I loooooooooooove our hospitalists! I've said it before, I'll say it again. And again. And Again.
Dr. Tulango (his real name is kind of the same as a dance, so when he is is on we say something like 'today, we dance the Tulango with joy, for Andy is with us and we celebrate!" Silly and stupid, but what fun is work if you cannot have a laugh or two?
One of the frequent fliers was on his admit list. This patient is manipulative and abusive. She refrains from taking her antihypertensives for days at a time, then comes to the ER with a BP around, say, Patent Pending/120. She complains of severe headache, gets dilaudid (a lot for her 15 out of 10 pain), Zofran, a whole bunch of labetolol and gets admitted to the ICU. They kick her out when her BP is back to normal and they are tired of giving her narcotics (allergic to toradol, etc. You get the picture). So she figured out a nearly foolproof method to buy herself a couple of days of room, board, and narcs. Administration eventually came up with a plan: if her BP was within a certain range, she would get oral antihypertensive meds, a visit with the case manager, and no narcotics.
This time there was some kind of loophole, because although her BP came down to an acceptable range, the ER doc felt compelled to admit her. Enter Dr. Tulango. Always very concientious, he went over the medication reconcilliation with the patient; it included a HUGE dose of methodone as well as oxycontin. Hmmm....... After some investigation and a chat with the patient's PCP, it was confirmed that no, there was no oxycontin prescribed by him and the methodone was 4 times what it should have been. Dr. Tulango was anxious to speak to the provider who scripted her these meds, but when she was confronted for the name of the provider she ripped out her IV, made disparaging remarks about Dr. Tulango's parentage and ethnicity, promised to go straight to the mayor's office...and stormed out. Normotensive, non-narcotized and feeling abused. OK, so you lied about it and got caught. Get over it.
Like I said, I looooooooooooooooooove our hospitalists!!