Patient presents to ED 46 y/o white male with L arm pain that began 3 days ago when his arm got stuck in a tobacco press.
Checking nearby hospitals the patient has been to several other EDs stating the exact same, literally the exact same story occurring at different intervals sometimes receiving pain medications and a negative work up. He had been to 4 EDs in 5 weeks and had been here before and flagged for drug seeking behavior.
I enter the room and discuss the patient's history and perform a physical exam trying to find signs of an injury but there are none.
Me: "Sir I don't think that you have an emergent injury at this time and it will go away with ibuprofen or other non steroidal pain medication"
Him: "Oh doc thank you but the pain is killing me! Are you sure you can't give me something. Are you sure there is nothing wrong?"
Him: "Doc are you sure there's nothing you can give me for the pain?"
Me: "Well you've had so many injuries that you I'm more concerned about your ability to operate a tobacco press".
Him: "What do you mean?"
Me: "Well it looks like your arm has been stuck in a tobacco press 5 times in the last 4 weeks according to our records at other emergency departments"
Him: "Well I...um"
Me: "Great welp see you later"
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