Sunday, November 09, 2008

"They"

People may disavow rhetorical tricks, but even my most under-educated patients will deploy a gamut of them to try to engage my sympathy and charity. Patients don't realize that my sympathy and charity were surgically removed, as they are in all physicians, during a 'residency orientation week' (which is really just a blur, and left a nasty scar just under my scalp).

The most common rhetorical trick is to answer a direct question with an indefinite statement... to wit...

ME: "Why haven't you had your gall-bladder removed? The last six times you came here we referred you to a surgeon for just this purpose?"

PATIENT: "They won't do it."

ME: "Who's 'they'?"

PATIENT: "The surgeons."

ME: "Which ones?"

PATIENT: "I don't remember."

ME: "Well what did 'they' say."

PATIENT: "They told me I would have to pay them."

ME: "And what did you say."

PATIENT: "I told them I didn't have any money."

ME: "But it says on your chart that you have Y-Care insurance?"

PATIENT: "I do but they won't pay for it."

ME: "Usually there is a copay, so I'm sure that's your problem, the copay is about a hundred dollars."

PATIENT: "I can't afford $100."

ME: "How can you afford to come to the ER?"

PATIENT: "The ER is free."

ME: "No it's not, there's a $150 copay."

PATIENT: "They never make me pay it."

ME: "Who's 'they'?"

PATIENT: "The government."

ME: "How did you get here today?"

PATIENT: "I drove."

ME: "Hmm, do you smoke?"

PATIENT: "Yes."

ME: "How do you pay for your cigarettes, and car, oh... and that cell phone?"

PATIENT: "Oh, my family pays for them."

ME: "Hmm, well maybe they can scratch together the $150 for you to get your gall-bladder out, it might save your life... I would be happy to arrange it for next week?"

PATIENT: "Oh, they can't afford to do that!"

ME: "Wow, that's amazing, and really too bad for you. As you drove your own car here tonight I can't give you any sedating pain medicines though I would be happy to write you a prescription... Your gall-bladder is full of stones but not infected, I highly recommend getting this taken care of before it gets infected... If it does you could die."

PATIENT: "Can you give me some pain medicine to take home with me and write me a note for a week off work?"

ME: "I'm so sorry, they won't let me. Good day."

59 comments:

  1. I know I have had this exact conversation hundreds of times over the years.

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  2. You actually waste time doing a history? I mean I talk to patients, just like with a Cat or Dog, to instill a sense of empathy, but its not like you're really gonna get anything useful out of it, except I think if someone can talk it means they have an O2 sat of 95%, but I'd rather listen to the reassuring BEEP BEEP BEEP of the Pulse Oximeter than have someone ask me to call their "Regular Doctor" to see how their "TEST-ES" came out. TEST-ES that I'm gonna have to repeat anyway, But I do miss that occasional "Benadryl Allergy".

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  3. ME: "I'm so sorry, they won't let me. Good day."


    PRICELESS!!

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  4. We have this degenerate fucking loser of a regular. He's, in the parlance of the times, a "chronic public inebriate". In other words, a fucking street urchin bum.

    He's also got a big ass hernia. And every day we scrape his sorry ass of the side walk, I have hear all the way to the hospital, "Oh, woe is me! They won't fix my hernia. Nobody cares about me. They won't help me."

    One day when this patient was passed out on my cot, I started digging through his pockets to see what interesting tidbit I could find.

    In his wallet, a 3" thick brick of a wallet, I found no less than 20 different appointment cards for surgery dates, followup visits, pre-surgery exams etc...stuffed into his wallet from at least a quarter of the 25 different metro area hospital.

    He hadn't bothered to go to a single one. In fact, when I offered to take him to a hospital that had foolishly taken on him as a special case, he refused, asking to go instead to a more distant hospital.

    Obviously, "They" give too much of a fuck and guess who the joke is on now.

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  5. As someone who pays a ton of money in medical expenses lately, this pisses me off. Here I sit doing everything I possibly can to keep myself healthy and have one thing after another go wrong anyway. People like this just make me mad because they COULD be healthy if only they tried and followed up on things and maybe gave up some luxury they have to take care of themselves properly. We are probably selling our house and moving to a smaller one just so I can afford all my recent medical stuff. It just makes me so mad that people think paying their bills and being responsible for themselves is an option.

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  6. Radiogirl,

    I SO HEAR you. Hubby and I were just lamenting today about how farkin' much we spend between taxes and our insurance premiums (500.00 a WEEK en toto). WTF? GAH! And we are "healthy," i.e., no chronic medical conditions, no htn, no NOTHING.

    It's fucking depressing. My kids don't even have winter coats yet or even 5 pairs of pants each for school wear.

