The $1 Hissy Fit
Posted by WhiteCoat on December 27, 2007
A young lady brings her child in for evaluation of a minor blunt head injury. Her child is fine.
As the nurse is discussing the child’s discharge papers, almost as an afterthought, the lady mentions that she is going to register to be seen by the emergency physician as well. The nurse asked what changed that made her want to be seen now, but not before. She stated that she just remembered that she had burning when she wiped after using the bathroom a couple of days ago and she also wanted a pregnancy test done.
The nurse stated that we probably would not be doing a pregnancy test and that she could go to the “Dollar Store” and purchase one for a dollar if she wanted to see if she was pregnant. The patient got upset and yelled at her. The nurse then came out to me and described what had happened. “By the way,” she stated “the patient has Medicaid. She just wants to get a free pregnancy test while she’s here.”
I have to admit that I was a little jaded by what happened. First, I don’t like it when anyone yells at my nurses. Second, the nurse was right. My wife bought a bunch of pregnancy tests when we were trying to get pregnant with our last child. Surely this patient could afford a $1 trip to the Dollar Store.
I walked in the room and examined the patient. She had no symptoms, a normal physical examination, and a normal urinalysis. When I told her that she would be going home, she became very insistent that I perform a pregnancy test on her.
“Ma’am, there is no medical indication for doing a random pregnancy test on you right now.” I reinforced the nurse’s suggestion that the patient could purchase a pregnancy test in the Dollar Store if she needed to know.
“My obstetrician won’t start me on birth control pills until I have my next period, and I’m a few days late now.”
“Are you trying to get pregnant?”
“No.”
“Are you having unprotected sex?”
“Yeah.”
“Then you’re trying to get pregnant.”
“I’m not tryyyying, but if I’m pregnant, I need to know now so I can schedule an abortion.”
That ticked me off.
“I’m not doing a pregnancy test on you during this visit. If you need to know, you can follow up with your obstetrician or you can go to the Dollar Store. The nurse will bring in your discharge papers shortly.”
The patient became upset with me, made some unflattering personal comments about me, and then yelled about how “rude” everyone in the emergency department was being. She left in a huff saying, “Fine, I’ll just go to the emergency department across town and get a pregnancy test done there.”
Put aside the miserable mindset of using surgical procedures as a form of birth control. That’s a social ill that we will never cure.
Want to know one of the reasons why the costs of medical care in this country are so outrageous?
There is a significant subset of the people who do not pay for their medical care who believe it is more cost effective to sit in an emergency department for several hours and to run up a bill of several hundred dollars than it is to drive to the Dollar Store and plunk down $1 of their own money plus tax for a stinking pregnancy test.
December 27, 2007 at 10:41 pm
Eh, I tell these people to go to Planned Parenthood. If they are low-income, they often qualify for free preg tests and the all-important FREE birth control pills. This is part of my kind, caring WTF are you wasting our time for speech. Of course, that requires the patient to have enough brainpower to dial a phone number and make an appointment and resist the urge to know RIGHT NOW for free.
Also, if another person asks me over the phone if we do “free” abortions in the ER, I’m going to jump right through the phone line and abort them.
December 27, 2007 at 10:52 pm
Why can’t the powers that be behind these programs come up with some incentives to not abuse the program this way?
I didn’t know you could get pregnancy tests at the dollar store. I bought some at Walmart this past summer and fall and they are around 15.00 for 2 in a pkg and I think one brand was around 18.99. The Walmart brand was around 9.99. But I really wanted to know I could trust the accuracy and so I was afraid to get anything other then a name brand so I probably wouldn’t have trusted the dollar store either.
Birth control abortions…I am not even going to go there other then to say the idea grieves me deeply.
December 27, 2007 at 10:55 pm
Free abortions in the ER…a common question?? sigh…
December 27, 2007 at 11:17 pm
It never ceases to amaze me, although I’ve seen it and it should.
December 28, 2007 at 12:21 am
Our code for these patients is “396″. We even write it on the big white board under “Complaint” sometimes.
