Salon Health & Body | Stupid Patient of the Year


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By Hank Hyena [02/29/00] Urge I like 'em short What short men lack in height, they make up for in might. By Julie Manis [02/29/00] Complete archives for Health & Body - - - - - - - - - - - - - - - - - - - - - - - -		Stupid Patient of the Year An emergency room doctor selects the best and the brightest. - - - - - - - - - - - - By J.B. Orenstein, M.D. March 3, 2000 \| Television has the Emmys, film has the Academy Awards. If emergency medicine had an award, it would be for Stupid Patient of the Year. Why SPY? You can blame it on the Emergency Medical Treatment and Active Labor Act (EMTALA), which guarantees that anyone who comes to an emergency department of a hospital, for whatever reason, is entitled to see a doctor -- whether or not the person is actually sick. The top award, for best picture, goes to the patient who expended the greatest effort to get to the E.R. in the face of the least degree of illness or injury. People certainly deserve some recognition for their inspiring creativity and determination to attain emergency care when they have no discernible pathology. As in any good awards show, I'm saving the big prizewinner for last. Yet the subcategories are spicy and bountiful: most horrifying self-inflicted injury, nonlethal; most horrifying self-inflicted injury, lethal (oops, stepping on the Darwin award turf -- apologies); most disproportionate fear of poisoning; most overblown symptom; most worried by a worrisome health report; and most creative excuse to cadge a prescription for antibiotics. The aggravatingly common, loathsome practice of scamming for narcotics is not without its own distinct pathology and might also qualify as a category (the Jim Carrey: These patients come in all the time with nothing wrong -- other than their craving -- and leave empty-handed). It must be stipulated that psychotic patients are not eligible. We're only interested in those who, seemingly, understand and abide by the boundaries of normal behavior. The floodgates are jammed open. The EMTALA requires emergency room doctors to provide a "medical screening exam" and to stabilize all patients, but does not specify who should do the examination or how extensive that exam must be. Mercifully, litigation has given substance to these wispy vagaries. A doctor must treat every person who opens our doors. This has been a boon to worried patients everywhere, an invitation to healthy people to clog up an already overburdened system. Want a doctor to see your child? Come on in -- and immediately become eligible for a SPY! Don't worry, we recognize the sacrifices made by parents: A humble bow to those mommies and daddies to whom no sacrifice is too great for their children. Current nominees are those who recorded the following chief complaints for their completely healthy babies: Baby is breathing like a pig. (There was no respiratory distress.) Lumpnoids (never found out what these were). Problem with tentacle (testicle). Can't move her bible (bowels). His breath smells like pussy (pus). My baby farts like a man (gassy newborn). Penis swollen and skin tight around his vagina (uncircumcised boy). I must admit, the intentions for the EMTALA were good. Hospitals were turning patients away because they had no money -- which isn't ethical -- and the EMTALA was supposed to change that. So the federal government, in effect, legislated a right to health care -- but not the correspondent legislation that would require insurance companies to pay for it. Both houses of Congress adopted "prudent layperson" language last year stating that when people go to the E.R., they know they're sick enough to need emergency care, so their health insurance should cover it. But the language was ultimately killed. So the government can define what constitutes a medical emergency in order to require me to see a patient but not when it comes to making the insurance companies cough up for my enforced service. Although I'm confused by all this, at least prudent laypersons throughout the land are not. They know that enjoying completely good health is no obstacle to being checked by a doctor. That can be the only explanation for the episode of the Farouk family (whose names have been changed), a nominee for the group achievement award. The Farouks were at some sort of ethnic carnival, delightedly partaking of native costume displays, exotic dance, music and magic. When it came time for lunch, the entire clan -- five or six children, a couple of uncles and aunts, and grandparents -- drank juice from boxes. Within an hour or so, six of them started hurling, and hurling repeatedly. So they did what comes naturally in this rich country: They called 911. Next page \| Guess who wins the stupid genital tricks award? Illustration by Caterina Fake/Salon.com


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