29 October 2006

Follow-up

One of the frustrating things about working in the ER is that you so rarely get follow-up on a patient you have seen. They leave the ER and it is as if they cease to exist. And when you do get follow-up, it's usually a bad thing -- "Remember that chest pain you sent home yesterday?" So today I was pleased to get follow-up on one of my patients from yesterday's post. It was Patient Number 5, Chronic Abdominal Pain Lady.

Now I didn't realize that it was her at first. For one, the name on the chart was different. Also, the details of the presentation were slightly different. When I walked into the room, though, I noticed that she looked very familiar. Then I saw the external jugular vein on her neck, a very distinct large and bifurcated vessel that I had had to cannulate to get blood off her the day before. (BTW, how sad is it that I didn't recognize her face but did recognize a vein?) At first, I played dumb and got some details from her. She recognized me and tried to give me a close approximation of the previous day's story, getting a little flustered when I pointed out that she had told the triage nurse something very different. I made an excuse and left. The admitting clerk approached me and told me of not the one but three other names they recognized her as having used. They all had social security numbers, dates of birth, phone numbers, and addresses which were identical, except for an occasional flopped digit.

I went back in and explained to her that I was happy to screen her for an emergency condition, and treat one if it were present. I also pointed out the . . . irregularities in her registrations. I did not accuse her of anything, but I said that I was concerned about her dishonesty. (Even when you have someone busted, it's wise not to overcommit oneself.) Predictably, she escalated and became angry and threatened to sue me and stormed out.

Ah, victory. I hate (really hate) having an adversarial relationship with patients. But it's hard not to savor a clean win when one comes along.

4 comments:

Flea said...

The feedback would arrive more often if you communicated with the patient's doctors.

Really!

best,

Flea

shadowfax said...

Ha ha! Touche.

Anonymous said...

I usually gave feedback when a patient showed up for suture removal, sporting a few dozen 6-0 sutures placed a millimeter apart.

Anonymous said...

ding, ding, ding, we have a winner! congrats.