“I’m on to you” – a patient who “only lied about one thing.”

“I’m on to you” – a patient who “only lied about one thing.”

Today I saw a young female patient with two children.  She supposedly has chronic pain after an accident. I "inherited" her after her last pregnancy. Her OB doctor maintained her on narcotics during her entire pregnancy, then discharged her. I have been seeing her for 5 months. She does have pain, but it is not pelvic.

Technically she should be seeing an orthopedist, but they won’t take her insurance. She has that "good insurance" (Medicaid). I don't participate anymore (you can all clap now) so she pays me CASH. I have been trying to get her to the University to see orthopedics since summer. She has had every excuse in the book.

She has been to the ER twice since she has been coming here. Both times there have been “issues”. The first time she was accused of child abandonment. Both times she was apparently inebriated.

Her story today about the injury that took her to the ER was different than what she told the staff and Doc there. I know for a fact that she was in jail for 7 days for domestic abuse since she was here. I had a call from child protective services yesterday about her.  They are concerned about her children and considering removing them from the home.

She has failed every urine drug screen since she has started here. On discussion today, she really doesn't like that Clonazepam. She just can't feel it. (She was on Xanax when she came here. I won't prescribe it to new patients). So she doesn't take it, and doesn't tell me she's not taking it. Her last two urine screens were negative for it. Others had other problems.  For non-medical people, Xanax is a medication that is used for “anxiety”.  It works fairly fast.  Apparently there is a good feeling with it.  Clonazepam is used for the same thing.  It is long acting, and has no rewarding “good feeling”.

I discharged her today in the office. Gave her 30 days of meds and sent her on her way.  My state requires 30 day notice before discharging a patient.  It’s a stupid rule in my opinion, but it’s the law.   She was shocked. "But I only lied to you about that one thing!" She tried to negotiate for staying without the Clonazepam. Then she wanted to stay "just one more month". Then she wanted to know if I would write her medications for her withdrawal when she got to the end of her prescriptions. 

I hate being manipulated and lied to.  She continued to try with a phone call about something after she left.  “I’m on to you!”