The Case of the Strange Sprain
Two days ago a slender middle-aged man walked into a local emergency room, complaining of neck pain after taking a spill in his brother's front yard. X-rays of the cervical spine were unremarkable, and the patient was discharged with a standard information sheet for home care of a neck sprain and told to follow-up with his primary care physician.
He replied that he did not have a family doctor, and was therefore given the name, address and telephone number of the physician designated by the hospital to be "on-call" for emergency patients on that date, January 24th, and was instructed to see him the next day should his neck continue to hurt.
When he discovered that the doctor's office was twenty miles away from the emergency room he had just visited, the patient did not complain nor ask to see someone closer.
The following day the patient appeared unannounced in the follow-up doctor's waiting room wearing a bulky cervical collar and complaining of a sore neck. He asked to see the doctor and presented his E.R. discharge sheet as proof of his diagnosis. After a rather long wait, the doctor whose name was on that piece of paper walked into the waiting room and addressed the patient.
There are some days when the twirling roulette ball hits the chosen number time and again, when every bet placed brings in a winner. It is during such a streak that a person's confidence may mutate into thoughts of infallibility, that his ambitions may soar beyond the gravity belt of common sense that keeps him secure in his wits. The man at the window thought he was having such a splendid day as he greeted the doctor. He did not realize it yet, but his most recent wager was about to bust. By sheer coincidence the hospital had paired him with the worst possible doctor around when it comes to a pain in the neck - a completely unhelpful, ungracious, uncaring, inflexible creep.
The man in pain was about to meet the pain man - and get the old heave-ho.
Mr. Drug Addict, meet The Cheerful Oncologist.
If there ever was a specialty where a little training in drug-seeking behavior might be a good idea, it is medical oncology. We cancer docs dispense narcotics like the local movie house sells popcorn, and frankly, it is one of the most important treatments we can offer our patients. We are extremely cautious in our use of pain pills. Rarely, and I mean extremely rarely, we come up against a scam artist, and when we do it is up to us to slap our lethargic cheeks and recognize the start of the con game. I did not immediately sniff out the ruse being performed in my office, but as I interviewed the injured soul some curiosities about his story were raised, such as why he bypassed six hospitals to go to one located forty miles from his home. Possessing a naturally helpful disposition, I at first tried to find him a specialist who could treat his neck, but while sitting at my desk looking up telephone numbers I suddenly had the notion to follow one of the Basic Laws of Medicine:
Don't even attempt to make a diagnosis until you have all the facts of the case!
With such sage counsel bubbling throughout the cranium I decided to pay a visit, via the miracle of the Internet, to the patient's hospital records. After a couple of clicks my lips were lo-and-beholding with amazement. The unfortunate neck-twister had been to that very same emergency room last November, and the year before - always with the same complaint! In fact, he had received x-rays of his long-suffering neck on each occasion. "Well, I'll be a monkey's uncle!" was the phrase of the day at that point. I printed out his radiology reports and headed back out front.
It was a brief but emotional reunion for the two of us - he with an increasingly anxious look on his face, like one who has just walked into church without his trousers on - and me, the Perry Mason of medicine, cross-examining the witness until he abruptly paid his respects and beat a hasty exit.
All's well that end's well, I suppose - I avoided becoming another victim of a classic flimflam by a dope fiend, and perhaps my opponent will re-think his strategy of promulgating perpetual pain to every emergency room in town. The moral of the story is clear:
Learn everything you can about your new patient.
Sometimes the secrets to a successful outcome in medicine, like clues hidden around the old dark mansion on the night of the crime, require the protagonist to play dual roles - that of doctor and detective.