Why? Because there are 4 Super Walmarts in our town; no matter where you live, you are nearly within walking distance of one. And the Walmart brand pregnancy test is, you guessed it, $3.96.
PS: Our docs almost always cave and do them, anyway. It infuriates the cynics among us.
December 28, 2007 at 12:23 am
All the F’ing time. Sigh.
In our state they are talking about mandatory copays for medicaid patients. that makes me laugh. We have to see and screen them (EMTALA, don’cha know) and can’t ask for the $10 in advance. So after they already have been seen, we can ask for money and they’ll just walk out, probably cursing us out for having the temerity to ask for payment. And then we can bill them. We’ll probably spend more in postage than we’ll ever collect.
Nice job at drawing a line in the sand. I’ve tried to do the same thing in the past, but usually get thwarted by a well-intentioned lab tech. That sort of thing almost always gets a complaint to administration, but the warm fuzzy feeling you get is totally worth it…
December 28, 2007 at 5:05 am
Wow, I remember back in the old days when we just waited to find out the hard way we were pregnant. Finding out at one or two weeks makes the whole process seem like it’s taking forever. Now people can’t seem to wait for anything. My husband was complaining the other day that the computer took too long to look up something. I told him he should just be glad he didn’t have to go to the library.
December 28, 2007 at 8:09 am
Too bad no one will make sterility an option. If she’s not interested in being pregnant and thinking about birth control, why not just clip the tubes and be done?
December 28, 2007 at 8:44 am
Sigh.
December 28, 2007 at 8:52 am
I think the “would be” mother has to have had at least children before clipping “the tubes”…
December 28, 2007 at 11:57 am
You can get them even cheaper on Ebay. I bought 40 ovulation tests and 10 pregnancy tests for $17.99 on Ebay two months ago. I even got to choose how many of which tests out of the 50 that I wanted. The tests were very accurate. Got a postive test at 11dpo. Oh but wait, that would mean they would have to actually plan ahead.
December 28, 2007 at 4:51 pm
[...] December 28, 2007 in women’s health, work dude, whitecoat knows my perils, i means really knows. read this. [...]
December 28, 2007 at 4:53 pm
thanks for sharing.
December 28, 2007 at 5:08 pm
Pemommy reminds me of this story about my cousin.
She was living and working out in LA at the time as a paralegal and was concerned she was pregnant. She was so obsessed about it that she kept buying the pregnancy tests but didn’t throw any of them out but instead left them lying on the window sill, the counter, the toilet and all around the bathroom. I don’t remember how may she bought but she was pregnant and she did give birth to a beautiful,healthy baby boy.
A man that worked with her in this corporation also was a writer for the Murphy Brown show. She told him her story, loved it and asked her if he could write it into the script for Murphy. They had Murphy doing the same thing when she found out she was pregnant on the show and it was based on my cousin’s real life experience.
December 28, 2007 at 6:02 pm
[...] The $1 Hissy Fit A young lady brings her child in for evaluation of a minor blunt head injury. Her child is fine. As the nurse is […] [...]
December 28, 2007 at 6:23 pm
I agree that abortion should not be used as birth control. But just because someone has Medicaid doesn’t mean they want to be on it and want to milk the system. I really feel for arrogant, self-righteous people like you.
You are absolutely correct that Medicaid does not necessarily equate to a desire to milk the system. But … when someone values their time so little that they sit in an emergency department for several hours and run up hundreds of dollars in costs to “save” $1 on a pregnancy test, I have an issue with the person and their thought processes, not with their payment method. When someone yells at me for not giving them a pregnancy test and says they’re going to spend more money in gas than it takes to just purchase the test to go somewhere else so someone else will do it for them for “free,” they are milking the system and taking services away from other people (including children) who really need them. You are either naive or horribly misinformed if you believe otherwise.
