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Drug Seeker – Part 2

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Megan was a “drug seeking” patient who sticks out in my memory.  Drug seekers are patients who use the health care system to acquire more medication, usually to feed their addiction to mind and mood altering drugs.  Of the many drug seeking patients I’ve taken care of, Megan sticks out for her sheer audacity.

Complaining of back pain, Megan and her boyfriend came to the hospital immediately after being discharged from a hospital 4 hours away.  She said she works in health care but that she was mistreated at an outside hospital; they would not address her pain.

Megan was admitted to our Hospitalist service.   After assessing her and reviewing her records, the physician could find nothing wrong with her back.  He knew that her long distance travel, request for specific narcotics, experience in the health care industry, and benign assessment all meant one thing: she may be a drug seeker.

He went to our state’s Prescription Drug Monitoring Program database. He pulled her up and saw that she had been prescribed 360 Percocet 2 weeks ago and 30 Vicodin 1 week ago.  Interesting. She told the physician and me that she had never tried Vicidon.  Assuming she had none left, she had burned through 2 months’ worth of narcotics in 3 weeks. Red flag much?  She was sent home with a taper of narcotics to help her wean off the drug. My guess is that after taking the taper drugs at a much higher frequency than recommended, she crossed state lines and went to a neighboring state.  Unfortunately, states maintain separate databases.  For all I know, she may have already been pulling her scam in multiple states.

Is Sunday a Day of Purgatory?

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Hospital administrators are fond of saying, “The hospital is a 24 hour, 7 day a week business.”

Some nurses, on the other hand, say, “If you’re having chest pain and it’s Monday, go straight to the Emergency Department.  If it’s Friday, take a Tums and aspirin and stay home until Monday.”[i]

The reason is, despite our supposed 24/7 availability, little gets done on the weekends.  For example, if you come in on Friday afternoon with chest pain and you might be having a heart attack, count on getting some emergency treatment such as taking an aspirin, getting blood drawn to check for certain enzymes,  and getting an EKG.  Also count on getting a stress test and other needed care—on Monday.  And to make your long weekend in the hospital more pleasant, we won’t let you eat or drink (or smoke)—all weekend.

Or suppose your daughter has a g-tube that is not working and she cannot get proper nutrition.  Regardless of your daughter’s current nutritional state, expect to get the new g-tube placed—on Monday.

While Sunday is supposed to be a day of worship, in hospitals it’s often a day of purgatory.  Patients end up in a state of limbo wondering when and if they will be able to get their needed procedures, wondering if they will be okay, wondering how serious their condition is, and wondering when they will be allowed to eat next!

It’s great that health employees can have Sunday off, but certainly there has to be a way to provide better care on Sundays.  Babysitting patients, without taking care of them, drives patients and staff crazy. It also means we are wasting a huge amount of money as procedure and operating rooms sit empty and beds remain scarce.  Granted extra staff would have to come in to work, but surely their salaries would be offset by the fact that it can cost ONE MILLION DOLLARS PER DAY to run a hospital. Further, patients can be paying about $8,000 a night at the hospital.  Keeping them in the hospital for extra days can cost patients and their insurers a huge amount of money.  If we were able to do stress tests, radiology procedures, etc. during the weekend, we will save money, make patients happier, and perhaps even save a life through intervening earlier.

Wouldn’t it be nice to spend fewer unneeded days in the hospital?  Wouldn’t it be nice to save yourself and the system some money?  And if we get you through your procedure and home on Saturday or Sunday, you can truly have and appreciate your day of rest.

[i] Please don’t take anything on this site as medical advice. It is for entertainment purposes only.


Addendum: My father would like me to point out that if you come to the hospital and you are indeed having a heart attack and not indigestion, you will be treated very quickly.  In fact, hospitals track how long true heart attack patients have to wait before receiving emergency care.  My point is only that if the first few tests come back negative, you will spend a lot of time waiting around.  If the first few tests come back positive you will receive emergency care and probably don’t need a stress test at that point anyway!