Sorry about no recent posts - I've been busy trying to find a new assistant and the like, as well as covering the full schedule for my associate, who was in England for a couple weeks.
So a couple days back I'm in the office on a Saturday, doing some paperwork and seeing a patient for an emergency. My cell rings and it's a young woman...we'll call her Jessica Thompson. Jessica says she hasnt' been in in a while but she's a patient of record and she has a toothache...what can we do? I told her to just come on over and we'll take a look.
When she arrives I take a few xrays and discover that she has a blown out wisdom tooth on upper right...the lower right one is a bit dodgy too, and she has tons of big fillings, so who knows what's going on with those... I told her that she has an infection in the upper wisdom tooth and needs it extracted. She's concerned about money, since she's Medicaid. I told her we'd take that and could extract those teeth. "I'm very anxious, and need to be put to sleep."
(I love it when patients ask to be "put to sleep," meaning sedated. I kinda wanna say, "Well, have you talked to your family vet? I"m told they offer that service...")
OK, well, I"ll refer you to an oral surgeon who can do IV sedation. Here's a script for some antibiotics - how are you getting by w/ pain meds?
"Well, i'm taking a ton of ibuprofen and it's not helping much."
OK, we'll get you some vicod...
"Oh no...vicodin doesn't work for me, and I'm allergic to codeine."
hmm... what does work?
"Percocet. I have a high tolerance for pain meds"
Ahhah. ok...why such a high tolerance?
"Well, I had two C-sections and also an ovarian cyst removed, so I took a lot of those and I need a lot to work now."
Well, ok... we'll write you some Percocet....
"Oh, and the regular kind doesn't work for me."
"yeah, the 5 mg kind.... I need the 10 mg kind."
(percocet is oxycodone plus acetaminophen...the narcotic is usually five mgs, but also comes in 7.5 and 10mg varieties.... Baby Bear, Mommy Bear and Daddy Bear. She wants the big guns.)
hmmm. OK, but let me tell you this: You are getting a LOT of serious stuff here. We are not fooling around. As such, if you don't follow up with the oral surgeon I'm referring you to, you will be dead to us. (OK, that's a paraphrase... not quite so much Godfather, but you get the idea, Gentle Reader)
"Its cool. I'm not a druggie."
(Um, never said you were - just told you to keep your appointments or we can't help you...)
So! Let me go make sure I write this all up in your chart before I forget.... It's Jessica Thompson, right? Hmm...lots of other Thompsons here...mom, grandpa, cousins....ok. No Jessica.... Let me go check the inactive files.... lessee...Hunting for Thompson.....huh! not there. Hey, Jessica - your last name ever change, or did you marry into Thompson?
OK, well, when you come back, I'll need you to sign a few papers and fill out a med history, but I'll let you go now, since you have to pick up your toddler.
So. Now I'm confused...after she leaves, I fire up the computer (remember, this is the weekend and they aren't usually running) and get into Dentrix and run a first name search on "Jessica." I find one with the appropriate birthdate, and it's listed under "Jessica Limbaugh." Sure enough, when I pull that chart, the label is affixed over another, and I can make out it used to be "Jessica Thompson." Upon pulling the notes out, I see that the last entry for Jessica Thompson (nee' Limbaugh) is from October of '05. My associate wrote, "Called pt to tell her we are aware that she is acquiring meds from several Drs and Pharmacies and we will not give her any more."
Now what's stunning here is not that someone lied to get drugs - that happens to me a few times every month. What's amazing is that it was such a bald-faced lie when I asked if she ever had any other names. Also stunning is the lack of shame of your average Narc Hound, cuz after she took the 12 percs I gave her Saturday, she was back for seconds on Monday. Still in pain, yes, she was taking the antibiotic, yes, she was taking Ibuprofen as well, and now she was crying and holding a two-year-old on her lap. Righto.
I say: Jessica, I understand you're in a lot of pain, and I want to help you, but we need to trust each other. I found your chart (holding it up) under Jessica Limbaugh. Did you ever go by that name?
"Yes, (*sniff*) when I was married....I guess."
OK, but Saturday, when I asked you, "Have you ever had any other names at all?" you said No.
confusedly: "Well, you see, it's just that I wasn't hardly married for very long at all." (pathetic tear drops duly noted)
I see. Well, I think there's a fair amount of paperwork involved in this sort of transaction - you can't just change your name on the internet - did the whole experience of being married and then not married just kind of slip your mind when I asked you?
(now sobbing) "Well...you see, a few months ago, I was in a car accident, and I had this concussion....wah wah."
Oh! OK, you had a concussion and some resultant amnesia that causes you to selectively forget that you were ever married?!?!?
Jessica, you should probably think of bottling some of that up, cuz I know a few people who would love to be able to selectively forget they were ever married....
So, I wrote another couple scripts to change up the antibiotics and get her another (lower end) pain med and told her to go to the oral surgeon. I found out that she ended up rescheduling her Thursday appointment with them to Monday AND got them to give her more meds 'til Monday, which just shows you how nice a guy Dr. Q---- is, since I'd called him to tip him off about her, but he still felt she must have legitimate pain (after five days of penicillin and 3 days of flagyl on top of it?).
So then she no-showed her Monday appointment. Or cancelled? I called her (from a phone that wasn't mine, I might add) and asked what happened. She said that Dr. Q----'s office wouldn't do IV sedation for her cuz it wasn't covered by her Medicaid, so she scheduled with Dr. Z----'s office a couple towns over. I'll need to call and confirm this, and alert Dr Z---- to Jessica's "high tolerance" problem, but I'm kinda skeptical about Medicaid ever covering IV sedation for extractions anywhere.... Perhaps Dr Z---- just figures it's easier to write it off than have people cancel cuz they're scared. However, if I did IV sed, I dont' think I'd want to expose myself, liability-wise, to a group of people who I've known to leap at litigious opportunities.... Hmmm.
Now, you can ask, Gentle Reader, "Gosh, Doc...how come you're so dumb? You KNEW she was scamming, didn't you?"
Sure I did. And that makes me feel like those guys who get caught on "To Catch a Predator" who are like, "Is this a set-up?" "No." "Well, OK...." "Hi, I'm Chris Hanson from Dateline NBC..." "I KNEW it was a set-up! I knew it!!"
Um, sure you did, moron, and you still walked in?
Well, I like to give people the benefit of the doubt, and don't forget, she DID have a gaping hole in the wisdom tooth. A past history of drug seeking (even for "legitimate (?)" reasons doesn't negate current pain.
As our President once said, "There's an old saying in Tennessee — I know it's in Texas, probably in Tennessee — that says, fool me once, shame on — shame on you. Fool me — you can't get fooled again."
(Speaking of politics, the psuedonyms used for "Jessica" in this piece are random, and are in no way related to famed substance-users/abusers from either end of the political spectrum. Thank you.)