August 10th, 2008 by Dr. Val Jones in True Stories, Uncategorized
Tags: Illicit Drugs, Pharmaceuticals, Psychiatry
2 Comments »
A psychiatrist friend of mine (we’ll call him “Dr. X”) treats urban patients who have substance abuse problems and often live in homeless shelters. Here are some recent conversations that had me scratching my head:
Mr. P: [recovering from crack cocaine, alchohol, and heroin abuse] Doc, I’ve been feeling really depressed lately and the therapy sessions aren’t helping.
Dr. X: I know that we’ve done all we can to manage your depression conservatively. You may want to consider trying a small dose of an anti-depressant medication. It could really help.
Mr. P: [Eyes bulging, jaw dropped] But, Dr. X, those anti-depressant medications might affect my MIND!
***
Dr. X: Ms. P, why aren’t you taking your prenatal vitamins?
Ms. P: [actively smoking crack while pregnant] I don’t trust that stuff. I think it could harm my baby.
***
Dr. X: Ms Y, I know you’ve been struggling with pain related to your broken leg. Why not let me prescribe some pain medications for you?
Ms. Y: Oh, no – I don’t want any prescription medicines. I don’t trust those.
Dr. X: Well how are you going to manage your pain, then?
Ms. Y: My sister has some pills that I take.
Dr. X: What pills?
Ms. Y: Darvocet and Vicodin.
***This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 2nd, 2008 by Dr. Val Jones in True Stories
Tags: Finance, Gastroenterology, Hospitals, News, Relationships
2 Comments »
I posted this true story on my blog previously, but I think it bears repeating (especially with the recent news of increased violence against physicians and threats at gunpoint). Details of the story were altered to ensure privacy of all involved.
***
The son of a business tycoon experienced some diarrhea. He went to his local emergency room immediately, explaining to the staff who his father was, and that he required immediate treatment.
Because of his father’s influence, the man was indeed seen immediately. The physicians soon realized, however, that there was nothing emergent about this man’s complaints. After several blood tests and a stool sample were taken, he was administered some oral fluids and monitored for several hours, they chose to release him to recover from his gastroenteritis (stomach flu) at home.
The man complained bitterly and said that he wanted to be admitted to the hospital. The physicians, with respect, explained that he didn’t show any signs of dehydration, that he had no fever, his diarrhea was indeed fairly mild (he had only gone to the restroom once during the hours of his ED visit – and that was when he was asked to produce a stool sample). The man’s pulse was in the 70’s and he had no acute abdominal tenderness.
The man left in a huff, and called his father to rain down sulfur on the ED that wouldn’t admit him.
And his father did just that.
Soon every physician in the chain of command, from the attending who treated him in the ED right up to the hospital’s medical chief of staff had received an ear full. Idle threats of litigation were thrown about, and vague references to cutting key financial support to the hospital made its way to the ear of the hospital CEO.
The hospital CEO appeared in the ED in person, all red and huffing, quite convinced that the physicians were “unreasonable” and showed “poor judgment.” Arguments to the contrary were not acceptable, and the physicians were told that they would admit this man immediately.
The triumphant young man returned to the ED for his admission. Since the admitting diagnosis was supposedly dehydration, a nurse was asked to place an IV line. The man was speaking so animatedly on his cell phone, boasting to a friend about how the doctors wouldn’t admit him to the hospital so his dad had to make them see the light, that he moved his other arm just at the point when the nurse was inserting the IV needle. Of course, the poor woman missed his vein.
And so the man flew into a rage, calling her incompetent, cursing the hospital, and refusing to allow her to try again.
At this point, the ED physicians just wanted him out of the emergency room – so they admitted him to medicine’s service with the following pieces of information on his chart:
Admit for bowel rest. Patient complaining of diarrhea. Blood pressure 120/80, pulse 72, temperature 98.5, no abdominal tenderness, no white count, patient refusing IV hydration.
Now, this is code for: this admission is total BS. Any doctor reading these facts knows that the patient is perfectly fine and is being admitted for non-health related reasons. With normal vital signs, and no evidence of dehydration or infection, this hardly qualifies as a legitimate reason to take up space in a hospital bed. And when the patient is refusing the only treatment that might plausibly treat him, you know you’re in for trouble.
The man was discharged the next day, after undergoing (at his insistence) an abdominal CAT scan, a GI consult, an ultrasound of his gallbladder, and a blood culture. His total hospital fee was about $8,000.
