a bill from the ED. We all pay for those that abuse the health care system and waste its resources. More and more people are complaining about their bills to me but ya know of that $250 I still only get like 30 bucks and the rest goes to swelling overhead and to subsidize those that abuse the system or don’t pay. a lot of people cannot pay but abusers make the situation even worse.

  17. Rogue Medic says:

    I thought party lines were mostly eliminated in the 60s and 70s.

    Imagine if Dr. Deborah Peel found out about this. A patient eavesdropping on a phone call about her abuse of the system. How horrifying that must be. We should put an end to physician to physician communication.

  18. Teresa says:

    Forget Deborah Peel, Patient Privacy Rights Advocate. What about doctor privacy rights? Do doctors not have a right to assume a private communication?

  19. catpaw says:

    Vicodin for kidney stones? Holy Crap! I’m moving to the US. I’ve had kidney stones twice and the doctors were very helpful and sympathetic – don’t get me wrong, honestly they were. BUT i was told “They will pass, you will wish you were dead, but you won’t die” and given a prescription for Tylenol 3. And guess what? They were right.
    Vicodin? Isn’t that a bit of over kill?

  20. SeaSpray says:

    Wow Catpaw! They must’ve known they would pass because i don’t think mine ever would because my ureter is more narrow than normal. And I ended up in the OR and the pain was worse then labor contractions with back pain and also had the pressure of labor. Tylenol #3 would never do.

    The ED gives you morphine or dilauded where I went but then I get really sick. God forbid there should ever be another but if so I know I can tolerate demerol. I think it is inhumane to not have narcotics for that but there must be degrees of pain according to stone size. ?? The hospital I worked in gives Demerol in conjunction with …i want to say Toradol but I could be wrong about that. They do give the Demerol with another drug though.

    Post stent removal (I had 6 removed that caused me kidney spasms) the after pain is so horrendous that they give you Percocet to take when you are home. Actually…my last stent removal the kidney pain wasn’t bad…just crampy/achy which was a welcome change. :)

    That is all behind me now..Thank God! :)

    I really feel for you Catpaw.

  21. jeffsher63 says:

    That’s one way to get rid of her :)

  22. ? says:

    At first I didn’t believe this thing about the patient listening in like it was a party line. Could someone really be so dumb as to put a phone with access to the same lines used for hospital business? To me that’s more remarkable than the rest of the story.

    As far as the 27 previous visits go, that doesn’t even approach the frequency of some of the patients I see regularly. We’ve got customers who’s charts number close to a hundred per year.

    We have multi-line phones on the wall in the trauma rooms so that the docs can contact consultants/other hospitals while still in the rooms. Never believed that someone would even think about picking up the phone to listen to the conversation until this woman proved me/us wrong.

  23. mottsapplesauce says:

    Catpaw,
    I agree with SeaSpray. The kidney stone I had in 2005, as my urologist put it, was the “Rock of Gibraltar”. He showed me the X-ray because they couldn’t get over the size, which was larger than a golf ball. They gave me a local when the radiologist had to cut my back to place the nephrostomy tube. In fact, they gave me two locals. I didn’t feel pain, but I felt him cutting. He literally screamed at me not to move, but the ‘twitching’ that was occuring during the placement was total reflex. I wanted to grab his nuts & twist them off but he was out of reach. Needless to say, that radiologist never touched me again. I never said a word, but apparently one of the staff told my surgeon what happened. All of that could’ve been avoided with a little Versed (sp?).

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