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Friday, August 28, 2009

Deciphering Those with the Entitlement Mentality

I see this same scenario in our friendly local emergency room time after time. It's 2AM. Things in the ER have finally started to calm down a bit and the nurse and I are trying to get caught up on paper work.

Before long the registration clerk tells us there is yet another patient. It takes about 10 or 15 minutes for the nurse to perform triage and the intake paperwork (assuming we're not otherwise busy) and then the chart is handed to me.

I immediately recognize the name on the chart and I go to the computer to find that this same person has been to the ER half a dozen times or more in the past 6 months for big emergencies like, toothache, rash, insect bites, headache, back pain......you get the idea.

I look at the nurse's note and read "cough and congestion for 1 week". I go in the exam room to find a sexy goddess adorned with an exciting array of piercings and some hideous tattoos. She's busy talking to someone on her I-phone and is not in a hurry to hang up to talk to me. (Who the hell could she be talking to at 2AM? Civilized people should be in bed.) I also notice a couple of packs of Marlboro's in her open purse and she has a smell of stale beer and week old body odor.

Patient> "I'm all stopped up and I can't get rid of this damned cough."

Doctor> "You've had this how long?" I'm pretending I've not read the nurse's note.

Patient> "Since last week."

Now I'm not proud. I don't mind stating the facts exactly as they appear.

Doctor> "Well, you've had plenty of time to see your regular doctor in the clinic for this ailment."

Patient> "Well, I thought it would get better, but it got worse."
Translation> "Since I don't work, I sleep until noon each day and I just don't want to take the time out of my busy day of watching soaps, going to court, and buying beer and cigarettes, to make an appointment at the office and sit and wait. Besides, he won't give me hydros." (She is referring to hydrocodone, a potent and addictive narcotic. It's also a great cough suppressant.)

She doesn't know that I looked her up on the Tennessee Board of Pharmacy website and found that she has had numerous hydrocodone prescriptions given to her by an array of different practitioners. Most people don't realize we have access to this information.

Doctor> "Uh-huh...."

I proceed with my exam. Her vital signs are all stable. Her oxygen saturation is 99 percent on room air. She has some mild upper airway congestion and her chest is clear. She smells so bad it's hard to stand near her for long. Ya know...soap and water is pretty cheap.

Doctor> "You have a cold. I'm going to write you a couple of prescriptions you can get at the drug store in the morning. (The nearest 24 hour pharmacy is an hour and a half away.)

Patient> "You need to GIVE me something now for this cough!"
Translation> "I need some hydros bad!"

Doctor> "Sorry, you've had this a week. You can wait until the drug store opens this morning. It's against hospital policy to dispense drugs to non-emergency cases." (Dispensing is actually up to the ER doctor but it sounds good.)

Patient> "Oh this is an emergency!"

Doctor> "No, sorry, cold symptoms for a week is not an emergency. These are issues you should be discussing with your doctor in the clinic."

OLD CHINESE PROVERB: HE WHO SEES DOCTOR IN MIDDLE OF NIGHT, SEES DRUGGIST IN MORNING!

I write her a script for a decongestant and a non-narcotic cough syrup.

As I leave the room, I drag my feet a bit and listen to her get back on the I-phone, "That sonofabitch wouldn't give me anything! He's just a piece of shit! I wouldn't take my dead cat to this hospital." (Remember this is her seventh visit in about 6 months.)

I figure that she and the party on the other end of the phone were planning on having a hydrocodone bash when she got home. Sometimes they sell them.

I make my way back to the desk and hand the chart to the nurse. I say to her, "Boy! I cudda had a woman like that! What was I thinking?"

I look again at this woman's computer file. She has Tenncare and is unemployed.
Here she is, perfectly able to work, but on the gubment dole, soaking up my tax money to feed her narcotic habit. I also see where she moved here from Michigan about a year ago..................WHY?????

You guessed it! To get on Tenncare.

Yall ever wonder why I'm called the GROUCH?

5 comments:

  1. I know that you see tons of people just like this one...

    Perfectly able to work,

    Yet on TennCare.

    How do they get on TennCare in the first place and how do they continue on it year after year. Is there NO investigation, NO qualifying rules or guidelines?

    And there you are working 24 hours straight and having to see drug seekers like that at 2:00 in the morning. You sure spoiled her plans to get high.

    Yep, you could have had a "woman like that" rather than me, all that natural beauty, aroma, class, style, and body art. What WERE you thinking marrying me??? heh

    Deborah F. Hamilton
    Right Truth
    http://www.righttruth.typepad.com

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  2. What can I say---you left nothing out. I was a social workers for a brief time years ago in CA---they really had the programs for drug and alcohol users---alcoholism was elevated to the mental illness status and those people were given state disabilities and given a check for about $500 per month and this was around 1990. Things have gone downhill from that point all over the nation.

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  3. Yeah, I work as a physician coder for a hospital. Before that I was a pediatric office manager for 8 years. Some PARENTS even try that stuff with their kids' medicine...adderall and codeine cough meds make for a fun evening, I guess.

    Indiana now has what they call the INSPECT report that our docs can utilize to check on "suspicious" patients, thank God. Looks like the well may be drying up around here...

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  4. Honey Pot:

    I dunno how some of them manage to get on and remain on Tenncare, but they do. I remember when Tenncare was new we had a glut of people coming in here from out of state for the sole purpose of getting on Tenncare. The majority of immigrants came from either Michigan or Florida. I don't know why but that was where most of them came from. I always thought there should be a 5 year waiting period before an immigrant could get state assistance but I guess there was probably a federal gubment regulation prohibiting such common sense.

    Lizzard:
    Yes, I am a cold, heartless bastard, and greedy too.

    Ron:
    Right Ron. I see people running around here on disability who appear healthier than me or the nurse waiting on them. A while back I treated a disabled guy who had hurt himself while roofing a house. He told me he did roofing on the side to make a little extra money.

    Sue:
    Some of my colleagues are not as zealous as I about searching for drug seekers on the pharmacy website. Some of the docs will just give people what they want to get rid of them. This of course exacerbates the problem. Frequently some of the regulars will call ahead to see who is working. If I'm there, they won't bother to come. Hee Hee!

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