Do you think he paid out of pocket for this? No. He submitted the claim for payment to his insurance company. Their medical director, of course, reviewed the hospital chart and realized that the man had no indication for admission, and refused medical care to boot, so he denied the claim.
So the son appealed to his father, who then rained down sulfur on the insurance company, threatening to pull his entire business (with its thousands of workers insured by them) from the company if they didn’t pay his son’s claim.
The medical director at the insurance company dug in his heels on principle, assuming that if he continued to deny the claim, the hospital would (eventually) agree to “eat the cost.”
In the end, the insurance company did not pay the claim. The CEO of the insurance company called the hospital CEO, explaining that it was really the doctor’s fault for admitting a man who didn’t meet admission requirements. The hospital CEO agreed to discipline the physician (yes, you read that corretly) and eat the cost to maintain a good relationship with the insurance company that generally pays the hospital in a timely manner for a large number of patient services.
Welcome to the complicated world of cost shifting in healthcare.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 18th, 2008 by Dr. Val Jones in True Stories
Tags: Addictions, Hospitals, Illicit Drugs, News, Psychiatry
1 Comment »
This alarming story (h/t KevinMD) of a physician attacked by a drug-seeker reminded me of my intern year. I worked in an inner city hospital in New York, and was scheduled to work in the “detox unit” for a full month. We interns had mixed feelings about our “detox month” – on the one hand, the patients were generally healthy and were unlikely to need blood draws, procedures, spinal taps, intubations, and such. This meant less work to do during our shifts. On the other hand, the patients were hardened drug users, often with a history of violence — and let’s just say that depleting the system of all the heroin, crack, alcohol, and various other substances didn’t tend to put them in the best mood.
I personally did not enjoy my detox month. I’d prefer a “crashing” ICU patient any day over a beligerant, hep C positive man trying to threaten me into giving him an additional dose of colace. And frankly, as a woman it was kind of scary to be around these guys. I never knew if they were going to snap, and no matter how many security guards are around, a lot of damage can happen in the 60 seconds or so it takes them to get to you.
One night the “detox resident” appeared for duty. His shift started at 11pm and the day shift nurses were eager to get home. The security guards were changing shift as well, and had not entered the lock-down area inside the unit. The resident went in alone. Suddenly, one of the patients snapped, and grabbed the unsuspecting doctor by the throat. The patient threw him up against the wall and punched him in the face, breaking his nose and fracturing his eye socket. Blood flew everywhere and the resident tried to fight back to defend himself. Unfortunately he was no match for the 250 pound patient, and sustained a few kicks to the ribs before the security guards were able to subdue the man. The resident was transferred off the detox unit rotation and given an extra week of vacation. I was the intern who was asked to fill in for him.
I felt somewhat paranoid that month, and refused to be inside the lock down area without a security guard within 15 feet of me. Fortunately, I was not physically attacked – I only experienced verbal abuse and the occasional very awkward conversation about genital deformities.
But it was a real wake up call for me – medicine can be a risky business, and white coats do not protect against psychotic aggression. I guess it’s just one of the risks we take in caring for all-comers.
***
Addendum: here’s another example of doctors being abused by narcotic-seekers.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 13th, 2008 by Dr. Val Jones in True Stories
Tags: Parenting, Pediatrics, Relationships
1 Comment »
My caller ID displayed an unfamiliar number and I answered the phone hesitantly. Background noise and static nearly drowned out the caller’s determined intent to introduce himself. “This is Dr…. [couldn’t quite make it out]. Is this Val Jones?”
“Dr. Who?” I asked, trying to recognize the voice.
“Dr. Anderson. Is this the Val Jones I know?”
My mind raced through its physician contact list, without finding a match.
“Doctor… Anderson?” I said, trying so hard not to betray my lack of name recognition.
“Yes, yes, that’s right. I was your pediatrician. Remember me?”
Suddenly it all came back to me – this dear gentleman did indeed take care of me when I was young. I remembered him as a tall, fit man with white hair and kind eyes. He had stitched my face after I was bitten by a dog, put my shoulder back in its socket, and diagnosed fractured ribs after I fell out of a tree house. I guess I went to see him pretty regularly growing up, though I hadn’t thought of him in decades.
“Wow! Of course! Dr. Anderson I… I’m so surprised to hear from you after all these years. My goodness. How did you find my cell phone number?”
