jmj11 Posted October 13, 2014 Share Posted October 13, 2014 Okay, this is a ventilatory exercise only. 1) Patient: (Who no-showed their morning appointment despite a reminder call) "Oh, I was busy and couldn't make my appointment this morning. Could you please call be before the day is over because I have several questions I wanted to discuss and I need some med changes." 2) (Actual call two weeks ago) Patient: "I'm out of my meds and the pharmacy said that you wouldn't approve refills. Office Manager: "You didn't keep your follow up appointment and you haven't been seen in 15 months so we need to schedule a follow up." Patient: "I don't need no damn follow up . . . I need my medications!" Office Manager: "But we can't just treat you over the phone we have to make sure you are doing well and are safe." Patient: "I am both so send in my medications." Office Manager: "It is a standard of care that we see you once a year if we are prescribing medications." Patient: "You are just a bunch of money-hungry pigs. You want me to come in to charge me money." Office Manager:"We have plenty of patients so we don't need to force anyone to come in just to make money. We do it because we care about the patient." Patient: "If you really cared about your patients, you wouldn't charge for your visits. All my other doctors see me for free because they do care about me." Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 13, 2014 Moderator Share Posted October 13, 2014 2:00am on call "I am out of __________________" Course their is no open pharamcys for 100 miles, and the patient is likely stoned..... or drunk But my all time favorite is 3:30am on a Sunday morning, little old 80yr old calling up for the results of her stool sample she dropped off on Friday...... Link to comment Share on other sites More sharing options...
FfIghter23 Posted October 13, 2014 Share Posted October 13, 2014 Thanks, you just gave me a few more reasons to never leave EM! Clock out... no phone calls until next shift!! No pager. No work phone. I do respect the amount of work and energy it has taken to build your outstanding practices! You guys are the pioneers for future PA's in your respected fields! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 13, 2014 Moderator Share Posted October 13, 2014 Thanks, you just gave me a few more reasons to never leave EM! Clock out... no phone calls until next shift!! No pager. No work phone. I do respect the amount of work and energy it has taken to build your outstanding practices! You guys are the pioneers for future PA's in your respected fields! you're not doing "patient satisfaction callbacks" yet? it's coming. we have to do 2/shift from the prior shift. I have always called back folks I'm worried about, but random calls to folks with URIs and back pain is just a waste of time... Link to comment Share on other sites More sharing options...
FfIghter23 Posted October 13, 2014 Share Posted October 13, 2014 you're not doing "patient satisfaction callbacks" yet? it's coming. we have to do 2/shift from the prior shift. I have always called back folks I'm worried about, but random calls to folks with URIs and back pain is just a waste of time... Nope. Nurses have that added to the one million other tasks they have. I definitely follow up on those from previous shift that I may be worried about, but nurses will put in initial call and we will speak to the patient if there are potential serious issues. Link to comment Share on other sites More sharing options...
Guest Paula Posted October 14, 2014 Share Posted October 14, 2014 Forget the phone calls....how about this: patient is scheduled at 2:30 for f/u of exacerbation of COPD. She comes in at 11:30am and asks for flu shot. She gets it and then the nurse exits the room and patient decides not to leave. She hangs out at the nurses station but both nurses are on the phones. I walk out of exam room and patient collars me: Oh, good, I wanted to see you. Can I have a refill of my Ambien? I respond: You are on my schedule at 2:30. I don't know, I need to check your chart. Her: I need my Ambien. Me: We've had this discussion before and ambien is not recommended for your age group. Her: But my shoulder hurts so much and I can't sleep. Me: We'll talk later. Her: well I'm not staying here until 2:30. Me: ok, bye. She got no ambien and she did not cancel her appointment and did not come back for it. Sigh. She will call tomorrow guaranteed. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 14, 2014 Moderator Share Posted October 14, 2014 Forget the phone calls....how about this: patient is scheduled at 2:30 for f/u of exacerbation of COPD. She comes in at 11:30am and asks for flu shot. She gets it and then the nurse exits the room and patient decides not to leave. She hangs out at the nurses station but both nurses are on the phones. I walk out of exam room and patient collars me: Oh, good, I wanted to see you. Can I have a refill of my Ambien? I respond: You are on my schedule at 2:30. I don't know, I need to check your chart. Her: I need my Ambien. Me: We've had this discussion before and ambien is not recommended for your age group. Her: But my shoulder hurts so much and I can't sleep. Me: We'll talk later. Her: well I'm not staying here until 2:30. Me: ok, bye. She got no ambien and she did not cancel her appointment and did not come back for it. Sigh. She will call tomorrow guaranteed. I love it when pts think threatening to leave is a bad thing. I'm busy. you don't want to be here. win, win. Link to comment Share on other sites More sharing options...
