Thursday, September 13, 2012


To call someone a liar is a strong term. And as much as I can, I believe in showing people some respect as I feel we all deserve that much. But admittedly, I'm not keen on seeing a particular patient tomorrow (assuming he shows up).
I had been involved with L for the last 3 years. A young man with poorly controlled diabetes, someone I 'inherited' from the pediatric endocrinologist when he became 18 years of age. And over the last few years, he frequently no-showed visits, and when he did show up, he always inevitably forgot to bring his glucose logs or meter. His hemoglobin A1c has never been less than 12%. And literally every 6 weeks, he would present with florid DKA, only to be treated in the ICU and then spends a few days on the floor. The few times I saw him in the hospital, he had his Xbox hooked up and had a bunch of friends in his room playing games and eating chips. If I hadn't known better I'd have thought that he actually enjoys being in the hospital.
Despite the office no-shows and the high glucoses, he'd always deny missing his medications. And he'd always offer some excuse or another for missing an appointment in our office.
Things came to a head last month when he cancelled yet another appointment. "Couldn't get a ride to the office", apparently. And then an hour later, his mother calls, and angrily demands to speak to the clinic director.
She accuses us of not taking good care of her son. That it was unfair that Dr. Vagus "was so behind in his schedules that he turned my son away". And that's when she was informed that her son did not show up for the appointment; instead, 12 mins after the supposed appointment time had called offering that excuse. Except that his mother herself had dropped him off at our clinic. A lightbulb went on in her head: her son had called from the lobby to cancel the appointment, and went God-knows-where instead. And blatantly lied to his mother.
Indeed, suspecting something amiss, I had called his pharmacy to audit his insulin usage and he had been missing over 75% of his doses. I shared that information with his mother as well.
And so, when he next finally shows up, this time with family sternly accompanying him, I laid things out frankly. Perhaps he's used to being treated as a child, but I told him that as an adult, he can do pretty much whatever he wants to to himself. He could skip his insulins, smoke weed all day, kill himself or whatever's left of his body. But at the very least, to act like an adult and be honest about it; I told him he blatantly lied, and had accused us instead for his shortcomings. I firmly told him that he violated the trust I had in him. And I gave him an ultimatum; if he misses another visit with me, I shall have no choice but to dismiss him from my practice.
We'll see if he shows up tomorrow.


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