Look at scales of economy. States pay hundreds of millions of dollars for unnecessary ED visits for “free” pregnancy tests, “free” Motrin prescriptions, or “free” pregnancy ultrasounds. Suddenly there is no funding available to provide Medicaid services to other people who really need the care. Will it still be self-righteousness if/when your loved ones have no or extremely limited access to care because the system has been sucked dry? Trust me, this scenario is closer to fruition than you think.
December 28, 2007 at 7:24 pm
MaryKayLady, it IS milking the system if one wants an emergency room physician and hospital to order and perform a simple pregnancy test.
See Crass-Polination and read down about 5 posts or so. Because? If you don’t work in an ER, you have NO RIGHT to opine on the feelings of those who do.
December 28, 2007 at 7:29 pm
Here it is for you:
December 28, 2007 at 7:29 pm
http://crasspollination.blogspot.com/2007/12/self-righteousness-101.html
December 28, 2007 at 9:42 pm
Marykaylady-my elderly mother has mdcr/mdcd, worked hard for most of her life but had some unfortunate things happen along the way. She doesn’t abuse the system. I know of other people who also had to go on mdcd for the kids, etc due to unfortunate circumstances. I remember a woman coming right over to me in the supermarket and thanking me for giving her the charity forms to help her with her hospital medical bills because her husband had died and she was left to take care of 4 young children. Many good, hard working people have benefited from this program and the charity care and thank God for them.
The problem is the pervasive mentality among so many that it’s a free ride…they KNOW everything done in the hospital will not be billed to them. They will use the ED like a clinic instead of going to one or to a doctor. This is a burden to the health care system. Admittedly,there are physicians who refuse mdcd pts because they don’t get paid much from mdcd. But there are docs who do take it.
I worked in registration for 20 years and I have seen the abuses time and time again. I was the 1st person they saw and I know their complaints and insurance status.
I feel defensive of people on mdcd when I hear the generalizations BUT…I also understand.
One time in a departmental meeting (which included the financial director for the entire corporation) regarding finances/insurances, one of my co-workers (who I liked) made a derogatory remark about mdcd pts and some people agreed with comments. (Not the director) It bothered me and so I politely yet assertively spoke up and said that my mother was on mdcr and mdcd. You could’ve heard a pin drop like in one of those old EF Hutton commercials. I didn’t say anything else -just that and I was glad I did. Maybe I shouldn’t have and I probably caused them to be uncomfortable for a few seconds but maybe it didn’t hurt to remind them to not be so quick to generalize.
It is also because of that mentality, that when my husband was out of work for 20 months and our income took a nose dive that we didn’t apply for public assistance and believe me …we qualified with a family of four. We didn’t even apply for the cheaper school lunches. I realize that was false pride and I would be the first person to encourage someone to apply for the programs because they are there for people in need. But we didn’t. In retrospect I think it was stupid on our part because the system was set up for that and we have paid into it over the years.
I worked in a small community hospital and there was a lot of mdcd and self pay pts. I can only imagine what it is like in the big city hospitals.
I have said this before but the welfare mentality is generational in many instances in that the kids are born into it, they have kids young and so on. It’s what they know. What is the solution? if you make it tough on the abusers are you then penalizing the innocent?
December 29, 2007 at 7:32 am
I’m sure there is some rule against it, as there seem to be so very many rules associated with hospitals and patient care - but it would be kind of nice if you could just buy 50 of the $1 tests out of petty cash, keep ‘em on hand, and then offer to let the patients buy them to take them home. Heck, charge $1.50 and make 50% profit.
Now I’m betting it wouldn’t work, because I’m not a health care worker. But I think things to make your job easier would be a good idea…
December 29, 2007 at 12:55 pm
Read # 13, 19, 20, and 21 here:
http://thehappyhospitalist.blogspot.com/2007/12/my-black-jack-21.html
I’m on your side man
To the lady that said having Medicaid doesn’t equate to milking the system, I can assure you this:
Having Medicaid doesn’t guarantee that you will milk the system.
BUT those that do milk the system are almost always invariably Medicaid patients.
Why?
Because FREE=MORE and it always will
Why do you suppose they demand pregnancy test and ibuprofen scripts?
