It is 12:30 AM, we have been asleep for a couple of hours, and we are awaken by the loud "*SQUAAAAAAAAAAAAAAAAAAAAWK!*" The dispatcher comes on with a 911 page,"Dispatch to Station 123, at 11234 Country Road 10, respond on a... um... chest pain? I think?"
Great... based on that dispatch, it's probably a non-emergent illness, but you never know. I get myself out of bed and get dressed. About 90 seconds later, we mark responding, light up our bright blinkie-blinkies, and crank on the siren. About 15 minutes later (we are in a very rural area) we arrive on scene. Grab the first responder back, airway kit, cardiac monitor/defibrillator and head on it. A gentleman meets us at the door, it's quiet inside, no chaos or screaming. At this point the call could still go either way, but his lack of freaking out makes me think it's either not an emergency or he's just a stone cold marine. We get in, and our patient is on the couch. She complains she is having chest pain so we get a little bit of history. Pretty quickly, we find out that she thinks her breasts are too large and thinks that she needs a breast reduction. Ok, well, we get the EKG done, and her heart looks fine. She is most likely not ill at all. We tell her this, and ask for clarification with a tone of disbelief, "You're having chest pain from your breasts being too large?" (Breasts that are too large usually only cause problem in the back, not in the chest, unless they are too large from say a cancerous growth)
"Well, I guess it's also in my stomach?" she replies. We can tell she is fishing for a clue from us as to what will be the right answer. We ask her where the pain is. She indicates it is on her upper abdomen, on the left side.
Immediately, my druggie-seeking-painkillers-ometer has kicked in and the dial has topped out. We immediately tell her that while we understand she is in pain, for what she has, pain is a diagnostic tool, so we can't give her any painkillers and there is no negotiation about that. She takes it surprisingly well, and we expect to be on our way back to the station soon. That's when she tells us that she still wants to go to the hospital. Okaaaaaay... We tell her that there is nothing the ER can probably do for her, but she says that her plastic surgeon tells her that she needs to go. (This was, unsurprisingly, misparaphrased as we shall later see.) Now I'm starting to feel that something is fishy, but I still can't place my finger on what it is...
If she wants to go, the department policy is that we have to take her, so we get her loaded into the back of the medic and prepare for the approximately 35-45 minute trip to the hospital (once again, remember, rural area). So during this time, me and my partner in the back continue to inquire about her history and then is when the full story starts to come out.
My patient has breasts that she deems are too large (42DD for those who care). She is a large woman to begin with, so they are not at all out of proportion for her body size. Lifting her I would estimate she weighs about 275-300 lbs. She was definitely spilling over the sides of our cot. Well, after much pestering of her primary care physician, she went to a plastic surgeon to see if he would do a consult for the breast reduction surgery. Unfortunately, he called back a week later and said that Medicare declined to pre-approve her surgery. Well that's a frickin' surprise. Turns out, medicare doesn't cover elective surgery. He advised her that, "because there is no documented pain or other medical problems arising from the condition, medicare would not cover the surgery. However, if she had symptoms, he would follow up with her at that time." Big mistake. Now she decided that she needed to document the pain. It's a shame she was too stupid to know what kind of pain having too large of breasts for your frame causes. It's also a shame that her smart phone that she paid $500 for and probably pays another $100/month for wasn't used to search for what her symptoms should be if she wanted to fake having a medical issue. Instead, now the government is subsidizing a $500 ambulance ride, the subsequent $3000 ER visit, and $500 bill for her meds. These are conservative estimates. But even by these estimates, that's $4000 that you and I paid for. And for what? She's not even sick! Not only is this a problem, but because she has to document her medical problems, it's probably going to happen a few more times over the course of the next couple of weeks. At $4k each time, you and I may spend $20,000 on moving this patient around between her house and the ER (because she has no real medical problems, we're really doing nothing more than paying for her to be moved to the ER, given a bed to rest for a few hours, and then taxi fare for her to be moved back home).
We asked her if she could tell us where her pain was again. She looked like she was thinking hard (which given her level of intelligence was probably required just to speak), and then pointed to her right side near her ribs. "Here!" she tells us. Wrong answer, just 10 minutes before it was your chest that was hurting, then your left side. Oops.
"On a scale of 1 to 10, with a 1 being a mosquito bite and a 10 being the worst pain in your life, how badly would you rate this pain?"
"Oh my GAAAAAAWD! It's gotta be an 11! I can't even sit up without it hurting!" Typical. Anyone who responds with an number greater than 10, as a general rule, is probably not in that much pain. The only person for whom an 11 might be a valid answer, is the guy I would never ask this question to, because I am too busy resuscitating him and working on him to ask, not that he could respond anyway because he is unconscious. In that case, yes, an "11" is a valid answer, because he's out cold and hasn't technically experienced this pain yet. Even police officers who have been shot try to downplay the seriousness of their injuries by responding, "Eh, a 6... maybe a 7?" It's then that I know they are actually hurting. I rarely care what the actual number is besides for documentation; I want to see what the reaction is from the patient.