jdenning Posted October 14, 2014 Share Posted October 14, 2014 This kind of stuff makes me feel better about my practice... I don't feel so alone thinking that I am the only one seeing some really crazy and irrational people. My personal favorite lately... "I'm going to stop all my anticonvulsant medications and just take marijuana. You have to prescribe it for me" Link to comment Share on other sites More sharing options...
jmj11 Posted October 14, 2014 Author Share Posted October 14, 2014 This kind of stuff makes me feel better about my practice... I don't feel so alone thinking that I am the only one seeing some really crazy and irrational people. My personal favorite lately... "I'm going to stop all my anticonvulsant medications and just take marijuana. You have to prescribe it for me" The blogosphere is full of testimonials of how pot cures seizures and how anticonvulsants make them worse and are just part of the evil pharmaceutical industry's conspiracy to make people sick. I had such a patient (when I worked some general neurology) a few years ago. She was helicoptered three times to the mainland in status. The last time she broke her femur when she went into a seizure and fell off a dock. But her boss, a health food store owner, convinced her not to take her lamotrigine. I think her near death experience at the end caused her to change her mind. Link to comment Share on other sites More sharing options...
jdenning Posted October 14, 2014 Share Posted October 14, 2014 The next sentence is usually "can I qualify for disability because of my seizures?" followed by "here are my forms" Link to comment Share on other sites More sharing options...
TWR Posted October 14, 2014 Share Posted October 14, 2014 I see variations of everything mentioned above and find it extremely frustrating. The "professional" pill seekers are very good at intimidation and threats. Sadly if they call the state medical board to complain, it triggers an automatic f/u by the board for if nothing else, "unprofessional conduct". At least in TX it does. PS years ago I did not see as much Fancy dancing by patients. I guess protecting patient rights is more important than practicng good medicine. Link to comment Share on other sites More sharing options...
Guest Paula Posted October 14, 2014 Share Posted October 14, 2014 Yup, my patient just called asking for Ambien. The answer was no. She will call again tomorrow. Drip, drip, drip. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 14, 2014 Moderator Share Posted October 14, 2014 Yup, my patient just called asking for Ambien. The answer was no. She will call again tomorrow. Drip, drip, drip. strike 2. can her butt. Link to comment Share on other sites More sharing options...
delco714 Posted October 15, 2014 Share Posted October 15, 2014 I had an arrogant patient in house today that called my office and asked to speak with my surgeon regarding her pain and trouble sitting just a few minutes after I rounded on her and said I'd touch base with said surgeon about her plan. I told her nicely she can't call our office and do this in the way she did, and I'm here to take care of her and she whined at me and said "and now I'm getting yelled at for calling?" Link to comment Share on other sites More sharing options...
jdenning Posted October 15, 2014 Share Posted October 15, 2014 We all have our "frequent flyers" - when I see their names on my desktop I cringe. Some more than others. That said it's really awful to have a degenerative neurologic disease or condition. One guy with Parkinson's disease would call every time he had a problem with his medication. Every time. When his meds work he can actually run and go out and travel but when his meds don't work it's like he's dying. Then he would deny having anxiety. (!) I counted 62 phone calls over a 4 month period. I kept telling him it's not a good idea to adjust his meds every time he has a bad day - I joke with our support staff that we need a candy dish at the front desk - not candy though, Prozac :-) - and you're not allowed to come back for your visit until you've taken 2 Link to comment Share on other sites More sharing options...
Guest Paula Posted October 15, 2014 Share Posted October 15, 2014 ^^^^^^! that is better than the patients who call and say "I'm out of my bennies and trammies". When that happens you know there is a problem. Their medications are their best friends and are called by the nicknames, like a pet. We have our controlled substance meeting today. Should be interesting as we are getting a handle on the bennies and trammies, which I rarely prescribe anymore since so many of our pts. have failed their contracts. I'm glad. Link to comment Share on other sites More sharing options...
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