Because when someone else is paying for it, it is in their best interest to demand the world. There is no self restraints.
What happens when you place a $10 copay on all OTC meds?
I can assure you that the demands will go away.
Today, in the hospital I overheard an in patient state she wants to get her mammogram because she’s “a couple years over due”.
Un-friggen believable. It wasn’t my patient but I told the nurse to tell the patient no. That is not a reason to get a preventative medicine test during a hospital stay.
December 30, 2007 at 12:04 am
We ALL lose when patients demand and receive unnecessary care. Way to go Whitecoat, I’m with ya too! My latest crusade is to not give antibiotics for the common cold. I recently had a patient rail on me pretty aggressively for not doing this (”all my friends got antibiotics from THEIR doctors”), to which I answered rather aggressively back with my reasons. I also invited her to find another physician (but I don’t think she will–PCPs are hard to come by in my town).
There was a wise internist in our town who left general practice to become a hospitalist (like so many before him) who is reputed to have noted that “It takes an hour to say NO, but just a minute to say YES”, as an explanation for some of the excessive testing and treatment that goes on. Not to mention the fact that a visit for a cold is a pretty quick and easy follow-up for a few bucks for the doctor …
December 30, 2007 at 6:34 am
Hey Doc,
This blog entry reminded me of one posted by CharityDoc over at fingersandtubesineveryorifice. I miss Charity Doc… wish he’d start posting again.
Anyways, here’s the post:
http://fingersandtubesineveryorifice.blogspot.com/2007/05/insurance.html
December 30, 2007 at 7:46 am
Yeah, it sucks that we have to accommodate every person who refuses to take care of themself, but any place I ever worked does a pregnancy test on almost all women of childbearing age just as a matter of routine, I mean, isn’t this something you’d want to know about your patient? Even an unnecessary patient?
We also end up doing a pelvic exam on almost all our female patients, no matter what they came in for the interview reveals possible problems “down there”, and they end up leaving with a shot of Ceftriaxone and a mouthful of Flagyl. My city leads the country in cases of gonorrhea and, as nice as it would be to refuse to treat it to be able to say we won, we don’t play it like that.
My place of employment goes overboard on almost all of our cases, we commonly find problems that nobody anywhere ever suspected, and we certainly go far beyond the requirements of EMTALA, but it amazes me sometimes how little is done at many other ERs. The blogosphere is very revealing.
December 30, 2007 at 1:45 pm
T Ellis, Why not just give them a shot of ceftriaxone and a mouth ful of flagyl and tell them to F/U with their PCP for a gyn exam.
An STD does not appear to me to be an emergency.
It’s the same as empirically treating, a UTI with antibiotics when clinically indicated.
December 30, 2007 at 1:50 pm
Spook RN…I miss Charity Doc too…he was great! I “think” he was working on setting up a clinic for the underprivileged.
I think this was a very funny post Charity Doc did- “Tricks of the Trade”-May 4, 2007 LOL!
I gave it to my urologist. I also gave my urologist your Chinese Pager Torture…also Hilarious! 
I don’t know how to get a link to work in the comments but if you follow spook RN’s link you will see Charity Doc’s “Tricks of the Trade” on his sidebar.
December 30, 2007 at 1:59 pm
I completely agree. I misunderstood what you were having an issue with. I apologize. Unfortunately, there are some really awful people in this world. I am working very hard to educate myself and my children so we don’t have to be in our situation any longer. Ignorance is not an excuse to abuse the system. Or to use abortion as a b/c method.
Not to indulge too much, but my doc wouldn’t let me have a tubal because I was 23 and had lost a child. He felt that I would change my mind about having more children. This was when I was covered by Blue Cross, before my husband was laid off. I used b/c and still got pregnant with my daughter! (I think I missed a day or something.) After her, I insisted on a female doctor and then told her that I did not want more children! This was when I was covered by Medicaid. Doctors need to listen to their patients.
