Thursday, March 11, 2010

Truth...or Consequences

There are four people in this world you never lie to. One is your pastor, because they have a direct line to God. The second is your accountant, because that lands you in jail. The third is your lawyer, because you’re already paying them to lie for you. And the last is your doctor, because if you do we might do something that kills you.

The fact is that it's actually pretty hard to lie in the ED. Experienced staff have an acute filter in place for products of bovine digestion. So if your alcohol level is four times the legal limit and you can’t remember what happened to you or why you are wearing nothing but a “Girls Gone Wild” tee-shirt, it’s not because someone put something your drink. (Well, technically you’re right. It’s called “alcohol.”) If your drug screen comes up positive for marijuana (as it did in a young lady my last shift), don’t tell me it’s because you were exposed to secondhand smoke. When it’s positive for methamphetamine, don’t have your boyfriend say you couldn’t be doing any because between motherhood and pole dancing, there’s just no time in the day to do so. And if cocaine shows up, the chances are pretty good that it’s not, as you say, because you held some for a friend while he was getting ready to smoke it and it seeped into your system through your skin.

Here are some other lies that don't fly in the ED:

“I don’t know why my doctor won’t see me anymore.” (Yes, you do. I do, too.)

“There were these two girls, and when I woke up my wallet was gone and this thing was stuck up in me.” (Don't ask what or where. I said, don't ask. Stop that now.)

“I’m allergic to codeine, but I can take Percocet.” (If you’re allergic to codeine, you can’t take Percocet because it’s in the same chemical family.)

“You’re going to treat me badly because one of your docs had an affair with my wife. (For the record, knowing the doc in question, the quality of what he’s dated, and the quality of the accuser, there’s simply not enough beer in this world.)

“All those records where they said I was looking for drugs? That’s my brother. He takes my driver’s license and impersonates me. All except for the time I had a heart attack. I’m still having pain from that. Can I have some morphine?”

“I’m allergic to oxygen.” (Presumably, this person also does anerobic exercise as well. Interestingly, patients who are allergic to oxygen often end up being labeled as oxygen thieves. An oxygen thief is someone who uses up perfectly good oxygen that could be used by another human being.)

Of course, there are also those things that sound like lies but really aren’t. One of these is the phrase, “I’m pregnant? How did that happen?” You’d be amazed how often I wind up explaining. Just recently we had a 19 year old girl who we diagnosed with her second pregnancy. I tried to answer her question diplomatically. “Well,” I said in my most grandfatherly voice, “it happened in the usual way, with unprotected sexual intercourse.” Seeing the look of confusion on the girl’s face, one of our nurses took over for me. “Honey,” she said, “you (homonym for clucked) without a rubber.”

Believe it or not, it really doesn’t bother me if you come into the ED higher than Marion Barry at the Mayflower Hotel. If I know what you’ve been taking, both our lives are much easier. Just ‘fess up and we’ll be fine. But if you'd rather tempt the tightrope of truth, be aware that lying does not go without consequences.

If you insist on an adverserial relationship with veracity, here’s what happens. First, I may not be able to give you the care you need or treat you properly. You’ve probably heard of the potentially lethal interaction between Viagra and nitrate medications used to treat heart attacks. This is literally just the tip of the iceberg. (That being said, I’ve found that most men over 70 who use Viagra are proud to admit it, extolling its’ virtues with beaming smiles while their wives shrink into the wall like the embarrassed schoolgirls they once were. Caring for skyrocketing blood pressure or a rapid heartbeat due to crack use is a different ball game than the same symptoms caused by other problems. An irregular heartbeat or seizure caused by overdose of certain antidepressant medications is treated in a different manner from those caused by other disorders. Not telling me about getting beat up may cause me to miss subtle signs of head injury. I may order too many tests, not do enough workup, or miss the boat entirely. It’s true that part of my job is to try to include the vast majority of life-threats in my plan, but it’s got to be a cooperative effort.

Second, I will call your bluff. I have a telephone, a computer, and a hospital laboratory at my disposal, and I know how to use them. I can and will find out things about you. And I will tell you what I’ve learned in front of friends, family members, law enforcement officers, or whoever happens to be in the room. Unless you’ve told your personal posse (and I use the term in its best sense) to leave the room, I’m assuming that you have given them permission to hear whatever I’m going to say to you. I will also document everything I’ve learned in your medical record for the use of the next physician who sees you.

Third, I will ask you if you’re interested in going to detox to help you with any drug or alcohol problem you might have. I will document this in your medical record, so the next time you come in for the same problem you will have no excuse for your behavior.

Finally, I will be much less likely to accede to any of your requests. This pertains especially to requests for additional medications, but also to requests for phones, food, taxi fare, bus passes, or virtually anything else that adds to your comfort in the ED. My job is to take care of your medical problems, not to facilitate your abusive behavior (I believe that lying to ED staff is not only disrespectful, but constitutes abuse of the individual doctor or nurse and of the health care system as a whole). So while it’s not an absolute rule and can be modified based on other clinical problems, in most cases lying gets you an enthusiastic recommendation for over-the-counter Tylenol and a trip out the door.

(Here’s another related pet peeve. You come into the ED asking for help in getting off of drugs or alcohol. Maybe you’ve even been talking with the local detox centers, AA, or NA in your effort. This is commendable, and I will do most anything I can to help facilitate your cause. I recognize that breaking the cycle of addiction can be a physical and psychological nightmare. But that being said, don’t come to the ED and ask for just a few more doses of your drug of choice until you can get further care. This makes no sense. If you want to get off a drugs or alcohol, then get off it. For the life of me I can’t figure out the logic of fighting addiction by giving you more of the same. There are perfectly good, non-addicting drugs out there to help manage alcohol and drug withdrawl, and I will be happy to liberally dispense these to you. And for what it’s worth, it’s no good telling me that they might use other medications with addictive potential at the detox center, and asking why I won’t do the same. The difference is that the detox setting is a controlled environment, where your doses can be regulated and you can be monitored for side effects. You want me to give you a few doses of a medication that’s not only addictive but potentially harmful, and then just send you back out on the street? I don’t think so.)

One final tip from me on this topic. If you feel like you have to lie, at least be consistent about it. Don’t tell me you’re in agony and then let me hear you laughing on your cellphone. Don’t tell me your pain in unrelenting if I have to wake you up to check you out. Don’t stalk around the ED demanding attention and then tell me you can’t get up and walk. Don’t tell me you have a seizure and then call me over to your bedside so I can watch you shake one arm up and down, point to it with the other hand, and shout, “See? See this?” Don't tell me you can't keep anything down and then let me see you happily munching on a cookie or a bag of chips. The internet can help you to insure that your feigned signs and symptoms match your ersatz complaint. Ain't technology grand?


  1. I find it interesting that you would suggest that one could potentially lie to thier mother. I, for one, would not support such blatant disrespect of the almighty entity who brought you into this world! :)

  2. Additionally, it should be noted that the code word I had to enter in order to make the last comment was... pewboar. I am guessing not a jewish phrase...