This is long. Thanks in advance for your patience.
I have a patient that I have trying to support in a myriad of ways for over a year. He is homeless, but used to be working and was taking very good care of himself. He belonged to a gym and was in very good shape, always well groomed due to access to showers. Kept his laundry clean, etc. I often saw him in his work uniform, which he had dry cleaned so it was always pressed. He ate well. He did suffer from depression, but took his medication and did not drink, take illicit drugs or use or request any prescription narcotics.He just seemed down on his luck, and couldn't save for an apartment (child support, which he paid diligently, ate up a lot of his pay).
I was moved by his struggle. I made a lot of calls on his behalf, got him moved up on the list for housing from 2000+ to #110. I used resources I have in the community to get him other assistance. Every time I had something set up for him, there would be a problem and it wouldn't happen. He didn't show up for his housing interview, and said his boss made him work and he didn't have minutes on his phone to call and reschedule. No other phone was available. blah, blah, blah. Lots of excuses. He embarrassed me by failing to keep up his end of commitments he made through organizations I set him up with and did him favors as a professional courtesy to me, skipping other people who were really ahead of him for services because I vouched for him and said he was deserving and would meet his return service commitments. He didn't.
I stopped trying to help him. Of the course of the year I have watched him deteriorate. His depression got worse, and then he started asking for pain meds. One BS story after another. And of course, he turned out to be "allergic" to everything except oxycodone. He got fired for an assault at work. Stopped maintaining his child support, his hygiene, etc, etc.
Still, when he comes to see me, he is quiet, concillatory, begging for help, meds, etc. Recently told me a story I will not elaborate on that I told him point blank I did not believe (and it really is preposterous), at all. His "injuries," more specifically the lack thereof, were inconsistent with the story, and I said I'd give him 1 oxycodone tablet to tide him over until I could get the records from the ED visit he stated he had made the night before, and he had to take it right in front of me (I have suspected the oxy is for sale, not for personal use). He declined, stated he only wanted it for sleep at night. I didn't give him any, he left.
I got the ED records. Only part of the story is true, basically that he went to the ED. That part is true. The rest of the details are drastically different (he greatly exaggerated the version he told me). They worked him up, didn't find anything wrong with him and discharged him with directions to use ibuprofen for pain. While he as there, they did give him dilauded for his c/o severe pain.
I am finally getting to the interesting part. I have the nurses notes. During this stay my pt, who treats me as if I descended from Mt Olympus, did the following:
1. threw a cup of coffee at his nurse apparently because it was cold, while cursing at her.
2. called his nurse a "$@#$%#@!" whore
3. was apparently very calm and cooperative with the physician, and then hearing the MD give the dilauded order waited until he left the area, and said to the nurse: "You heard him b!#$h, go get my effing medicine!"
There were a few other things documented, but to put it in a nutshell, he behaved like a total jerk. I suspect he is a total jerk, and has been lying to me and manipulating me for a year. Needless to say, I will not go out of my way for him again.
The question is, would you ask a patient about these behaviors? I admit, I spent many a shift in my career putting up with that kind of nonsense and I may be personalizing it a bit too much. That, plus my extreme disappointment in this patient, has more more angry than I ought to be. I know, rationally, that there is nothing to be gained by this, and I don't want a confrontation, but I would at least like him to know that I know
, that I am on to him, lol, and that I am not fooled any longer.