Patients Are Liars

Tuesday, February 20, 2007

Someone on a great and now defunct blog (http://trenchdoc.com/trench/) asked a brilliant question recently. "My question is one no one seems to be asking, how do you prevent 'patients are liars' from becoming a kneejerk bias within healthcare and ensure it doesn't penalize patients inappropriately?"

I don't think you can. The really good medics, doctors and nurses (in emergency medicine) are the ones who realize that everything is bullshit until proven otherwise. The skill is in being able to tell the difference, generally at a glance and within seconds of meeting the patient. The crap doctors, nurses and medics are the ones who think everything really, truly IS bullshit, treat as such, and miss things. Either that or they assume everyone is legit and overtreat everyone (which can be just as dangerous as the first category).

The simple fact is that 85% of emergency patients aren't emergencies, they're just too lazy to go to a family physician, trying to get out of going to jail, or don't feel like going to work/school. Witness the 19 year old female complaining of heartburn, 2 episodes of emesis and swollen feet (for 4 years). She wants to go to the hospital across the street in plain view from her front door. She's willing to get a 500$ ambulance bill and 1000$ ER bill for what could have been a 10$ copay at a doctor's office. She's unemployed (but able bodied) and gets medicaid benefits.

And we wonder why healthcare is collapsing???