    Makes me want to give up, seriously. Although, I will head off to a second-hand store tomorrow to see what I can do. I'm resourceful like that...much to the "entitleds'" chagrin.

    And WHA? Beans and rice is awesome with some cornbread. Makes me grateful for the home-cookin' skillz I have learned over the years.

    As an aside, I actually TRIED to teach someone who was bitching about food prices about the way to butcher a whole chicken for meals (3 at least). Said person was "grossed out" about the "thought" of doing that.

    WHATTHEFUCKEVAH.

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  7. dear radgirl,

    so sorry to hear about your problems, i hope you take comfort in being our model patient. i wonder if you have exhausted all means of insurance? i wonder if there is a university study somewhere for trial therapies of your particular condition. you might ask your primary care physician or your specialist. if you like i can take a look myself.

    dear pink,

    if you can figure out a way to make personal responsibility a viable political platform then let me know.

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  8. The problem with insurance is that they won't pay if it is not "medically necessary". They decide, not the doctor. My radiation for the cancer was "not medically necessary" except my doctor said it was or else the cancer would continue to grow. My life is more important than money, so we did it. The problem is these things keep coming up.

    We are fine, we probably don't need to move but I freak out when I feel like we are financially pinched. I don't want to end up in a situation where we don't have enough for what we need with a little left over for some of our wants too. If I could just be healthy for a while with nothing new coming up, it would be nice and make me feel safer with the money thing. The moving isn't a huge deal, we have an enormous house and the one we are considering buying is by no means small, it just stinks that we have to give up so much for things other people don't take responsibility for.

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  9. 911

    Why must you remind me about everyday at the ED. Swing shift tomorrow, here I come.

    As an aside, I love the patient who comes to our ED after having been discharged from another hospital after a 14 day stay. It never fails that they say "THEY didn't do nothin for me-(translated the dose of narcotic wasn't near high enough to saturate my few receptors I have left)" When I do receive the chart finally (thanks HIPPA) I find a million dollar workup (MRIs, ultrasound, consultations) that came up with a supratentorial explanation of the patients problem.

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  11. Hit the button twice on that last one.

    I think I will start "redistributing" the narcs in the ED, you know give someone 5 of morphine, and someone else 5 whether they need it or not. And we can redistribute the pain scale as well, if this guy has a 9/10 and this guy has 3/10, make 'em both 6.

    I think I like this stuff.

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  13. DEAR READERS!!! i don't like to talk like a fourth grade teacher, i am much more comfortable being talked to like a fourth grader (the suits), but READ RADGIRL'S COMMENT AGAIN, then read Lofty's posthereand think for just a minute about what you read.

    we are all angry and frustrated and while we would all like to make more money, our complaints about our jobs are not fundamentally about money. it is true that we believe that were we paid what we were worth that patients would be able to be informed consumers of health care and it is true that we believe that we are paid by a ponzi scheme run, ultimately, by the government, but why should you care?

    you should care because people like radgirl are out there. they have drawn an unlucky card from the deck, and ARE INSURED, but the burden of providing 'free' care is borne by patients like radgirl and physicians like me and 'cat et al.

    the 'doctor' in charge of radgirl's care is a flunky at an insurance company reading off a chart. her care is rationed and we haven't even instituted 'universal health care' or 'single payor health care' yet. and yet we, the physicians, are reviled for pointing this out.

    best to you radgirl.

    he 'cat, stay cool like always.

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  14. If he is breathing without wanting to die, then his GB isnt that bad. When I had my infected, filled to the brim GB taken out, i would have given all in my accounts to have it taken out, it hurt so much. No amount of narcs helped. Once he is really in pain, he'll pony up the cash.

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  15. dear c.,
    the problem with what you say is that a cholecystectomy absent infection is a snap and has a low morbidity and mortality (people rarely have any problem with this procedure), but, once the gallbladder is infected one plays with much higher odds, and hospital stays are longer due to the fact that the operation has to be 'open' (longer incision, peritoneum exposed etc...). elective cholecystectomy is typically a two day hospital stay. ascending cholangitis, if you live, more like two to three weeks.

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  16. Perhaps my post was misunderstood; it actually had nothing whatsoever to do with radgirl's situation. I'm sorry, radgirl, for your troubles. Your comments demonstrate a serious problem with the system, one of many problems. You will be in my prayers, both for your physical and financial health.

    911, best to you, and I apologize for whatever it was my comments appeared to you to be saying. I still do not understand. But then, so many things I do not understand.

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  17. Oh shit!

    I just picked up a copy of Atlas Shrugged!

    Did you know this mofo has 1000plus pages??!!

