Wednesday, February 3, 2010

Gerald O'Malley, DO: I can't help you, part 3

In the ER we are frequently tasked with trying to help people that really don’t have emergency problems.

The system just isn’t designed to accommodate satisfactorily individuals with nonemergent problems, and my patients frequently become frustrated at my inability to assist them, although occasionally I have a small victory.

A patient showed up at 9:00 a.m. one day complaining of ringing in her ears for the past two months. Her primary-care doctor had made an appointment for her to see a specialist — in another three months. The high-pitched ringing was worse at night. She couldn’t sleep and was nearly suicidal. Read more
I spent 45 minutes on the phone with her insurance company and her primary-care doctor securing a referral and pleading with the specialist, and I got her an appointment at 1:00 p.m. that same day. During those 45 minutes, another six patients showed up in the ER and their care was delayed for hours while I negotiated on the phone. My patient was lucky — the specialist agreed to see her expeditiously.

As bad as things are now, I suspect that the day is coming when the specialist will just say, “I’m sorry. It is simply not worth it for me to take on this additional work and risk.” At that point it won’t matter how long I stay on the phone and no amount of pleading or bargaining or cajoling will matter. We have to savor these quiet triumphs.

Another patient wanted me to do something about the ganglion cyst on her wrist. It had been present for “a while” but had recently begun to interfere with her work, which was exotic dancing. The cyst rubbed against the pole and caused pain. She also wanted me to treat her hyperthyroidism.

“Who told you that you have hyperthyroidism?”
“Well that’s what causes you to do everything real fast, right?” she said. “Well, I talk real fast and I dance real fast too.”

She gave me a short demonstration of how quickly she can dance. The nurses loved that picture.

“So I figure that I have hyperthyroid and I need something to treat it to help me slow down.”
“Do you do a lot of cocaine?”
“Not a lot — only when I’m at work or at home.”
“I’m sorry, I can’t help you.”

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