Monday, July 2, 2007

Mining for Gold

“How’s your pain today, Ms. Drugseeker?”

“It still hurts like hell!”

“How’d you rate it?”

“Same as yesterday, a fucking 10! God, why don’t you give me anything?” Her eyes demonstrate a clear desire for pain meds; desperate and conniving as is often seen in connoisseurs of opiates.

“We are giving you pain medications. We aren’t going to increase the dose at this point as you've yet to gain any relief over several days.” I lie to the patient. Really we know she’s full of it and we’re planning on taking her down, giving something for her iatrogenic constipation, and giving her the boot.

I proceed to complete the requisite physical check which includes the patient jumping with “pain” each and every time I touch around her left chest. Oddly enough every test performed to this date has come back negative. Wonder of wonders. She doesn’t have ACS, an MI, or any other problems - except drug addiction and vagrancy. I’ll be glad when she’s outta my hair.

I learned quite early in my 3rd year of training that some patients need a place to stay, some need a bed and a meal for the night, and others just want drugs and use the hospital for these purposes. Things that I knew already, but never quite understood how it was that they were able to manipulate the system so well. I've seen the scams and read about others. Oddly many are very similar, but unique with the person involved.

Ms. Drugseeker will receive a bed because she is middle aged, has abused her physical and psychological health for years, ingests varied amounts of drugs which she obtains by doing unmentionable acts, and has not seen a regular physician since Nixon was in office. An abnormal EKG results and labs will most likely surface, relegating the on-call team to take on this freeloader in a useless search for the etiology.

The patient stays, getting a bed, free food, free healthcare, free drugs, and a place for her hubby to sleep as well while the doctors, nurses, and medical students try to not think about the waste of money this person has become. Hubby remains sedated throughout the process until he hears they're being "evicted". Then he suddenly is concerned about his wife's condition.

Unfortunately for our society this is an all too common occurrence. Many private hospitals won’t take them and will either give a quick drug cocktail and/ or street the druggie. Then the charade plays out all over again, at another ER, another clinic, wasting the same taxpayer dollars; but nothing can be done because god forbid if the constant abuse of heath resources by a parasite might actually lead to the discovery of some illness. Then the lottery is in town.

Hell, we might find gold in them thar hills…so wouldn’t it be a shame to not go looking at the same or slightly varied complaint for the upteenth time while knowing full well that you‘re most likely not going to find anything other than someone who can only tolerate a “D“ drug? That’s what a litigious society has constructed for our kids.

Personally this abuse pisses me off. If we’re going to ever have a healthcare system that has any potential to become universal this exploitation has got to stop. Personally I like the idea that people have a certain amount of points that they can use. Use it up and your done for the month, year, etc. If you’ve been diagnosed with a legitimate disease that will increase your healthcare use then you receive additional points.

This would reduce the overuse of ER’s for minor ailments, reduce the ICU stays with ridiculous attempts to prolong lives already long lost, and might just curtail drug seeking abuse. Of course there's a lot to be desired from this plan; it won't define what an actual "emergency" is, it won't create jobs and decrease poverty/ addiction in many abusers, and it won't take care of the illegal immigrant crisis. But I like it in it's infancy.

Till then the exploitations will continue, the drug seekers shall refine and perfect their lies, the viral URI's will get treated with antibiotics at 3am, illegal immigrants shall continue to invade ED’s for each and every complaint to avoid INS troubles, and my taxes and health insurance premiums will continue to increase.


Anonymous said...

Great post!

Redspiral said...

I absolutely hear your frustration and I've heard this scenario time and again from countless med students online, it's a recurring theme that is no less frustrating for anyone on the care side of things.

I just want to say though, that as a non-medical student (yet), as just a woman walking on the earth, this statement made me very sad:

"the waste of money this person has become"

As the daughter, sister and niece to several drug addicts, this statement just made me very sad. At what time is money more important than a person?

I know that resources are precious and few, I totally do understand. I know that the physicians and nurses time is equally precious, and I know that likely nothing positive will come out of her being in that facility for no reason other than a clean place to sleep and the hope of more drugs. I get that... but when is a dollar bill, a thousand dollar bills, a million dollar bills, more valuable than one person's life, even if they are too sick to do anything positive with it?

I guess hospitals must decide that a thousand times, every single day. Is it true that people with money get better care? Of course it is. Is it true that people on state aid or with no insurance do not get the same care? Of course it is.

It's not right. And it's jading doctors against people who are ill with addiction because they are 'less worthy' of care than those who are sick with physical disease.

She is still someone's daughter, maybe someone's mother. She might have been a teacher of young children or a pastor's wife, or a coffee shop barista, she had hopes and dreams at some point in her life, aspirations to be something bigger, and it's all lost to her now. She deserves a firm hand and a compassionate word, and yes, a boot out the door... tough love, as it goes. Love, nonetheless.

Anonymous said...

Want to say, MSG, I completely agree with you. Drug abuse is not a medical problem, it's a problem of character, of not finding anything more interesting to live for (including themselves, family and friends) than a 'fix'.

But what really puzzles me is how these people can so abuse their minds and bodies for so long and there not be anything medically wrong with them when they go to ER looking for drugs!

Anonymous said...

Oh my....

Is addiction an illness?
Is mental illness a character flaw?

There is always a blur where the person's illness (mental health and addicitions) meets the person's character.

As in: many irritable and annoying people are actually suffering from depression can be treated.

However, psychotrophic meds can never treat moral short comings.

It sounds like you can diagnosis a drug seeker in a sec.
You see there addition....

Treat it!