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  19. Hey Ellen! So you don't call the morning after??!! I agree with the slam of Ayn Rand, if Atlas is Shrugging, why should I give a flip??? I'd recommend Larry King's "How to Talk to Anyone, Anytime, Anywhere: The Secrets of Good Communication" Check out Chapter 4, Ellen Kimbell, I think he's talkin about YOU.
    FD

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  20. Hi Ellen!

    How did you get to be immortal? I mean, you say that Ayn Rand is 'dead and buried' as a lead in to pooping on Objectivism. You then cite a 'stepson' with 'unrealized dreams' as another strike against her.

    I happen to agree with you that Logical Positivism is not a fundamentally coherent philosophy, but not because your stepson has 'unrealized dreams' or the Author of 'The Fountainhead' is dead.

    Are you the vanguard of the Obama acolytes who is getting the ground ready for obamacare? sell it somewhere else.

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  21. Hey 9-11, We should still do an Auburn-Georgia challenge bet, loser has to write a 300 page essay on why Fibromyalgia is an under reported disease. I'll be a nice guy and only ask for 14 points. You got the Stones to play with the Drack-meister?

    Frank

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  22. Ellen....

    Gee....I bet the "tormented" Ayn Rand would only get "angrier" if she knew that Atlas Shrugged was ranked second only to the Bible in the Library of Congress' survey of "most influential books"

    Read the book Greta......and make up your own mind. I read it in about a week....and my life has never been the same. It rocked my world!

    Just ignore the sex scenes....in that department my Ms. Ayn was a twisted kinky very masochistic girl

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  24. Therein lies the "problem". Something must be done....We've got to fix this.... Somebody has to help....The Dems/Libs are great at creating a crisis, then hoping you will be too lazy, apathetic or stupid to fix it or let the free market (i.e. I have a good or service and you want or need it and pay me for it...sounds complicated, eh?) run its course.


    I really don't believe Ms. Rand caused people to run their lives off the rails. I have read The Fountainhead and Atlas Shrugged.
    I would be much more afraid of someone following Che, Mao, Lenin...or Obama than Ayn Rand.

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  25. I think you all make good points with regard to the philosophical impact of Ann Rand's writings.

    However, I believe that Beverly Cleary dealt with generational conflict issues with a greater degree of clarity and simplicity. Furthermore, her books were much easier to read.

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  26. Beverly Cleary was for the G-rated crowd!

    Now Judy Blume.....that's where the juicy issues were!

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  27. 911,

    Thank you for the explanation. I was borderline as the GB was infected, the surgeon wasn't sure if the lap would do it. Mine was emergency and was prepared for a long stay and the potential of the "open" surgery. Thankfully the lap was enough but the point of extraction was larger and deeper than usual in order to get the offending organ out.

    My point is that if he isnt in enough pain to pay $100, he isnt in that much pain. Of course I am a biased, unsympathetic b*tch, who pays full freight on my insurance premiums as I am a business owner. The GB attacks felt like someone was tearing out my insides with a butter knife. With that kind of pain I would have sold my family to get the cash. Come to think of it, I would sell them anyway ;) I also understand your point of if he had the surgery now the cost will be a lot less than if it was a lap choley. A 2.5 day hospital stay and admit from the ED was 25k. Three weeks plus the cost of time off from work would be HUGE. However, sounds like this guy doesn't work.

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  28. Jennifer, I encourage you to ready "Ramona gets a 'Dirty Sanchez'" (one of her lesser known works) and then we'll argue about whether she was G-rated or not.

    And in "The Mouse and the Motorcycle" as the maid chases Ralph with the vacuum....don't you think that's a euphemism for something? G-rated my ass.

    Cleary was a philosophical porn genius.

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  30. Next you'll be telling me that "Ramona the Brave" was about her coming out party! LOL

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  31. Yeah, I think I'm older:

    DOB: May 30, 1847

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  32. Ellen, you're older than you are, you were born in 1932.

    FD

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  33. No, you didn't look at the title closely enough. It was "Ramona AND the Brave". It was about Ramona's 'coming of age' with a young Indian boy.

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  34. Psst Ellen, we don't say HoMO anymore, its GAY, get it right. And do you ever watch "Larry King Alive" and say "Damn, I could have been MRS. Larry King??!!"
    Enquiring minds want to know.

    FD

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  35. I recently gave my roomie Atlas, every day I come home he is running with all of the idea's he knew he believed in but never saw expressed into words before.

    Fransico D'Anconias speech at the party about money should be required reading for everyone on the planet.

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  36. I don't know which I like better - the post or the comments. Both are hilarious.

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  37. I can't figure out whether Ellen is a real person or just an elaborate hoax by someone having us all on. It's hard to believe that anyone really thinks the things the Ellen writes, but it's also hard to believe that anyone would go to that much trouble to create a hoax.

    I'm leaning towards hoax, at the moment. For some people, humor is easy, so "Ellen" may not be going to much trouble to create this persona.

