How did hospital know?

I took a friend to an E.R a couple of nights ago. We were out of town & he
had not been to this hospital before. My friend, I’ll call Joe, has back problems
and has taken a pretty large amount of narcotics in the last six months. In his
defense, he really does have a legitimate back injury. It took a while for the doctor to come in to the room. When he did, he seemed a bit irritated…gave Joe
a cursory exam & asked him if he’s been treated recently for this problem. Joe
said no, not real recently. Then the doc says, “You’re being dishonest with me.
You’ve been treated for this for at least six months. This E.R. will not give you
narcotics.” Then the doctor left the room. Joe was embarrassed, I was kinda
embarrassed for him. Then I started wondering how the hospital got what was
obviously quite a bit of info on Joe while he was waiting to be seen. How does
that work? When you sign any ER papers can they start digging wherever they
want to? Curiosity is getting to me…
oh, and Mods, if this needs to go to another spot, forgive me, please move it.
Thanks.

Was his insurance company paying for the treatment? If so, they were probably more than willing to squeal on him. He probably signed something saying it was okay for them to do so, as well.

What was the outcome? Do you think your friend really was merely trying to obtain narcotics, like the doc suspected, or was it his earlier back problem resurfacing.

Did the E.R. do anything at all for him?

The doctor just blew him off. And I really thought that Joe was in real pain but I
guess he could have been looking for the narcotics. It’s possible. I just don’t
know what made them even look into his background…or where they looked.
The doctor just acted pissed…my thinking was that the doctor could have at
least been compassionate enough to say,“Looks like you may have a problem
with narcotics. Would you like some suggestions on how that problem can be
helped? Is there something we can do to help you?” I ended up finding him
something else to use for his pain…and not wanting to “incriminate” myself,
I’ll let ya’ll think on that!!

He probably didn’t check out your friend’s background, in fact. Experienced ER docs have seen a certain pattern of behavior that is correlated with drug-seeking patients: They complain of serious, debilitating, but non-specific pain, (headaches and, you guessed it, back pain are common complaints) and request specific meds, among other signs.

Obviously, not everyone who can be characterized this way is looking for drugs. You buddy, however, whether he was looking for drugs or not, probably got thrown by the doc into this mental category.

QtM can add more an (I’m sure) regale us with tales of such patients.

I’m not brushing aside the notion that the doc had information on Joe…and I agree it’s most likely from an insurance company. However, this just sounds like a plain old CRAPPY doctor to me, who likely took a look at a chart and just took a wild guess as to the previous treatment.

I am not a doctor, but aren’t they supposed to TREAT people who come to the emergency room? Even if the doc thought he was a “pill seeker” he could have offered SOME method of pain relief. Perhaps, “You’ve been on medication for a long time, maybe it’s time to think about surgery to correct your problem.” Or “Here’s an ice pack.” Or some anti-inflamatory meds or SOMETHING.

Maybe Joe has a problem. But I’ve heard more than one doctor say that people don’t get addicted to pain medications if they actually take them because they’re in PAIN. He should have been treated in SOME manner. I give the doctor an F. Sounds like a jerk.

Yeah, my sis-in-law is an ER doc, and they can often smell it out. It’s not easy to imitate some illnesses well. However, she does have stories of the dosc and nurses accusing somebody of not having a problem and then suddenly some undeniable evidence surfaces that they were wrong. :smack:

Background: Ten years ago, I was wearing moccasins, touring a cemetary in Memphis, and stepped in a hole. I caught my foot and hyperflexed it up as I stepped then down as I fell. Severe unbearable pain. DeHusband pulls the car as near as he can and I crawl through the cemetary on my hands and knees because I can’t stand.

We go to Memphis Methodist emergency room, a teaching hospital. They think I’m faking so I can get narcotics. Cursory exam and I get crutches, ibuprofen, and told to suck it up. With me, no bones in my foot were broken - all the tendons and ligaments had snapped and torn. They didn’t notice that. They didn’t even let us use a wheelchair to get to the car. And yep, I’m still just a little bitter about it.

Come to find out, that as a teaching hospital they will get the same injury multiple times over several days, each time the person getting a new prescription from a different harried overworked intern. Some people will do anything for narcotics. I know people who hop from emergency room to emergency room, doctor to doctor, everytime they think they *might * be able to use an injury to score narcotics. And these aren’t stereotypical junkies. Normal, everyday people, like you and me, who just really like abusing percocet every so often. Back problems are a notorious ruse to get pills. Doctors in emergency rooms are understandably wary about someone who comes in often.

What they have to treat a person for:

When I worked as an Insurance Rep, about 2 years ago, it was my understanding that everytime you visit a doctor/hospital the report got sent to a central agency, MIDI (or something like that). It wasn’t uncommon for us to get people’s entire medical history for an evaluation from this one source. Do doctors have access to this database? Beats me.

