Work tales

Had a Psychiatry consult on one of my patients. Yesterday in their note for a care plan they wrote: Do not prescribe anti-psychotics as they can contribute to thrombocytopenia.

OK, you've told me what not to give to my delusional patient, how about a suggestion for treatment?

Today's note read: Continue plan

What? Continue to not have a plan?

I've run into this Psych Fellow before. He's a really nice guy. He's from India and speaks beautiful English, but doesn't always grasp colloquialisms. He's the one who told me my patient's antipsychotics all needed to be changed.

"What? Why? He's doing fine."

"Oh, no, he's obviously psychotic today. He spoke of having a frog in his throat."


Then I had a patient who was discharged yesterday, but refused to go. As sometimes happens he was unhappy with his prescribed pain medications. Now, mind you, he had accidentally admitted to me that he was selling his Oxycontin, but my refusal to give him a prescription for more came as a complete surprise to him. Go figure. Being a cancer patient I'm sure he does have some pain, but I'm not going to let Medicaid pay for a drug that he will just sell when he needs extra cash. And then when he has pain he'll show back up at the ER for something IV.
After going around with him all day yesterday I finally ended by giving him methadone. It works well for pain control and has zero value on the street.
Unhappy he was. He refused to leave and the pm folks didn't really know what to do, so they let him stay.
This morning I reiterated my position and told him he was discharged. Then he called administration, who called me and got huffy until I told them to discuss it with risk management. (See lawyers do occasionally prove useful!)
Then he insisted on seeing a Social Worker. Of course, their only interest was in whether he had a ride home. On being told no, they offered a taxi voucher and he snarled, "Never mind, I'll just walk!"
Social Worker said, "OK, here's your bag."
That really hurt his feelings, so when I left he was insisting on seeing a Chaplain. Guess I'm really gonna be in trouble now.
So far two days and lots of energy have been wasted trying to discharge one patient. Glad we have such strong oversight from the Gubmint, or he might just have been kicked out without allowing all the drama.