Archives: The Boy Who Cried Wolf

February Third Year:

Among our practice, there are a group of patient's who we refer to as frequent fliers. They are folks who wind up in the ER on such a regular basis, that we all know them well. Some, unfortunately, have medical problems that are resistant to outpatient control. Despite their best efforts and ours, they just keep bouncing back.

Then there are the GOMERS. Aptly named by the book "House of God", a GOMER is a 'get out of my ER'. It doesn't sound very charitable, but believe me.

These are patient's who mix in a lot of crazy with a little bit of illness and know how to work the system. They usually come in with the same complaints that can't be objectively proven and are often attached to some secondary gain. When the ER calls us to say that 'miss cyclical vomiting syndrome' is back again, there is much eye rolling to be had. If anyone had ever seen her vomit, or had evidence that she was in need of anything except more narcotics, there wouldn't be such a reaction.

But I got to thinking today: It's a dangerous game, this letting ourselves roll our eyes at the patient's we've come to expect melodramatic reporting from.

I got a call on a patient of mine who was back in the ER with the same pain complaints she has always had. The ER is so tired of her coming in for this, that they barely even initiate a work-up before giving her massive doses of pain meds. I walked in to her room with a pre-conceived notion of what she would say and need. And, for the most part, I was right.

Except there was one new symptom that she brought up. Could be part of her previous syndrome, I thought. Could be something new. I stopped. 'What would I do if I'd never met her before? What would I order if I had no idea her history of coming back again and again with these symptoms?"

It changed my management. I'm not sure if anything will come of it, but it was a humbling moment. Usually continuity is the thing that makes good medicine tick. But every once in a while, the past only obscures our view of the present.

In our friendships, in our work relationships, in our families, we've all come to expect certain things from certain people. But sometimes, we need to let that go. We need to believe that people innately have the ability to surprise us, and leave our doors open to be receptive to that.

Because at some point, we're all going to be the one asking for belief and a chance. And we all deserve to be heard.