This just gripes the crud out of me...

[AngelfireRN]

Y'all feel free to tell me if I'm awful for feeling this way. I've just seen so much of it lately, I'm sick.

Had one today that absolutely tipped my control balance.

He came in a few days prior, saying that he HAD to see the doc about 'his breathing'. We had no appointments, and he was not in distress at that time, so we made him an appointment for today, and I pulled the chart for review before he was to come in. There was no mention in any previous visit of any pulmonary dysfunction, and also nothing related to lung issues on the medical history form he filled out on his inception to the clinic. No treatment for breathing trouble, nothing.

He came back in, and I questioned him about the complaint.

"Well, I'm filing for my disability, and I want to put my breathing for part of my disability, so my lawyer told me to get to my doctor and get put on treatment."

"I see. And how long have you had this trouble?"

"Oh, YEARS. I've been using my brother's meds, and they really help. I have an awful time."

"Where have you been treated before, and do you remember who treated you and with what?"

"No, no one ever treated me. I just tried my brother's squirter and that stuff you put in that pipe."

"So, no diagnosis of asthma, COPD, emphysema, or anything like that, ever?"

"No, but my lawyer said I needed to get put on treatment so I could claim it on my disability application."

All of this, with no notable SOB, and a pack of Marlboros in his shirt pocket.

"OK, the problem is, sir, you have never mentioned that you have breathing trouble, nor did you list it or any medications that you take for it on your medical history. So, with you admitting that you're only seeking treatment on your lawyer's advice so that you can claim this on your disability application, it looks, well..."

"Suspicious?"

"Exactly." ( My patient's number one compliment about me at this clinic is that I DO NOT LIE to them. Not about anything. This guy was not going to get a candy-coated version, either.)

So, we did some tests, O2 sat normal, lungs clear, PFT normal as could be. The most telling thing, after Doc and I reviewed the tests, and I told him that they were normal, he got irate.

"I DO!!!! I DO have trouble breathing! My work told me that 3 years ago! They said I had the lungs of a 90 year old! They gave me antibiotics! I DO have trouble breathing." All this at the top of said 'terrible' lungs, with not a cough or a wheeze to be heard.

He got a script for a rescue inhaler, and a refusal for an early refill on his pain meds, and stormed out in a snit.

Call me heartless (really, go ahead, seems to be the going thing, lol), but I refuse to lie about anyone TO anyone so that they can cheat the system. I have to go to work every day, regardless of whether I feel like it or not, and I expect every able-bodied person to do the same. And the disability attorney will request the test results, and have a review team see that they were normal as well, so my lying and prescribing unnecessary meds would not have helped in the long run, even if I were unethically inclined.

I guess it gripes me that some of my poor little elderly patients have worked all their lives, only to be unable to get disability for a legitimate complaint, and here's this clown trying to get a free ride.

Thoughts?

[MomRN0913]

I recently had a pt in the ED who had developed cellulitis on her hand. Due to swelling, she wanted us to cut her ring off (it kinda looked like she found it in a cracker jack box). Anyway, we have the fancy electric ring cutter. As the PCT was cutting the ring off, the pt said "oh just go ahead and cut my finger off too, I can add that to my disability check." This really upset the (hardworking) PCT, I just rolled my eyes (while not in the view of the pt of course!). A little while later she is being discharged. She comes out of the room and says, quite loudly, while in the hallway, "hey, someone better get in here with my papers. I have been waiting 15 mintues for them, and there just ain't enough working going on out here for my my taste!" So now I'm really, well, mad...this lady, who has no problem walking/yelling/expressing her feelings wants me to contribute more of my pay to her disability check. At the same time, she knows enough about nursing, my day, and how our ER works to offer a critique on my/our work ethic. That part of the system really upsets me. (sorry, a rant, but on topic for the OP).

for me, those discharge papers probably would have taken at least an hour more.

[nurseprnRN, BSN, RN]

document those normal pfts (be sure they get billed to his insurance) and when he applies for disability, that will come up in the med record review. oh, well, another good idea foiled.

[KeepItRealRN, BSN, RN]

There must be some way to report this person for attempting to defraud the government. I have to believe that at some level what this patient was trying to do was a felony. The sad thing is there are thousands more like him that have been successful at this fraud and is costing taxpayers billions.

[KeepItRealRN, BSN, RN]

document those normal pfts (be sure they get billed to his insurance) and when he applies for disability, that will come up in the med record review. oh, well, another good idea foiled.

he probably doesn't have insurance, and the tax payers are going to pay for them too. this s**t just burns my butt.

[Crux1024]

So why did he get a script for a rescue inhaler?

I wondered the same.

Op, Can you enlighten us?

[OCNRN63, RN]

So why did he get a script for a rescue inhaler?

Probably to shut him up. It's probably not going to hurt him. When I worked in the ED, occasionally we would give its. meds just to shut them up and get them out the door.

[AngelfireRN, MSN, RN, APRN]

So why did he get a script for a rescue inhaler?

Because his PFTs, while essentially normal, suggested that he MAY have very SLIGHT obstructive disease. Hence, the rescue albuterol. That way, he can not say he was not treated.

He can say that he did not get the treatment he wanted, but he can not claim refusal to treat.

And, in some ways, yes, to shut him up.

[AngelfireRN, MSN, RN, APRN]

He probably doesn't have insurance, and the tax payers are going to pay for them too. This s**t just burns my butt.

Nailed it...he's Medicaid. We're already paying for him to sit on his lazy bum, but he wants more.

[AngelfireRN, MSN, RN, APRN]

There must be some way to report this person for attempting to defraud the government. I have to believe that at some level what this patient was trying to do was a felony. The sad thing is there are thousands more like him that have been successful at this fraud and is costing taxpayers billions.

As soon as you find out how, I wish you'd tell me. I documented the whole incident, which made him even madder. Now it part of his chart, and it's considered a legal document. And it says everything that transpired. In detail.

[AngelfireRN, MSN, RN, APRN]

You probably foiled his maniacal and highly unusual plan to sue big tobacco after he gets his disability check. Bad nurse, bad bad!

I always say, Jen, the only thing holding up that halo are the horns!

[AngelfireRN, MSN, RN, APRN]

I recently had a pt in the ED who had developed cellulitis on her hand. Due to swelling, she wanted us to cut her ring off (it kinda looked like she found it in a cracker jack box). Anyway, we have the fancy electric ring cutter. As the PCT was cutting the ring off, the pt said "oh just go ahead and cut my finger off too, I can add that to my disability check." This really upset the (hardworking) PCT, I just rolled my eyes (while not in the view of the pt of course!). A little while later she is being discharged. She comes out of the room and says, quite loudly, while in the hallway, "hey, someone better get in here with my papers. I have been waiting 15 mintues for them, and there just ain't enough working going on out here for my my taste!" So now I'm really, well, mad...this lady, who has no problem walking/yelling/expressing her feelings wants me to contribute more of my pay to her disability check. At the same time, she knows enough about nursing, my day, and how our ER works to offer a critique on my/our work ethic. That part of the system really upsets me. (sorry, a rant, but on topic for the OP).

I would have pointed at her and said,"Really? Well, we're exerting exactly the amount of effort to get you discharged as you're exerting to try and be a productive member of society."

And then I would have been fired, lol.

[JeneraterRN]

I always say, Jen, the only thing holding up that halo are the horns!

Ironically, that is also one of my favorites!