My mother is a nurse and has been my entire life. We were not in the system or on welfare. I had my children young. That’s not why I’m on Medicaid. I think it is wrong to judge those who are on it. There is a vast movement in my state to boot the people off it that don’t need it. You have two years to get off it. They even have programs to send you to college to get you off assistance. Nobody knows of these programs because they are not advertised. I’m sure people would abuse them and do abuse them.
As for me, we have Medicaid because my husband and I are in school. My husband had a great job before 9/11. He made enough money for me to be a SAHM and we lived comfortably. Then he got laid off. He decided that he wanted to be a professional. He wanted to go back to school and make something of himself. For the past 4 years he has worked his ass off to pull us up. Our kids are young and we both felt they need me more then me working. Plus, it would cost more to pay for daycare for three kids then I would make. (Another kink in the system)I could go on and on about how the system is broken.
I have been attending college forever. We did not want to be in this situation. The both of us are working hard so that our children do not have to live the life we live. It is unfair to make a blanket assumption about people on welfare or Medicaid. I think there are more people working to get off it, then to stay on it.
Just to let you know, I avoid doctor’s like the plague for this reason. I don’t want some white coat treating me like I’m a nut job because I don’t feel well, due to those who abuse the system. I had food poisoning and had to be carried into the Urgent Care because I refused to be judged. I refuse antibiotics, medication, or exams. I can’t wait for the day when I have private insurance and I can go to the doctor when I need to.
To the person who was talking about the mammogram, aren’t there places that will provide free mammograms to low income women? I heard about this a few years ago. Maybe if the communities where these people live would provide this information they wouldn’t feel the need to run to the doctor for unnecessary things. I think a lot of people don’t know what is available to them, like centers that do free pregnancy tests. When I was pregnant with my son I had a free pregnancy test done at a Christian Youth center in a well to do neighborhood. (Because the rich girls were getting themselves knocked up too!) Maybe the doctors and nurses should have this information readily available for patients that come in for a head injury and want a pregnancy test.
There are so many views on this topic. I don’t yell at my doctors or the nurses. I respect them. I know the bigotry as well. I have experienced it first hand. I know that there are a lot of doctor’s who look down on low income people. It is discouraging on both fronts. I feel for you. Really I do.
December 31, 2007 at 8:46 am
Seaspray, how did you know I took all 10 pregnancy tests, lol. I couldn’t believe it worked on the first try with all of the gyn issues I have had.
Maybe an idea is for the hospital to buy in bulk. They can just hand them out like condoms when someone requests one. Saves time and money?
December 31, 2007 at 2:28 pm
Ha ha! Pemommy…I just assumed. I had difficulty conceiving and after infertility tests, found out I had endometriosis which had cleared up by the time my c-section was done.
I used to use the basal thermometer to try to determine ovulation along with other physical symptoms. And I prayed a lot! and cried and prayed. Anyway, If I had them at my disposal those little tests probably would’ve overflowed into the rest of the house.
And if I was afraid of being pregnant…would have done the same thing because I wouldn’t trust the negative results and wouldn’t “want” to trust the positive results!
I had some recent scares over the last couple of years and I do admit to 4 tests at one time but then I called gyno doc to have blood work instead and THEN I felt safe.
I think the idea of buying them bulk and then making a small profit on them is a good idea.
OR…even better…you know how the EDs give out stuffed animals (we did) or stickers to little kids after they’ve been sutured or whatever? Well have a basket of these tests with educational literature and maybe a condom-a kind of gift packet.
Of course…legal considerations I suppose and then the free factor…word would get out and then there probably wouldn’t be enough charitable donors to keep up with the demand.
January 2, 2008 at 10:06 am
Thanks a LOT. Sheesh. I should have KNOWN better than to come read you first thing in the morning. Now I’m so pissed off I want to go stomp on tulips or something. I think I’ll go down to the dollar store, buy a hundred pregnancy tests, sit in the parking lot of our local country hospital, and just randomly throw them at women lugging around five or six children under 10 years of age. Maybe that will make me feel better.
