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?

[Medic/Nurse, BSN, RN]

Write it as you find it - that will likely put an end to that little scheme. And maybe a Bar complaint against the attorney who sent him as an ethics issue promoting deception and FRAUD!

Go AngelfireRN! When I've had patients uninjured, walking around, on phone and having a cigarette on the scene at an MVA and when I ask if they are injured and they deny and refuse - and after "conversations" via phone (or maybe they look up and see the billboard of a personal injury attorney, call them for immediate advice??) then they chase me down and tell me they want "one of those collarey things on their necks, so they can sue" you better believe that I write it as I find it!

Lawyers likely see me in their dreams!

[OCNRN63, RN]

Not everyone on Medicaid is lazy or just sitting on their bum. It's possible I may have to go on Medicaid. I've worked and contributed to society as long as I was old enough. Now I'm in a situation where I may need help. Guess I'm just a lazy, bottom-feeder who spends all day eating Cheetos and watching Dr. Phil.

[psu_213, BSN, RN]

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.

Yeah, me too

[xtxrn, ASN, RN]

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

There are a lot of people who work who need Medicaid- either for themselves or their kids. Medicaid is NOT all about free-loaders. Even people who make more than the poverty level but have extraordinary medical bills can qualify for Medicaid- with different parameters re: their qualifying income, and "deductible" (called a spend down). This is a common assumption, but very, very wrong.

[xtxrn, ASN, 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.

all it takes is a phone call to the center for medicare/medicaid services (cms). the number is easy to get. but you want to be sure. (and i agree this guy sounds like a winner -- but, none of us knows the whole story). idk if it's a felony....but fraud (verified and provable) is a crime.

and to those who feel disability and medicaid are pretty much easy street for bums---

i paid into the soc sec system for 20+ years. i'm now on disability. and medicare. and periodically medicaid (depends on the lump sum bills i get that there's no way i can afford). the diagnoses i'm on disability for are epilepsy and dysautonomia (which are viewed as very "flaky" by ed staff- who writes the notes disability sees); also have other diseases that are not part of my disability, but don't make it any easier.

fortunately, i'd had enough documentation of an objective nature to support my application. if i had to depend on nurses notes (that can be swayed to reflect opinions of 'validity'), i'd be sxxxxxd, homeless, and on full medicaid. now, i pay 450.00 per month in premiums for medicare to get the maximum "insurance" i can (with 1/3 less income that i got when i worked-- no cost of living increase for the past 3 years, but premiums climbing every year, food bills up (like everyone else) etc...it's not any picnic).

am i a worthless sloth as well? i could be you one day. i certainly never pictured my life being like this- at all. i got ltd insurance in case i got into an mva or something random like that.

[xtxrn, ASN, RN]

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.

I hope everyone realizes that most of the people on disability aren't scams. And getting disability, even for very legit reasons, can take years and a lot of appeals (with no income in the meantime). To get Medicare, someone must be on disability (so those during the appeal process need Medicaid- which not all docs accept- understandably since it pays so SLOWLY- and poorly). So, the person is stuck with an PCP, who probably doesn't specialize in their illness/injury having to punt while the process goes on and on.

I would give anything to be able to work again. As it is, I can only do basic errands (and only one in a single day).

The morons are not the majority. Please remember that :) It's degrading and demoralizing to be useless.

[CFitzRN, ADN]

Thoughts? My thoughts are that there are tons of these deadbeats who are doing everything they can (many successfully) to "cheat the system" and many doctors and other healthcare workers who don't want a fight, so they cooperate with these scum-sucking lawyers who make a living from these deadbeats cheating the system. It is only getting worse, and it is breaking our system. Good for you for refusing to contribute to this issue.

[AngelfireRN, MSN, RN, APRN]

And I have nothing against Medicaid, except those who abuse it. I'm not generalizing. Someone mentioned that we were likely paying for his care, and Medicare/Medicaid comes out of my check ever two weeks.

Never said that all people on MCD were sloths, or lazy, or anything.

I said that this PARTICULAR lazy sloth (and attempted fraud) was on MCD.

And as degrading and demoralizing as it is to be useless (which I don't want to think about), I would find it moreso to CHOOSE to be useless. He obviously does not share this opinion.

[AngelfireRN, MSN, RN, APRN]

Not everyone on Medicaid is lazy or just sitting on their bum. It's possible I may have to go on Medicaid. I've worked and contributed to society as long as I was old enough. Now I'm in a situation where I may need help. Guess I'm just a lazy, bottom-feeder who spends all day eating Cheetos and watching Dr. Phil.

In no way and at no time did I say that. If you NEED help, then you should be able to GET help. This jerk does NOT. He is looking for an easy way out, and asking my clinic to aid and abet.

I never generalized, but, yes, we are paying for his healthcare, every last one of us that pays into MCD. And it infuriates me.

[AngelfireRN, MSN, RN, APRN]

I can't speak for all disabled persons everywhere, and I'm not trying to.

This post was about one case that starched my Underoos, no more. I didn't generalize, and I didn't call names to anyone except the original guy.

If you want to make it personal, that's your call. But my statements are about the case I started with.

I know not ALL disability cases are not scams. I know MCD is not easy street. I see it every day. Trust me, I know.

[redhead_NURSE98!, ADN, BSN]

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).

Gawwwwwd it'd be hard for me to not ask her where she worked, and then tell her that she has no frame of reference from which to decide how much work is "going on out here."

[redhead_NURSE98!, ADN, BSN]

all it takes is a phone call to the center for medicare/medicaid services (cms). the number is easy to get. but you want to be sure. (and i agree this guy sounds like a winner -- but, none of us knows the whole story). idk if it's a felony....but fraud (verified and provable) is a crime.

and to those who feel disability and medicaid are pretty much easy street for bums---

i paid into the soc sec system for 20+ years. i'm now on disability. and medicare. and periodically medicaid (depends on the lump sum bills i get that there's no way i can afford). the diagnoses i'm on disability for are epilepsy and dysautonomia (which are viewed as very "flaky" by ed staff- who writes the notes disability sees); also have other diseases that are not part of my disability, but don't make it any easier.

fortunately, i'd had enough documentation of an objective nature to support my application. if i had to depend on nurses notes (that can be swayed to reflect opinions of 'validity'), i'd be sxxxxxd, homeless, and on full medicaid. now, i pay 450.00 per month in premiums for medicare to get the maximum "insurance" i can (with 1/3 less income that i got when i worked-- no cost of living increase for the past 3 years, but premiums climbing every year, food bills up (like everyone else) etc...it's not any picnic).

am i a worthless sloth as well? i could be you one day. i certainly never pictured my life being like this- at all. i got ltd insurance in case i got into an mva or something random like that.

did you ever go to the doctor and say "i have trouble breathing and my lawyer says i need you to document it so i can get my disability?" then she's not talking about you, nor is anyone else.