A few shifts ago I was fairly burnt at 6:00 am when an ambulance delivered a 30 year old with chest pain. On arrival he refused EKG, chest x-ray and blood work, and said he was already better. He drank a six pack the night before and woke up at 4:00 am “feeling weird” so decided to come on in. This was his fourth similar visit. He walked to the 7:00 am bus to head on home. I suspect the beer followed by the bus fare home were his greatest expenses. Anyone who works in ERs can tell similar tales.

I, however, don’t blame the patient. He’s an alcoholic with a phone. Dangerous combo. We in medicine and those who haven’t refined EMTALA since the 80s are the clowns.

Pre-R on the other hand has been just the opposite experience. Patients call with questions that I often answer without even taking names. Sometimes they say thanks with fruit, a card or donation. If they need a prescription or house call we do more formal intros, but only if they’re sober and friendly. If not (rarely), then “I’m sorry, but you’re seeking apples, and we sell oranges.” If we miss the call but they leave reasonable messages, then we call back ASAP. If they don’t, then we don’t. It’s positive reinforcement.

If that same patient with alcohol related chest pain calls Pre-R, I’ll still have a chat with him. “What’s going on today?” “Well if you choose to go to the ER, they’ll offer you an EKG and some other studies, but it sounds like you may have an alcohol problem as well. Would you like the number of my friend Dr. Ken Starr… or a nice rehab in New Mexico?” Click.

Thank heaven EMTALA hasn’t yet found Pre-R.