You know those people who make you sigh when you see their name on your schedule?
I have one (or two) of them.
I saw a lady last week with a pain -- no, it was not a pain; it was a DISCOMFORT -- in her left side; sort of in the middle, but lower down, and around to her back. She had a fullness in her lower abdomen and a sense of having to urinate (but not really urgently; or frequently; no burning with urination.)
Me: How long has this been going on?
She: I've always had this.
I finally managed to ascertain that it had been a few weeks. No nausea, vomiting, anorexia, or change in bowel habits. Her past history was significant for IBS, a TAH-BSO, no kidney stones or family history of them. Her exam was completely negative; so was her urinalysis and blood work. GYN evaluation was completely normal; a urine culture was negative. I'd ordered an ultrasound of her abdomen months ago when she came with right upper quadrant pain and nausea -- sort of -- that she still hadn't gotten around to having done. Then she called and said what she wanted was a CT scan of the lower half of her body.
This is not a clinical puzzle. This is something between somatization and hypochondriasis. That, and she calls. Often. Every day. Several times. And talks. A lot. Every time.
Somewhere in there we also had to pre-authorize Avapro for her hypertension, because according to the chart, lisinopril had made her cough. (Actually, the cough had gone away while she was still on it, because even though I gave her the Avapro and told her to stop the lisinopril when she told me about the cough, she had wanted to "finish up what she had." In fact, she'd been fine on Avapro before, but had asked for "something cheaper." Then her insurance had changed. In any event, it was easier to fill out the form for the pre-auth and fax it off.)
Today we got notice from the insurance company: they approved the Avapro. Even though they approve it all the time, this notice included a message I'd never seen before (caps theirs):
"A DECISION HAS BEEN MADE TO AUTHORIZE THIS DRUG BY ADMINISTRATIVE EXCEPTION. THIS ACTION WAS TAKEN DUE TO INTERNAL ADMINISTRATIVE/PROCEDURAL ISSUES AND IS NOT A DETERMINATION BASED ON THE SUBSTANTIVE ISSUES PRESENTED IN THIS REQUEST."
I showed it to my staff and chuckled. I joked that they probably got sick of listening to her and just said, "What the hell; just let her have it! Anything to get rid of her."
Then I called the patient to let her know about her normal CA125. I also told her the insurance company had approved her Avapro. I swear this is what she said, and I'm proud to report that I managed not to crack up until I got off the phone:
"I know. I was on the phone with them for an hour and a half yesterday."