scope 2009-FINAL.qxd_scope06Final.qxd - SIU School of Medicine

you to be fully evaluated. It goes against medical advice to let you go, knowing you’re
bound to have a massive heart attack soon based on today’s symptoms. I really think
you’re doing the wrong thing by not going to the emergency room now.”
“I don’t want to stay and you can’t make me,” Boone said emphatically.
“No, that’s true, I can’t,” Santini replied. A look of resignation came over his bright
face like a shadow. He turned to me. “Do you have any paperwork on Mr. Boone?
“No.”
“Why not?” Santini replied.
“It turns out he never got registered. He looked so ill and in so much pain, I just
assumed he was a walk-in. Otherwise, I would have sent him straight to the ER.” I felt
rather embarrassed.
“Well, let’s stamp up some papers on him, write down his information and what was
done here.” Addressing the patient, Santini said officiously, “I’m going to ask you to sign
your name to acknowledge that we advised you to stay and to have a full cardiac work-up.
You can take a copy of this with you. Is that agreeable?”
Boone nodded.
“Then, I’ll have the nurse practitioner take your vital signs again and write you out
a prescription for nitroglycerin tablets. Put one under your tongue when you get that chest
pain, and if the pain doesn’t subside in ten minutes, take another one. If the pain is still
bad, call 911. The nurse practitioner will write those instructions on your discharge copy.
Do you have any questions?”
“Nope.”
Dr. Santini left.
As I handed the patient the prescription and papers, I asked him seriously to reconsider.
Torn over how much more I should presume to say, I decided to take the plunge.
“Mr. Boone, look, you obviously have regrets about your drinking and the way you
treat your wife. Have you thought about other options? You could get counseling, join
alcoholics anonymous, or go through an alcohol rehabilitation program. It doesn’t have
to be this way.”
He looked up at me blankly.
Mr. Boone seemed like he was considering what I had just said. Then he smiled
slowly and said, “I’ll think it over. Give me your business card.”
I escorted Mr. Boone to the main hallway of the medical building and told him
where to find the nephrology clinic. I advised him to use the elevators and avoid stairwells
at all cost. I reassured myself that he had heeded my words by taking his prescription.
When I returned, Santini was back in my office. In a serious tone, he said, “Now, if
you think that patient is going to count as a number on the clinic revenue ledger, you’re
sadly mistaken. Remember, register the patient first, and then see the patient.”
“But —.”
Santini burst out laughing and held up his hand defensively. “I’m joking, I’m joking.
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