Abdominal pain or pain due to condition that doesn’t cause pain.
History of Present Illness:
This is a really, really annoying patient with a given age and sex presenting with an acute exacerbation of a symptom or condition that cannot be disproven with repeated negative objective data. It started when the patient last left the hospital and intensifies anytime a nurse or doctor walks into the patient’s room. The pain is a 45 out of 10, associated with every other symptom a human being can ever possibly experience, made worse by everything in life including a gentle breeze, and relieved only “with that pain medication that starts with a D.” Patient notes constipation (surprise, surprise).
Patient denies medications, though the state prescription drug monitoring program and calls to local pharmacies reveal otherwise.
Acetaminophen, aspirin, NSAIDs, tramadol, morphine, epinephrine, air, water, health care practitioners, discharge planning.
“Can’t you just read my chart?”
Denies smoking, alcohol, or illicit drugs though actively smoking, reeking of alcohol, and holding “a water pipe.”
Review of Systems:
Positive for everything, including itchy nails and tooth spasms.
The stablest of stable.
Patient comfortable playing with a smartphone and watching TV. Exam normal, notable only for the stench of BS.
CBC and chemistries unremarkable. Urine drug screen either refused or positive.
Assessment & Plan:
This is a liar presenting with acute on chronic BS and narcotic deficiency, admitted because the patient fooled an unsuspecting but well-intentioned health care practitioner. Plan for daily confrontations and arguments over drug-seeking behavior. Plan to spend thousands upon thousands of healthcare dollars trying to prove this patient wrong but inevitably fail. Plan for this patient to suck resources away from genuinely-ill patients who actually deserve my time, energy, and patience. Plan to get threatened with a negative patient satisfaction survey or, better, a lawsuit. Suspect patient will be discharged with help from administration or leave against medical advice (AMA) in about a week’s time.