I finally throw a patient out of my office

It was just another day practicing medicine in a maximum-security prison. Not all that different from private practice, but my patients are, on the average, more polite. I was perusing my schedule for the day, and seeing the same old same old: Follow-up hepatitis C; follow-up diabetes; follow-up heart disease; follow-up Hep C, diabetes, & heart disease and wants stronger pain medicine; assaulted another inmate in the fist with his teeth; wants a sports bra (really, it was a guy).

When I got to the one that said “wants to discuss asthma” I figured it was a no-brainer. Then I read the note in the chart. The young man (18, I think) wanted to be pronounced free of asthma so he could go to boot camp. Boot camp is an intensive military-style training and rehab regimen reserved for those young offenders deemed “potentially more salvageable” and whom perhaps shouldn’t be exposed to some of the senior criminal element. It shortens the sentence time, and is generally considered desirable. It is also not permitted for anyone with a history of the disease of asthma.

I won’t try to defend the policy of excluding anyone who ever was diagnosed with asthma. The bureaucracy put it in place after someone who had a history of mild intermittent asthma died in boot camp, from an attack. The guy hadn’t had an attack in years, and didn’t keep an inhaler with him anymore. He died, and they made the policy. No more asthmatics in boot camp, no matter how mild their disease.

So I look at the chart. Two and a half years earlier, the kid had been in juvie hall, for some unspecified crime (I generally don’t bother looking into their crimes). His very first visit to the Corrections health system during that incarceration had been for complaints of cough and shortness of breath, and he gave a history at the time as having had asthma. Wheezes in the lungs and reduced lung peak flows were duly noted by the doc, who prescribed anti-asthma inhalation treatments, which promptly cleared his symptoms, his wheezes, and improved his peak flows. He’s treated for asthma appropriately for the next 6 months, with notes being made that he’s under good control. Then he stops using his inhaler, and does ok for his remaining year in juvie hall.

Now he’s all growed up, and admitted to Adult Prison. For a new offense. And he’s just found out he can’t go to Boot camp with asthma. He starts the discussion by saying that his asthma hasn’t bothered him in years and years! I say sorry, but it’s documented you have it. Noone with a history of asthma goes to camp. Even if it’s gone now. Then he backpedals a bit, and says that he never had asthma at all, someone just put it in his record! When I point out that he himself checked “asthma history” on his admission health screen years ago, he changes his story and says he just put that down because he thought if he said he had asthma, they’d feel sorry for him and let him out sooner, but he never really had asthma.

So I ask about the documentation in the chart of treating him for it, and he gets really pissed! “That’s just what they said about me! I’m telling the truth! Why do I always get disbelieved? They could have been lying too, you know!” I pointed out that his past and current circumstances tended to undermine his credibility, so he shifted tactics again, and told about the death of his father, and his dying mother, and how he’d seen the light, and how he deserved this chance to do this and make changes!

Well, I asked some pertinent questions, and examined him and did all that doctorly stuff, and told him that it appeared his asthma was not active at present, but it was well documented that he’d had it in the past, and that was something I couldn’t change.

Then he began to allude to how good his lawyer was, at least as good as Johnnie Cochran, and did I want that kind of lawyer after me? If I didn’t play ball and send him to boot camp, he’d sic him on me! I pointed out that the state had lots of lawyers to take care of that end of the business, and he could point his lawyer anywhere he felt the lawyer needed pointing. Besides, if his lawyer was as good as Johnnie Cochran, what was he doing in prison? And furthermore, what I said didn’t matter, his diagnosis was clearly spelled out in his medical record, and that was what any decision would be based on.

At that point I saw his slick nature take over completely. He’d been 80% con man, 20% sincerity before, but now it was 100% criminal mind at work. “You mean that’s the only place where it says anything about my asthma, in my record? You could change that for me!” “What do you mean?” “Change my record! Take out all that stuff about my asthma! Do that for me!” “Why would I do that?” “So’s I can go to boot camp and get out of this fucking prison! Just do it!”

This was the first time an inmate tried to make me overtly complicit in unethical behavior. In the past they’ve tried to wheedle stuff out of me, making stuff up and faking symptoms, and playing on sympathy, etc. Never before had one come right out and told me they wanted me to violate rules and laws for their benefit, however. I was pissed.

“Get out. Leave now!” “What?” “leave this office.” “why?” “Don’t say another word, or I’ll do my best to see that you spend the next month in solitary confinement. Go. Go now. Goodbye!”

So he left, and I wrote it up in his chart, but not in a conduct report. I may yet regret that, I may not. We’ll see. But as I’ve pondered the whole thing, running it over in my mind, I realize just how big a narcissist the kid is, and also what pissed me off the most: He’d tried to get me to pity him, he’d tried to intimidate and threaten me with his lawyer, but he never did try to bribe me!!! Turkey. Of course I frankly can’t conceive of him having anything I’d want, much less be willing to compromise myself for, but good grief, kid! And he thinks he’s a player.

