Mac is either all-in or all-out when it comes to sketchy pain complaints.  He will do drug screening on some of the complaineurs of the Holy Trinity of Pain (back pain, migraine, and dental pain) if he has seen them a lot.  On occasion he will give them narcotics if they agree to the piss test.  Sometimes he just tells them to hit the road with ibuprofen.  It's still a pitch 'til you win situation since most will keep hacking away at us until they get what they want, day after day after day. 

Yesterday, a guy with chronic back and neck pain came in.  On top of the chronic pain, he had some sketchy injury and claimed to have difficulty moving his arm, as well as way increased pain.  Although he had no insurance and no primary care physician, he stated he had an MRI scheduled in two weeks.  Mac decided that this guy needed it sooner. 

Call to MRI (we NEVER do this); they had an opeining, send him down. It was stressed to him that time was of the essence since MRI was going to hold the spot for him. We did the appropriate paper work and sent the patient on his way by private car.  The procedure is that patients check into the ER, the test is ordered, and then the ER doc has the responsibility for giving the patient results and follow up.

Three hours later, we got a call from the ER that the patient never showed up and further more, when they called to see WTF was going on with that, the wife started yelling at them that they had FREE CARE, and her husband wasn't given gas money to get the 12 miles there and back. 

Wow, really?  First we heard of it, and what a lovely concept.  He didn't need an ambulance, although we could have gone that route but somebody would have had to pick him up.  If transport was a problem, we could have given him a cab voucher but again, you only get one per day and somebody would have had to pick him up.  The MRI that we so thoughtfully arranged was just not as much of a priority to him as it was to Mac.

 Lisa came in while this was being debated to work a few hours for Kate.  She had come directly from an appearance at Bear Went Over the Mountain ER which is 15 miles away. Guess who had showed up there about 40 minutes after we had discharged him?  Yep.   His story was similar except HE HAD A COPY OF AN MRI FROM ANOTHER HOSPITAL with him.  That is never, never fishy.  I'll give you one guess as to what he wanted;  if you guessed "gas money", you are incorrect. Two of the nurses had recalled that he had been a  dick at another visit, which is what we find to be one of the most endearing qualities about dealing with the public.  ER nurses have VERY long memories.