Is it possible that ‘This ER will not give you narcotics’ meant that it was the ER’s policy not to do so? Some ERs will not dispense narcotics at all (except, I suppose, in cases where it is obviously necessary). Unfortunately, there are certain categories of drugs that have sufficient abuse potential that everyone requesting them might be considered suspect. Misinterpreting ‘have you been treated recently?’ as ‘have you been treated in the last week?’ might be enough to be labeled as a drug-seeker. That’s why it’s probably better to be detailed and specific about treatments and medications. Even then, there are some behaviors that I think are quite natural (‘I used to take morphine for it, and that worked great’) that might be considered drug-seeking behaviors as well.

I work in a hospital, though not in an ER, and I can almost guarantee you that nobody dug up Joe’s medical records from other hospitals and delivered them to the doctor. There are all kinds of privacy laws and regulations that, if not making it impossible at all, would cerainly make the the records transfer a drawn out thing needing permissions, forms and signatures. Our hospital will not release any medical information without a signed release form in hand.

You don’t say anything about why Joe went to the ER and what symptoms he displayed. What did Joe expect, what did he ask for? You were both out of town together – did he have some kind of attack, or did he just knock on your door and suggest you both head for the nearest ER? Were there any blood tests? What was Joe’s story? My guess is that the ER doc correctly figured out that Joe was self-medicating and Jonesing for relief.

Not knowing any more than your OP, my best guess is that the doc was a smart guy who broke a bad cover story easily with no help at all.

Joe did not ask for anything. We were out of town helping friends move. This is
what caused the back pain, according to Joe. And he did seem to be in pain.
He was checked in, BP taken, etc. No blood work was done. He was taken to a room, a nurse asked him some general health questions (heart problems? diabetes?, etc)–he has none of those problems. He told her about his back pain &
his injury that happened about 18 months before. Then we waited almost 2 more
hours, this dr. sweeps in, Joe tells him the same thing. Again, Joe never asked for
any specific kind of medicine. He just said he was in pain. That’s when he got the
“This ER will not give you narcotics” speech. It was kinda bizarre…like they’d
been holed up in a back room somewhere with a special computer or something
checking on their patients.

This must be something doctors face quite a bit… a bit of anecdotal evidence:

I have been going to a orthpaedic surgeon for the last couple of months due to my Jones fracture in my foot. 2 of the 4 times I have been there I have overheard him talking to the nurse about how many people he has seen that week that were obviously just trying to get narcotics subscriptions. Sounds like he has several people every week that he identifies as just trying to get more pain meds.

[QUOTE=Boyo Jim]
I work in a hospital, though not in an ER, and I can almost guarantee you that nobody dug up Joe’s medical records from other hospitals and delivered them to the doctor. There are all kinds of privacy laws and regulations that, if not making it impossible at all, would cerainly make the the records transfer a drawn out thing needing permissions, forms and signatures. Our hospital will not release any medical information without a signed release form in hand. QUOTE]

This statement made me finally cough up the 14.99 - I had to reply.

I work as a medical secretary in a teaching hospital and - since getting information on patients is half of what I do all day - I can tell you that privacy law is a very fuzzy thing. What you said usually only applies when you’re dealing directly with the medical records department in which case - it’s not going to happen without a witnessed, notarized, sealed, triplicate release signed in blood.

On the other hand if you call a primary care doctor’s office and try to get those records - particularly if you’re a doctor treating the patient in an emergency (or in this case we’ll say “emergency”) - then you’ll get whatever you need. You’ll almost always be able to get the primary care doctor on the phone to talk with you. This is my guess about what the er doc did. It was night - so that would have been tougher, but he could have had the doctor on call paged.

I refer you to myth#1 in this privacy faq. Basically doctors can talk about you amongst themselves in order to coordinate your treatment. In emergencies or “emergencies” HIPAA is totally flexible.

There are grayer areas when doctors try to get information on you - can or can’t a doctor get labs they didn’t order on you from the radiology deparment? Depends on the radiology department. But basically when a doctor needs to know something about you in order to treat you there’s a lot of discretion that’s used by whoever’s providing the information and usually it’s in favor of giving the doctor the information they need. This is an eminently good thing.

Oh and he would have found out who the primary care doctor was from the insurance company. Or forms Joe filled out. In our hospital your PCP is considered a vital demographic, like your name date of birth.

Let’s see. Your friend went to the ER in pain and the doc walks in and immediately declares he won’t prescribe narcotics?

So how long were you two visiting West Virginia, anyway?

Must … control … bitterness …

Some states have a network in which every prescription filled for a scheduled drug (such as a narcotic) is reported to a central agency. A doctor only has to make a phone call to get a record of all the controlled substance prescriptions that patient has had filled. (Kentucky has such a system, called KASPER; North Carolina does not.)

It’s possible that such a check was run, and if it showed that he had had several prescriptions filled for narcotics in recent months, they refused to give more.

I’m surprised that someone hasn’t developed a brain scan of some sort that is able to detect a pain response. If they can detect my alpha waves, why can’t they detect this red hot hell searing my brain?

Actually they can. The problem is in finding someone who knows how to read the scan and in getting the insurance company to pay for it.