Wednesday, January 27, 2010

Gerald O'Malley, DO: I can't help you, part 2

Some days in the ER, I just can’t seem to help anyone.

Here's the story of another patient, this one about 25 years old with chronic back pain who showed up requesting that I provide him with several different narcotics. He said he had recently moved to Philadelphia from another state and he had run out of his pain medication prescriptions.

You’d be surprised how many people show up in the ED complaining of chronic painful conditions that they had been suffering with for a long time that “suddenly run out of pain medications” and want refills. I never want to deny a patient pain medication if they are truly having pain, but my prescriptions have been forged and stolen and diverted to schoolyards. I have to be careful. My normal practice is that I require the patient to show me something to work with.
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It’s not fair to me for a patient to show up empty-handed and say: “I normally go to a doctor in New Jersey, but I lost my doctor’s phone number and I can’t remember his name but you couldn’t contact him anyway because it is 9:30 on a Saturday night and the office is closed and I don’t have any documentation of my chronic painful condition and I don’t have any empty pill bottles so can I have 120 oxycontin tablets please?” If you think I’m exaggerating, spend one Saturday night in any ER in this country and prove me wrong.

My patient today was a little more savvy than most. He showed up with a DVD containing all his X-rays and MRIs. They were all five years old, but at least he had the decency (or is it chutzpah?) to bring them with him. I contacted the last pain clinic that he had attended and, with his permission, they faxed over several pages of records including a letter from the director of the pain clinic discharging the patient from their care because he had broken the pain management contract numerous times. The receptionist at the out-of-state pain clinic told me that she gets several phone calls each week regarding this patient.

When I confronted the patient with this information, he became quite upset and defensive. He insisted that he could “barely stand up” and he needed to take several different types of narcotics, plus muscle relaxers every day in addition to an occasional percocet tablet just to enable him to do his job.

“What kind of work do you do?” I asked.
“I’m a roofer,” he said.

I called the pain center at my own hospital and they offered to see him and evaluate him in one hour. The patient declined and became testy. “I wasted two hours here, and you won’t help me at all. What did I gain from all this?”

“You got to eat lunch, watch Jerry Springer, and got a referral to the pain clinic. What more do you want? I’m sorry I can’t help you.” He muttered something under his breath and haughtily strode out of the ER.

It used to really bother me when guys like this would present themselves to my ER, but over the past 15 years, I’ve come to accept the fact that we are limited in our capacity to help certain patients because the system simply isn’t designed to accommodate their particular problem. It’s not my fault, it’s at least partially the patient’s fault, but it is primarily the fault of an increasingly inefficient system that is overburdened, overregulated, and unable to provide timely help for non-emergent but urgent problems.


  1. Thanks for fighting a good fight!!! Most of our ED docs would admit this patient for uncontrolled pain and dump the problem on the on call doc just to avoid the confrontation.

  2. I know who plays Gerald, but I can't picture him in the movie. I just want to see the character. Can someone help?