Just don’t hit any of the kids in the head with errant throws, will ya? I don’t want to see two patients instead of one. -WC
January 3, 2008 at 6:08 pm
And who here wants free health coverage for all?
Puuulease…. if anyone wants to fix this mess we need to bull dose 85% of all Law schools and start locking up all the ambulance chasers. Next, don’t allow welfare for anyone who doesn’t have a job or doesn’t go to school. Then there is no other option but to walk their lazy ass down to the $1 store. Give them more incentives or make the right choice? Here’s one… don’t get these idiots a choice at all. Make the right choice for them since obviously they cannot.
January 4, 2008 at 2:57 pm
I hope she went across town…some insurance companies will not pay for a second visit on the same thing in the same day. I hope this is the case here and that she will be charged ER prices for her $1 test.
January 6, 2008 at 10:39 am
Put the cheap pregnancy tests in the vending machines, tell them it will be quicker.
Now THIS is an idea whose time has come! Can you see the agony, though? “Cheetos or pregnancy test? Cheetos or pregnancy test?” Hmmmm.
January 10, 2008 at 1:54 am
I’m an EM resident and my husband and I are planning to get pregnant in the not-so-distant future. I was at the dollar store over the holidays and came across these legendary one dollar pregnancy tests I’d heard about through the frustrated health care worker grapevine. I, too, have had the ambulance for pregnancy test/ambulance for ultrasound patient multiple times. I loaded up on the dollar store pregnancy tests and that’s what I’m going to use. Then, when it happens again, I can say, “You know what I did? I went to the dollar store and I spent five bucks to get five tests. Then, when I had a positive one, I scheduled a prenatal care visit. And I went to it.” Maybe (this is a stretch, but I’m hopeful) if people hear about doctors getting really wild and entering the realm of pregnancy without the christening of an ER visit, they might think it’s okay if they do too. Here’s hoping…
May 20, 2008 at 8:28 am
I just wrote a blog about these dollar store pregnancy tests because I didn’t get it. Now I do. Thanks!!
May 21, 2008 at 1:19 pm
Maybe she didn’t like the condescending suggestion of the “dollar” store, which was meant to be cutting and was. I have seen my share of snippy ER people. And I have insurance, as do most people who go to the ER. Your approval for her consideration of an abortion was not needed.
From your comments it is readily apparent that you have little knowledge about how the healthcare system works.
The insured patient population in the “ER” directly correlates with the location of the “ER.” The percentage of patients in our “ER” who have commercial insurance is 12% - hardly amounting to a “most people have insurance” designation.
To avoid appearing condescending and snippy, perhaps next time I’ll first suggest that a patient like this go to Sachs Fifth Avenue for a designer pregnancy test. Thanks for the suggestion.
When you (even with your insurance plan) can’t get timely emergency care because the system has been bankrupted by people with this woman’s mindset, come back and read your post so you can see how wrong you were.
May 21, 2008 at 5:38 pm
Maybe she didn’t like the condescending suggestion of the “dollar” store, which was meant to be cutting and was. –Star
Chill out. Neither you nor I know whether the suggestion was meant to be cutting, so don’t assert that it was. If it had come from my lips, it would have meant to be helpful. Because, you see, I LOVE the dollar store. I find a lot of bargains there. I find a few things that are more expensive there than elsewhere, but I find lots of stuff there that I think is a bargain. An EPT for $1 would fall into that category. So I appreciate a tip like that. Besides, in what possible way could it be “cutting” to suggest getting something at the dollar store. Are you too elitist to shop there, or what?
Your approval for her consideration of an abortion was not needed.
OK, we get it, you’re in a bad mood. We all have days like that, honey.
But to get to the meat of the issue, Dr. Whitecoat merely expressed irritation that someone would use abortion as a means of birth control. People on both sides of this issue find that abhorrent. If you don’t, then you are in a very tiny minority.
June 4, 2008 at 5:29 am
[...] and shell out a copay if you can be seen immediately for free? Why would you waste even one dollar on a pregnancy test if you can get one for [...]