My patient should go stick his head in a pig

My patient was upset with me.

He said he had horrible back pain from kidney stones. He said he’d had stones so severe before they were removed surgically. The scar was in an odd place for surgical removal of stones, though.

His urine samples were full of blood, so that was a possibility. His symptoms and his bloody urine continued, despite treatment. Funny, his CT scan didn’t show a damn thing, though. They’re usually good at picking up stones.

He wanted Vicodin or Oxycontin and/or Soma. (I hate Soma. It gets metabolized to a barbiturate, and IMHO is good for nuthin!) Got quite incensed when I told him that given his medical problems and his history of extreme drug abuse (the reason he was in prison), those weren’t good options in this particular moment. He tried to bargain. Said he wouldn’t report me to the Medical Examining Board for withholding necessary treatment if I gave him those drugs. I told him to feel free to report me; just make sure you spell my name right. Qadgop with a Q, but no U.

He demanded something be done. I told him we should get him to a urologist for cystoscopy (well, I told him we’d put a scope up his penis to see what the problem was). He said he’d rather not bother with that. Soma would be ok.

His story and his symptoms didn’t add up. Sitting there calmly and comfortably, telling me his pain was a “10 out of 10”. Blood pressure, heart rate normal. To me, a 10/10 for pain means you’re tearing the skin off your arms with your teeth to distract you from the discomfort. No relief from Toradol. Odd, the literature indicates toradol (a nonnarcotic painkiller, and a potent one at that) works better than opiates for kidney stone pain! His exam was really normal too. None of the signs were there of someone with renal colic or other painful pathology.

But we’d better do something, he told us. He was peeing blood, dammit! The newspapers would hear about this. So we did something.

I told him: Give a urine sample, now. He did, unwitnessed. Loaded with blood. See, he says! I’m bleeding. Wait, I say. We’re gonna watch you give the next one. I can’t go, he laments! No problem. Sit here, under the eye of the officer, and drink water until you can. 45 minutes later, he produces a witnessed sample: Absolutely o blood at all.

Well, I tell him. Blood in the urine can be other things than a kidney stone. It could be a fatal kidney cancer! It could be Lupus, which will also threaten one’s life and maybe send one to a dialysis machine. It could be an overwhelming infection. But you don’t have anything to worry about, because you don’t have any blood in your urine! Isn’t that swell?

As he left the office, he asked one last time if he couldn’t get some Soma.


But what if he’s Muslim?

Or Jewish?

Seriously, sounds like a right wanker.

Another prison doctor story from BBC TV comedy Porridge. The lazy con Flectcher is scheming to get cushy library duty, so he keeps telling the doctor at his medical exam that he’s got flat feet. Every question, same answer: flat feet. Finally, the doctor asks him perfunctorily, “Are you now, or have you at any time been, a practising homosexual?”

“What? With these feet!”

Now that’s a rant.

::golf clap::

Should I ask where the blood was coming from?


When I was in medical school the first patient I met had the opposite problem. He was a prisoner who started having blood in his urine and the prison doctors told him it was fine to have blood in your urine and that he shouldn’t worry about it. By the time they got him to the hospital he had a tumor the size of a football.

Anyway, good for you for taking better care of your prisoners than they do in Texas, where you hear the sentence “By the time they got him to the hospital he had a tumor the size of a football” a little too often.

from a hangnail.

They’re my patients. They just happen to be inmates, which does affect some things about how I can take care of them. They still get the benefit of the doubt from me, and I assume they are being honest with me until subjective complaints do not correlate with objective findings.

And even some of the chronic drug-seeking liars get really sick sometimes.

Now, I don’t spend as much time as I ought with narc-seekers, but, pray-tell, how in the hell does one fake putting blood into your own urine? Perhaps I’ve misread something.

Uhhh… simulpost.

This looks like a good place to tell a related story.

Mom’s a nurse and is currently doing telephone triage (whatever that means) for her department and several others. A week or two ago, this woman kept calling because she was unhappy that the doctor said that she could go back to work with certain restrictions. I don’t know what her problem was, but she apparently would just keep going on and on about enviromental factors. Things like, “the company won’t allow me to do my job with this restriction” and “I can’t drive to work because I drive a stick.” Apparently she did this for two or three days with Mom trying to be polite and all. Good thing it wasn’t me, as I would’ve told her to figure out her own problems and then to fuck off long before that, considering that there was nothing Mom could do and the doc was out of town.

A drop of blood from the finger (or wherever) into the cup containing the urine. Instant factitious hematuria.

Well, since the bloody sample was unwitnessed, it’s an easy matter to use the hangnail that QtM cited to just drip some blood in. Note that the witnessed sample had no blood - he had no opportunity to “spike” it.

And QtM - what do you have against pigs? :frowning: (Besides their manure smell, that is. Damn…)

Wow. My seekers rarely go to that much trouble. Thanks to one of my patients, though, I’m on a first-name basis with the lady at the North Carolina State Medical Board.

I’ve already claimed Dr. J’s Sign–allergies to Tylenol and NSAIDS. Maybe I’ll add a pain rating of 10/10 and a normal blood pressure and make it Dr. J’s Triad. (Those who rate their pain as anything greater than 10 out of 10 are in a class by themselves.)

I enjoy treating people who really are in pain. Why do assholes like this have to make it so hard?

I refuse to prescribe Soma on principle–whichever drug company it was that named it either hadn’t read Brave New World, didn’t understand it, or is playing a colossal joke on us. I use Flexeril if I have to use a muscle relaxer, though I honestly don’t think I’ve ever even written a script for that, either.

That drug name bothers me too - sounds like a sick joke, really.

Are all American medical doctors so elliptical? Or is this a prescribed elicitation technique?

I’d just like to say that I wasn’t aware we had 3 doctors here, I was just aware that QTM was. This board really has all sorts of people, and not just one of them. A wonderful thing if I must say.

::golf clap::


Not sure exactly what you mean by “elliptical”, but we tend to develop strong senses for rooting out bullshit. It starts with a simple “this doesn’t look right” and the rest follows pretty naturally.

I’ve been around longer than QtM–though, to be fair, he’s been here as a doctor longer than I have. :slight_smile:

more than 3. KarlGauss, KP, me, DoctorJ (whom I remember as a lowly med student and then lowly intern), a dermatologist and a pathologist whose names I misrecall at the moment, and a few others too.