What's wrong with health care: Reason #506

I recently called the mother of a 40-something year old patient to verify his version of events surrounding his tale of unexpectedly passing out. He told me he had essentially no symptoms beforehand, adamantly denied any drug use, and firmly stated that his mother could not arouse him for several minutes despite her frantic efforts to do so. I called mom because I wanted an eyewitness account, but there were also several things about the patient's tale that sounded fishy. His mother's version of events dramatically differed from his own.

Despite the fact that his mother's account suggested a benign issue at most, my attending noted that I was obligated to treat the patient as though I believed his story of what could have theoretically reflected serious illness. In other words, I was essentially forced to work up his presenting symptoms with a battery of expensive tests and continuous cardiac monitoring even though I am 99% certain these tests will reveal absolutely nothing. He has state-sponsored insurance.

Coincidentally, he also reported that he had run out of his pain medications the same day and emphasized that they hadn't been working all that well, anyway. He has metastatic cancer, so he has a good reason to have pain. He received a lot of powerful intravenous narcotic pain medication in the ED and repeatedly asked me for more.

On the whole, it seemed he had made up a story simply to get IV pain meds. Did a cancer patient really need to so elaborately dupe several doctors just to get a little pain medicine? Seriously, no. Having cancer is like having a season pass to a Dilaudid theme park. Doctors generally err on the side of making sure cancer pain is controlled, even when the patient has a history of major ongoing drug use, as this patient did.

This patient's ED visit and admission were a big waste of everyone's time and I shudder to think how much money taxpayers will pay and the hospital will lose by caring for this patient. Of course I dislike being duped, but I dislike it a lot more when it drains our already fragile resource net that too often inadequately serves those with real medical needs.