Aw, but doctors have it so easy and make so much money, you can’t have needed a bribe. :rolleyes:

At least you have this documented in his chart, in case he tries to bounce back and bite you in the ass with it.

Frankly, I’m impressed you’ve practiced this long without throwing somebody out. God knows I’d love to give some of DrJ’s patients the boot, and I only have to hear about them second hand. I’m truly impressed, doc.

He could have at least had the decency to offer to suck your dick.

What a little punk. It sounds like you were way more patient with him than you had to be. The “just do it” line is really insulting. I hope he has a tough time in there.

No kidding. Hasn’t he read “Miss Manners’ Guide to Exchanging Sexual Favors in Prison”? Falsifying medical records is clearly deserving on at least two blowjobs and an optional sodomization.

You’re right, Qadgop, I’m not changing my major. :wink:

Maybe you could have told him that asthma doesn’t generate half the sympathy that “solder my spleen vents shut” type ranting does with the parole board?

Sucks to your ‘ass-mar’ :smiley:

I can understand the oversensitivity about asthma. I admitted a 41-year-old lady to the ICU a little while ago who was as healthy as anything this morning, went to her doctor when her shortness of breath wasn’t relieved with a neb treatment, and four hours later was coded in the ER for 45 minutes. Now she’s in my unit on a vent with blown pupils while we try to round up the family.

Of course, that doesn’t happen to 99.9% of asthmatics, but the second you signed off on this guy, he’d be Mr. 0.1%. Then it’s your balls in the vise.

At least, it seems, he left peacefully. I’ve already had to have one clinic patient escorted out of the building by hospital security while the chief resident and I barricaded ourselves in the work room. I have to admit, though, being able to threaten my patients with solitary would be pretty sweet.

Dr. J

I am just curious, but aren’t you Doctors at all woried about HIPPA violations by discussing patients on an open message board? The way the Hospital I work at made it sound, you aren’t even allowed to divulge general patient information. I know that names aren’t used, but there are enough details here, that if the patient in question somehow got wind of this discussion, there could be real problems.

Well, without doing some real digging, I don’t really see how anyone would know who the patients in question were.

We know that QtM works in a max-security prison somewhere, but I’ve never run across any clues as to the general region, much less the specific facility. Sad as it is, I’m guessing that more than one prisoner across this fine nation has tried to get his medical records altered by these means. How, exactly, would the patient in question show that it’s his case being discussed?

DrJ’s case is a little more of a gray area, I guess, since we know that he’s a resident and lives in Greensboro, NC. We could conceivably narrow down the 41 year old female asthmatics in the unit, here and in the surrounding areas, and find our patient. However, this patient is just waiting to die, and I don’t really see her rising from the dead to raise a stink about it.

Well, I’ve been privy to more of Qadgop’s stories over the years than most people, (heh) and I can probably make some generalizations about what he will and won’t say. When he gives details about a case, patients are NEVER identified by anything other than a gender, a fairly broad description, and perhaps a general age range. I’ve never known him to give out information that could be traced back to an actual person by anyone other than people who have access to the medical history AND know who he’s seen, and I’m decently experienced at googlestalking. (Plus I know where he works, giving me an advantage!) Details in this story are so vague that I think it’d be hard for even one of his coworkers to put a name to the patient after a couple of weeks’ time. So, in short, if you’re trying to identify someone from Qadgop’s posts about them, um… good luck. You’ll need a lot of it.

Oh. And…uh… hi, Dad. … Dadgop?

I SWEAR I’m not stalking you. It’s just a natural move to check out the rest of the board after reading the blimp story, you know?

Welcome to the boards, Elfbabe! Check out the Tolkien thread in Cafe Society, you’ll like.

I haven’t yet seen any real identifying information to connect the patient’s identity to the story related; I know I try to keep that in mind when I talk about patients I deal with at work. And that’s not to mention that the storytellers are themselves going under pseudonyms.

Grr, hit reply too fast - great story as always, QtM! Even with the “get to throw patients out” benefit, you’ll excuse me if I still prefer my workplace. :wink:

/wave to elfbabe - welcome to the boards! I was born and raised in the particular county you live in, and your dad and I have swapped some stories. :slight_smile: I hope you enjoy it here.

Keep this guy’s paperwork handy, with that kind of fucked up attitude, he’ll be in that revolving door.

Hail, fellow SK fan! :smiley:

Nice wording.

I would put in a conduct report, it’s almost certain this individual will try something similar on a future prison term (he ain’t gonna change)

Although you have concerns about medical confidentiality, his futile efforts to corrupt you seem to signal to me that he will refine his technique in time and may beome a security risk.

Whenever I get cons making humorous comments about how much a person could make by bringing drugs in with them or somesuch corrupt practice, I put it down in their security file, it often turns out they are either known drug dealers or they work for one.
It all helps the security specialists keep a lid on things.

Do the prisoners always want pain pills and benzos? I’d imagine that’s what they’d be trying to con you into.

I just want all to know that I wasn’t coming down on the good Doctors. I was just curious about the HIPPA regs. The way it was described to us, even discussing general patient information to people without a need to know was frowned apon and possibly fineable.