“Well, it wasn’t easy. Your parents have moved off the farm, and your university didn’t have any recent records. I finally found someone you used to work with and they found you on the Internet and got me in touch with Revolution Health…”
“Gosh, I’m sorry you had to go through all that to find me. What was it that you needed to talk to me about?”
“Well, I’m 90 years old now, and I’ve been thinking about my former patients. I was going through my records and I found your file a few years ago. My wife and I have been praying for all the kids I used to treat, and we started praying for you a while back. You were such a bright little girl – I always knew you’d do great things in this world. I guess I was just curious how you’d turned out and what you were doing in life. This is kind of like a follow up visit I guess.”
I was stunned. I became misty-eyed as I imagined this 90 year old man and his 91 year old wife praying for his former patients, remembering them fondly and even going out of their way to contact them for follow up, for no other reason than to know how they were making out in life, and wishing them well.
I spent about half an hour telling my pediatrician about my life and catching up with his. His wife had undergone biltareral knee replacements after her 90th birthday and was walking around with the help of a cane. He had 5 grand children that were doctors, was actively involved in his church, and still traveled extensively.
“Gee, Dr. Anderson – I’m so glad you’re doing so well. It was so nice of you to call.”
“I’m so glad I got to hear your voice, Val. Nothing makes me happier than to know you’ve grown up to be a doctor. Now take good care of your patients, ok? Keep track of them, and make sure they’re doing alright.”
As I said goodbye I thought to myself, “Those are some pretty big shoes to fill. But it sure feels good to be a patient who was NOT ‘lost to follow up.'”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 26th, 2008 by Dr. Val Jones in True Stories
Tags: Autism, Disabilities, Parenting, Psychiatry
2 Comments »
I spent the last few days in Orlando, Florida with my husband’s extended family. His nieces and nephews were looking forward to the vacation for months in advance, because they were really excited about going to Disney World. However, two of their parents have disabilities – my sister-in-law has stage IV breast cancer with metastases to her hip (making it impossible for her to walk), and my other sister-in-law is married to a man who is hearing impaired. Therefore, navigating theme parks can be a real challenge for the family.
As a rehabilitation medicine specialist, I’m always interested in learning about special accommodations for the disabled. So I contacted Bob Minnick, the Technical Director of Global Accessibility and Facility Safety at Walt Disney Parks and Resorts, to find out what Disney had to offer guests with disabilities.
Bob kindly agreed to meet me at his office on the Disney World grounds, and we had an animated 2 hour conversation about all the exciting programs that his team of engineers have designed. I was impressed with the depth and breadth of services they offer and thought I should let my readers know about them – because even if you or a loved one has a disability, you can still experience “the magic of Disney.”
But before I explain the specifics of the special programs at Disney, I wanted to pause to tell you a true story based on some information that Bob shared with me.
***
A young, non-verbal teen with autism (we’ll call him Johnny) was raised in rural America by two loving parents with scarce resources. They spent all their extra income on services for their son, hoping to give him the best chance at social integration possible. Johnny liked to watch cartoons, and was partial to Disney movies. He spent lots of time viewing them, replaying them many times over. His mom would often try to engage him in conversation about the cartoon characters, but sadly, he remained silent.
Years passed and the parents saved up their money to take Johnny on a trip to Disney World since they knew how much it would mean to him. He had been watching Finding Nemo a lot, and they wondered if somewhere inside his mind he could relate to the little fish with the weak fin. So when they were poring over the Disney theme park brochures and found a show at Epcot Center called “Turtle Talk” with Crush (the turtle character from Finding Nemo) they were determined to make sure that Johnny attended.
When they arrived at the auditorium one of the greeters realized that Johnny had special needs and asked if he’d like to sit in the front row. His mom’s heart skipped a beat – this was going to be a great day for Johnny.
As the lights dimmed and the crowd of kids hushed, a large, animated, moving model of Crush floated effortlessly towards the children in the front row. The blue lights and waving seaweed made the stage come alive with ocean wonder. Johnny fixed his eyes on Crush, transported to another sensory world.
As the sea turtle approached Johnny – almost nose to nose – it spoke to him. “Hello dude, how are you today?” Said the turtle.
And with a slow, deliberate voice, Johnny replied clearly, “Hello Crush. Nice to meet you.”
Johnny’s mom burst into tears and glanced at her husband as the two embraced their son – he had spoken his very first words right there in the auditorium in front of hundreds of people. And although no one else understood the significance of his response – to Johnny’s parents, it was the happiest day of their lives.
You might even say it was magical.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
