I had a patient come in requesting a lab panel to test "for everything".

[Aristus]

I tried to verify that there was something specific that he wanted me to test for.

"No, I just want to get tested for everything."

Testing 'for everything' involves something in the neighborhood of two hundred to three hundred individual lab tests, and requires specimens of blood, urine, stool, semen, saliva, and sputum. You'd be dead by the time we got all the specimens we needed in order to test "for everything". But at least we could see what would have killed you if we hadn't drained all of your blood.

He is a healthy male in his twenties, so I'm running a routine metabolic panel, thyroid, and cholesterol panel.

I give him 10 out of 10 for health awareness. But 0 out of 10 for clinical practicality...

[hlthe2b]

1. Better hope he doesn't order the 23 and me or some other dna test...

His panic over perceived (unvalidated) risks will know no bounds.

[Cirque du So-What]

2. This one time, at the doctor's office,

I was told that they wanted a blood sample, a urine sample, a stool sample, and a semen sample.









I surrendered my skivvies.

[hibbing]

8. Ba Da Ding...I remember that one

[Major Nikon]

3. I do that

They keep telling me I'm not pregnant, which is a relief.

[unblock]

4. slept with a prostitute is my guess....

he knows he needs antibiotics but can't admit why.

[GemDigger]

5. STD's?

[Aristus]

6. Oh, I can usually get it out of them that they're here for an STD test.

Usually, I don't have to ask.

The schedule will say something like 'cough', or 'headache'.

"Good morning! Having a bit of a cough today?"

"Huh-uh. It's......it's...." *points to groin* "It's down here. Can you take a look?"

Then I get a full history from him and order the necessary lab tests.

I can't quite figure out why someone wouldn't come clean with us as to the reason for the visit. We will neither point and laugh, nor judge you. We just want to get you the appropriate treatment.

[GemDigger]

7. Good point.

[In_The_Wind]

9. That would become rather costly.

That should slow down his desire for information.

[ploppy]

10. Two all beef patties

special sauce, lettuce, cheese, pickles, onions on a sesame see bun. That's everything in my head.

[KayF]

12. the Dalai Lama walks into a pizza shop...

[VOX]

14. I've never seen that clip until now.

It's fantastic. The silliness of the joke, the timing, everything. And he gets it.

Thanks for posting this!

[raccoon]

11. Do you think he was drug seeking? Nt

[Aristus]

13. Oh no.

If he was, he used a technique I've never seen before.

Here are the usual:

1. Complains of 10/10 pain, but is in no evident distress, and blood pressure, pulse, and respiration are all within normal limits.

2. Puts on an Oscar-worthy performance of agonizing pain and states that his pain level is "Twenty, man! It's a twenty". Meanwhile, as above, vital signs are all normal.

3. Usually has a very specific medication in mind. "I gotta have Percocet! Percocet is the only thing that works!.

4. Often has a pet-name for his/her favorite medication: "I gotta have my Percs!"

5. Often goes the different route, knowing that there's only one medication that's effective, but can't 'remember' the name: "It begins with a 'D', I think. Dil...um...uh......Dilau?.....um...uh......Dilaudid?"

6. Has a prescription registry history of multiple scrips for multiple medications from multiple providers, but claims he's not 'drug-seeking'.

7. "Oh no, man; I don't want no narcotics. Tramadol will do me just fine!" When told that Tramadol is an addictive opioid like the others, he replies: "No it's not! My doctor told me it isn't!"

8. "Well, if you're not going to give it to me, I'm just going to have to buy it on the streets!"

9. "I use heroin because of my pain! If I can't get my medication, I'll have to use heroin instead!"

10. States his medications were stolen. "Could I just have a small amount to hold me until my pain doctor can give me more?"



*sigh*

All in a day's work.

I always prescribe opioid medications when they are standard of care. I have a patient with polycyctic ovarian syndrome, for which Tramadol is part of the treatment protocol. I referred her to GYN and wrote her a scrip for Tramadol without a single qualm.

[Aristus]

18. So it begins...

First patient up for the morning (last clinic day before the three-day weekend) - drug-seeker. Showed up demanding oxycodone and Tramadol. Checked her out on the state prescription registry. Sure enough: she recently filled a 60-tablet prescription for oxycodone from one provider, and the next week, another 60-tablet scrip from another provider.

I sent her packing...

[csziggy]

15. My sister pulled this sort of thing on her doctor last fall

She was freaked out because my kidney cancer was found purely by accident during a CT scan prior to my aortic valve replacement. The night before they took out my kidney our mother was diagnosed with metastasized liver cancer by chance when she was X-rayed for neck and back pain (she also had cracked vertebrae probably from a fall she does not remember). We also had a brother in law whose pancreatic cancer was not found until it was Stage IV even though he had symptoms for a couple of years and had been to doctors and hospital complaining of problems.

So my sister decided she needed to get a CT scan to find out if she had any problems that were asymptomatic. Her doctor was willing but her insurance company was not. Since she is a cheap skate I don't think she ever got one.

[Aristus]

16. I wonder what else the doctor did to work her up.

A referral for a CT alone won't cut it. I'd order a complete metabolic panel, which would give me a kidney function level. And a quick exam trick to assess CVA (costovertebral angle) tenderness. Place the palm of your hand over the region of the upper back underneath of which are the kidneys. Hammer ('percuss') your palm gently with your opposite fist, first on one side, then the other. Any pain elicited by this test could be indicative of kidney disease. It's a pretty common test to evaluate possible kidney stones. I would have tried it.

Decreased kidney function and CVA tenderness recorded on her chart might be enough to convince the doctor working for the insurance company to approve the CT. Certainly a CT costs much less than treating for kidney cancer.

[csziggy]

17. She asked at her regular annual wellness exam

If it is like mine that would include a full blood panel and urinalysis. She has had kidney stones in the past (crappy Tampa water) so her doctor probably does the "hammer" test you mention.

What scared her was that my kidney cancer had absolutely no symptoms - no decrease or change in kidney function, no pain, nothing. I was incredibly lucky they found it early before it had a chance to spread. The only follow up I have after the removal is to get sonograms and chest X-rays every six months for three to five years to make sure there is no recurrence.