Wednesday, March 05, 2008

The novice. . .the expert. . .the master.

The most incredible advances in medicine have not come out of cancer research or robotics or nanotechnology. No, instead, the greatest advances in modern medicine have been the creativeness in the stories told by drug seekers. There are 3 categories of drug seekers:

The novice: allergic to IV contrast, can't take toradol. Very easy to defeat these days due to non-contrast CT scans. Just send them to the ER or for a CT.

The expert: was in pain "while in Vegas", went to hospital, has no insurance, can't afford CT scan. More difficult here, but the trick is to pin the patient down on the exact name of the medical center, the dates of service, and demand a faxed report from the ER or treating physician. If they are unable or unwilling to provide you with that information, they are most likely drug seekers.

The master: Actually has a stone—even better if they have blood in the urine as well—but the stone is not obstructing and not causing their pain. These cases of tough ones and many-a-physician has been tricked into treating, even to the point of surgery, these patients. The key test here is to get either an IVP or a lasix renal scan to prove that there is no obstruction and then refer them to "the experts" at the university. Typically, these folks will get you for a couple narcotic scripts before you figure them out. They are THE MASTERS!!