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Raising the Bar in Rehab

Frequent Flyer

Published September 3, 2009 7:33 AM by

A patient came into our Emergency Department last week with chest pain, shortness of breath and a generally malaise-type feeling.  The patient couldn't point to any specific cause, and had a significant family history of heart disease.  The patient was classified as "obese" by her BMI and was a smoker.  The patient was hooked to a 12-lead EKG and admitted for observation on our cardiac floor.

I left out a vital piece of information in that introduction.  This was the 24th ER visit from this patient since February.  24 times in 7 months means approximately one visit every 10 days.  Words like "multiple hospitalization" don't even cover the spectrum of resources this patient wastes. By the time the patient is admitted, blood tests taken, and the protocol for cardiac patients is started, literally thousands of dollars have been spent.

It is unclear if the patient is driven to seek attention, trying to receive pain medication, or if the symptoms are truly legitimate.  There are many factors pointing to the former.  While I enter every treatment center with an open mind and good intentions to provide the best therapy I can, part of these treatment sessions are hard for me to get through.

While you hate to blame patients for abusing the health care system, 24 visits in 7 months seem outrageous.  Yet, no health care plan will be able to adjust for these expenses.  Part of the problem with our health care system involves the innate American culture. 

posted by


Great title!

I understand your frustration.  I worked a lot with chronic pain patients, at one time exclusively.  Malingerers are present and annoying.  They waste your time when it could be spent more effectively on actual patients.  Once you've seen that behavior, it is difficult not to let skepticism rise up when you see indicators.  

The first time your skepticism is proven wrong and a patient's life is irreparably changed, or nearly irreparably changed, that skeptism is more easily put in its place.  

When you are on the receiving end of that skepticism and your life is irreparably changed, skepticism almost never rears its ugly head again.  

Almost never, because after all those malingering, attention-seeking, and med-seeking patients are still out there.  And they still get under our skin.

janey goude September 8, 2009 10:39 AM

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