Now, if you think it's hard to put one over on the IRS or your spouse you have another thing coming when you meet most triage nurses. To them no one is sick, no one... everyone is a bullshitter, and they are usually right (of course I am taking poetic license here, but not much).
I, on the other hand, think everyone is sicker than shit and I act accordingly, and I am usually wrong (poor specificity). So why do I do this, and why do all ER docs who practice more than a few months think this way? Because once a week, maybe twice, sumdood like the above dood ambles through our ER and I look for badness and, shit on a stick, I find it.
The above gentleman WAS drunk... I'm talking professional drunk, BAL 350. He fell down went boom the night before and his dad brought him in because he was slurring his speech. DUH! He's fucking plastered right? YES! He is. He had a little abrasion on his forehead. That's it. He also has an intraparenchymal bleed that may kill him. We scan, not because we can, but because we must.
In the ER the expectation of the physicians is that we miss exactly ZERO serious medical conditions (100% sensitivity). I scan and lab and poke and prod even the most obvious malingering drug seeker because the malingering drug-seekers get sick too, and they are exactly the people (along with their families) who will call the Cochrane firm at the merest whiff of a mistake on my part. They also do not, typically, pay for their care, and they abuse the EMS system to get to me because they 'don't have a ride'.
The above CT scan is a fine example of why a triage nurse can base a lot of her judgement on the obvious, but, as tempting as it is for me to do the same, I would like to keep my house and my car. Gotta go, there's a drunk gal with belly pain just arrived by EMS... I think I'll scan her.