In any case, my partner, looks at me and from her eyes, I can tell she is just begging me to let her give the radio report. Our driver calls out our 10 minute ETA, and I motion at her toward the radio. With a big grin, she grabs the radio and transmits the following:
"Good Morning Metro Hospital South! This is Medic 123 enroute to your facility with a 20 year old female. Her chief complaint this morning is going to be that her 'breasts are too large.' We were dispatched on a chest pain, but her pain has since moved to three other locations depending on when we ask her. We did do an EKG which we transmitted to your facility. It shows no abnormalities. She claims the pain is an 11 out of 10. Please be aware that she has seen a plastic surgeon in the past week at your facility and was advised that her breast reduction surgery was considered elective by Medicare unless she could provide documentation of pain or other medical issues that could be resolved by a breast reduction. Vital signs are within normal limits, and we will be at your facility in about 10 minutes if you have no further questions or orders."
This was followed by dead silence on the radio. Now this is the time that the hospital usually tells us if they need any more information from us and if not, they confirm that they copy the information and either give us a room assignment or tell us they will tell us when we get there where to go. Sometimes they have to consult a physician before replying, and we'll usually get a "please stand by" when this is the case, but we got absolutely nothing. 30 seconds elapse and my partner keys up the mic again. "Medic 123 to Metro Hospital South, did you copy my patient report?"
Still dead silence. I'm thinking that there is an issue with the radio now, so I grab the backup and key that up. I think the different voice finally got their attention that they had yet to respond. "County Medic 123 to Metro Hospital South. How do you read us?"
I hear the speaker key up and a lot of laughing in the background. Finally, a voice breaks the silence and simply says, "We got it!" Now usually I expect to her something like, "Medic 123, we copy your transmission clearly, we received your EKG and will provide you with a room assignment on arrival. Metro Hospital South Out." It turns out, they were laughing too hard at the chief complaint still to get out any more words than simply,"We got it!"
Rolling into the ER, they were still laughing at the nurse's station when we got there. We explained to the charge nurse the situation and documented every single thing she said in our report which would be sent to Medicare. Not that it's going to matter.
The people who process her claim will probably never notice that her symptoms started only after her claim was denied. The doctor won't tell them that (and who can blame him? he has tens of thousands of dollars to make out of the surgery as long as someone will pay!), the hospital will, and we have in our report, but Medicare is very bad at putting 2 and 2 together. She'll most likely get her surgery in a month or two, but at least I did my part to try and stop it.
So why does this piss me off so much? It's not only because it's a complete waste of resources and that I'm paying for it. Sure, it gets to me that society will have spent probably about $80,000 on her cosmetic surgery when all of this is said an done, maybe more. If I'm going to have to pay for a boob job, can I at least choose who gets it? It would do more good on the girls who are strippers at the local club. At least then it'd be boosting societal morale right? And we could get two of them done for the price of one here because we wouldn't need the run up of tens of thousand of dollars worth of running her to the ER just so she can document her "medical necessity."
What really gets to me is the short term effects of her actions. Yeah, I'm a bit grumpy that I had to get up at 12:30, but even that you can placate in me. If you are having a real emergency, I will never complain about getting up in the middle of the night. That's what I'm here for and the whole reason I volunteer. Even if you are not having an emergency, say you are a new mother and your baby has a slight fever and you just freak out and call 911, even then, I won't complain. I'll go take care of your baby, tell you he's all right, and that while you should have him checked out by his pediatrician in the morning, there is no emergency and you can both go back to bed. But this is irritating. Can't you document your, "Medical need" at say, 12:30 PM instead?
And onto the larger effects. By calling for us, you just took us out of service for 2 hours so that we could take care of you. Our run district is nearly 200 square miles. That means that if someone else were having a real emergency during the time you called us, we are not available. We would have to call the next nearest unit which is 45 minutes away. That's right, had someone had a heart attack between 12:30 and when we got back to our station at 2:30, your need for a breast reduction paid for by the government just killed that man--someone's father, grandfather, perhaps even some family's sole income source (that's right, most people have to work for their money, the government doesn't send them a check every month). If a kid were having a sever asthma attack or allergic reaction? You just killed someone's son. That blatant disregard for the EMS system and for the rest of society pisses me off. You may not understand how costing the government $80,000 in budget that's in the trillions of dollars makes a difference, but you should be able to understand how you may be killing someone by abusing the highly trained volunteers that come into your community (e.g. ME!) to prevent mortality and morbidity where it would be rampant without us and how that is not acceptable for others to die just for you to get your boobs done.
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