There was a pretty good thread about 4 months ago on this
http://forums.studentdoctor.net/showthread.php?t=602899
I had one of those life-sucking patients the other day-
I saw her on one visit for 4 weeks of headaches, "sinusitis", and severe congestion.
To paint the picture, she was an older lady, about 6 feet tall. A little disheveled, with bad teeth. She was very hard to get a history from, rambling all over the place and usually ending the sentence with, "I'm just so sick doctor, I need to be admitted to the hospital." She had been on amoxicillin, a z-pac, and augmentin in the prior 4 weeks.
I CT'd her head and sinuses, looking for a fungus-ball, or sinusitis eroding away into her brain. She was so whiny, even after headache treatment that I lumbar punctured her looking for viral meningitis or partially treated meningitis. Everything was stone cold normal, except for a white count of 11.5. She complained of severe, intractable nausea (as she incessantly ate jello and drank juice for her 8 hour ER stay.
She came back with the exact same symptoms and the next ER doctor looked at my work-up and admitted her immediately to psych for 5 days.
She came back, requesting more antibiotics (a PCP had put her on penicillin (fourth course of antibiotics in 6 weeks), and when I refused, she wanted to be admitted to psych, because of sleeplessness. I talked to her mother (equally crazy and in her 70's, who demanded that she be admitted to psych because she was so annoying that visitors at their house couldn't stand her. Her mom said that she laid in bed with the lights out all day long, blowing her nose incessantly (had used up every kleenex box and toilet-paper roll in the house). She had a stuffy nose, and was distressed that blowing her nose a hundred times in a row didn't make it better.
The patient had been put on an atypical anti-psychotic on discharge from the psych ward, but recently found out that it wasn't covered by insurance and she couldn't afford the several hundred dollars a month that it cost. I discussed various options for drugs with the psychiatrist, and he recommended some haldol. I went to tell the patient that, and she said that had caused a psychotic reaction in the past and refused it. I ended up talking to the psychiatrist and asking him to admit her. He was willing to, but told me to warn her that it probably wouldn't fulfill admission criteria and wouldn't be covered by insurance.
She finally decided to go home. (with klonopin and some steroid nasal drop prescriptions.
Is insomnia, and a stuffy nose a reason to go to the ER? Three times?
She has been seeing an out-patient counselor for weeks. In the end, I realized that they had family in town visiting at her house, and she was making their visit unpleasant, so they dropped her off at the ER and told her to get admitted. Her mother told me that it would be "convenient" if she were admitted. I was so irritated that I ended up yelling at her and telling her to stop blowing her stinking nose and to go outside in the sunshine and get some exercise. The nurses were laughing their butts off at me. That was my first patient on a long night shift. I spent 40 minutes talking with the patient, the parents, and the psychiatrist, (each, at least two different conversations). Between the paper-work and the time talking to patient, I would bet I spent at least an hour, all for some when who is simply crazy.
I have insufficient knowledge and experience with psychiatry to deal with these kind of ridiculous issues in an efficient manner, at least, now.
I just came off 4 nights, I am definitely burnt.
But, hey, what percent of physicians in the nation have the next 3 days off and are wasting their time on the internet?