Sunday, July 09, 2006

Duped

Category: Clinical Rotations

A woman in her early to mid 50's came to the Emergency Room because of an injury to her wrist. She had slipped and fallen, and her wrist was pretty swollen and tender. She seemed to be in discomfort but she wasn't screaming in pain or anything. The woman was very ordinary-looking, medium sized, clean, dressed in very ordinary clothes, pleasant, and sort of soft-spoken.

The x-ray of her wrist showed a possible fracture. We scheduled her for a bone scan for the next day, splinted her wrist and wrote her a prescription for Lortab 5 mg - six pills. The particular ER doctor that was working said he never wrote for more than six. I remember thinking, "Oh good grief - if that's really fractured it probably freakin hurts. He needs to give her more than six! It's not like this lady is some drug-seeker or something." But, of course, I didn't say anything. She thanked us and left, and we went about saving lives and doing good for the world.

About two or three hours after she'd gone, we get a phone call from the pharmacy over an altered prescription. Guess who? Nice, soft-spoken, ordinary, not-seeming-to-be-the-criminal-type wrist lady had turned the number 6 into 16. "What the h?" I thought to myself. "That's just insane! She's not the type!"

I've been told that after a few years of practice, doctors develop an eye for drug seekers. And they try their best not be fooled, but sometimes it happens. "Everyone's going to get duped," one of the ER doctors told me. "It's nothing to fret over, but it does sharpen you for the next time. Besides, there are people with real pain - what can you do?" He shrugged it off and accepted the fact that sometimes we would be fooled. Doctors try to keep the drug seeking to a mimimal by using narcotics contracts and developing personal policies on when to give controlled substances and how much.

I felt slightly stupid - I try my best not make too many assumptions and there I went. "She seemed like such a nice person," I thought. Well, what of it? Lesson for the day: The nicest seeming people can turn out to be the ones that treat you the crappiest, and the ones that seem to be the most troll-like might actually turn out to be truly sick.

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