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  38. ellen,
    of all the presumptuous gall. i knew about you from drackman's blog. i knew you were an idiot from there and all of a sudden you show up on my blog. short fuse? you are part of the problem. telling me that medicine is broken? duh. it's what we've been saying for three years and people like you have broken it by putting personal responsibility behind group politics, gender politics, and common sense. you might not get people speaking their minds to you because you carry the so popular protection of being a woman with you and take advantage of the old school predisposition to not take you too seriously or insult you to your face, well fuck that, the worst thing in the world to happen to our health care system is a bunch of buearucrats and government flunkies taking financial power in the first place. they destroyed the doctor patient relationship and now people like you want to come in and tell me what a problem we have. fuck off.

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  39. Watch out 911. She'll go all old school on your ass and use her MSM investigative powers (translate to insinuate in the absence of fact aka. make shit up) to smite you with her red liberal hammer.

    She's already revealed Frank's true identity to us, informed us that he's blogging from prison, and that the IRS documents on the government's website are incorrect because she, Al Gore, and Larry King have proven it to be otherwise.

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  40. in that case i amend my prior post to read, "please ms kimball, your finely tuned journalistic brain, seeing all things clearly, especially medicine, is just what's needed in our current crisis. please fix it for us with more legislation and money shuffling, and do us a favor, and put us humans known as doctors at the end of the line in this endeavor. please?"

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  41. oh, and frank,
    i make a point not to bet on the bulldogs... if they win i think i had something to do with it, and if they lose i blame myself. i am willing, however, to listen to your proposal.

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  42. 9-11 are you sure you're an SEC fan?? Of course you're the reason they win or lose! I've been e-mailing Tuberville with new Defensive Schemes all year. All I want is 9 1/2 points, which was the current spread this morning, more than fair I believe, and the loser has to write a really disgusting essay, like how we'd love to have sex with Ellen Kimbell, or something even more disgusting, talking to a Fibromyalgia patient,

    Frank, M.D.

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  43. If you were to have sex with Ellen, wouldn't you worry that that Dr. Richard Kimball would come after your ass?

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  44. It's on Frank. I'll post about fibro and give you 9.5 if you post about the glorious history of UGA (the dog).

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  45. I should just shut up and take your bet, but I don't have that deep hate for UGA like I do with the Gay-turds or Tide, after all, Vince Dooley was a Tiger QB, and Pat Dye a Georgia Lineman, and I LIKE UGA(the Dawg), so you're free to come up with a more humiliating topic, just as long as its by kickoff Saturday (How Sad to be the RAYCOM 11:30 Central Time Game while Alabama and Mississippi State get the Prime Time ESPN slot)

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  46. Oh yeah, just checked, spreads only 8 points, so you got that goin for ya.

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  48. Dementia is a bitch......Thank god for bookmarks or she would have never found her way back to this site.

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  49. Hi, I'm Larry King, and I suffer from Peyronie's Disease. In fact thats the only reason I introduced Ellen (it was Kimble-STEIN back when I was banging her)to Larry junior. Her vagina was a perfect mirror image of my curved member, and I would have married her, but she wouldn't shut up!!! Talking and Talking, non stop, thank god I was already married, ain't life grand.
    I'm Larry King

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  50. Oh my gosh! My stomach hurts. ROFLMAO.

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  51. The Ghost Of Richard1:43 AM, November 11, 2008

    Vernon,

    This is not funny, I'm old. Why do you keep picking on me. For the record, Lawrence was too big for my tight ass.


    If you don't stop I am going to threaten you with more meaningless lawsuits because I am a Democrat, and thats what we do.

    Your a big jerk face.

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  53. Someone played Dr. Richard Kimble BEFORE Harrison Ford? MY GOD woman, you ARE old!

    J/K, I used to love that show when I was a kid.

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  54. Oh just for semi-clarity, I wasn't kidding about the "old" part, I was kidding about the Harrison Ford part.

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  56. My oldest sister is the same age you are. I'm the product of the last gasp of my Mom's ovary. I'm told that a little dust came out right behind the egg. (Maybe that explains my allergy problems).

    I never thought my sis was old until stuff started falling off of her and orthopods started screwing things back into place a few years ago.

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  57. I'm halfway expecting to see a post on one of these medical blogs begin, "I treated a patient named Ellen Kimball recently..."

    I'm thinking Ellen Kimball is the new Deborah Peel.


    Ellen, your ego is amazingly large. It must have squeezed your super-ego right out of your brain, which would explain the judgment problems. This has to be a joke.

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  59. ellen,
    come by anytime but really, to admit to frequent the democrat underground site makes you immediately suspect here as someone that we will love to pounce on, especially if you just come by to flog your blog.

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