Can't Win for Losing

I have written previously about patients using the ED for their primary care, usually ''because it's free''. Here's one better. I took care of a patient yesterday that I remembered from three weeks previously when I had evaluated him for shoulder pain. This young, otherwise healthy gentleman does a job which involves repetetive motion. He stated his pain was preventing him from doing his job. No problem, even though I do not do worker's compensation diagnoses I can certainly treat pain and refer these patients to a specialist who can address the issue more thoroughly. I got him a referral to a local orthopedist and some medicine and I explained all this stuff to him.

So he shows up yesterday with the exact same story not having followed up with the orthopedist. I asked him why he hadn't followed up and he stated that he had no insurance and didn't want to pay for this. In essence he was telling me that he came to see me because my services are ''free''. Also, he had been seen here one time inbetween these visits for the same problem, was again referred to an orthopedist, and again failed to follow the discharge instructions.

I did an xray of his shoulder against the remote possibility that I would see bicipital tendinous calcifications adding weight to my presumptive diagnosis of rotator cuff strain. It was, of course, a negative film. I again referred him to an orthopedist and explained that we had nothing more to offer him in the emergency department.

He then got mad and told me he had waited almost two hours for ''nothing'', that an xray was useless because it only shows the bones and he knew he didn't have a broken bone, and that the last doctor had at least given him a pain shot. He then asked for a complaint form which he filled out saying what a schmuck I was for treating him differently because he had no money, and left in a huff with a free shoulder sling and a perscription for motrin and lortab and another referral to an orthopedist.

How funny. He thought I did substandard care on him because he couldn't pay! The reason I did substandard care on him was because he was from Sweden, and I hate the Swedes with a passion.