You all know the story of the boy who cried wolf...  In case you live under a rock, or in another country where this story isn't a childhood staple, I'll give you a brief recap. 

Boy sits on a hill, bored, watching his sheep. 
Boy decides to spice up his day and cries, "WOOOOOLF!!!"  People come running.
Boy says, "Heeeeeyyyyyyyy.... wanna hang out?"  People give him dumbfounded look, and walk away.
Boy continues to sit on hill, bored, again.  It's the equivalent of day 6 of an 11 year old's summer vacation.
Boy decides to try again to have a little hill party, and cries, "WOOOOOOOOLF WOLF WOLF WOLF!"
People come running again.  Boy says, "Well, hey, now that you're here, wanna hang out?"
People give boy angry perturbed dumbfounded look, and walk away.  And stop inviting is parents to parties.
Boy sits on hill some more, and gets a little MORE bored.  He contemplates calling for "friends" again.
Boy notices moving object in a distance.  He realizes it's a WOLF!!!!
"WOOOOOLF WOLF WOLF WOLF WOOOOOLF"
People look up hill, laugh, and go back to playing cards. 
Boy gets eaten.

So, maybe the ending wasn't just like that, but it's close enough. 

Ok, so now you ALL know the story.  Moral of the story:  Don't cry wolf if there really isn't one, because people won't pay attention when you're about to get eaten.  So, how does this relate to medicine, you may ask?  And how does it relate to the ED?  Well, I'll tell you.

There's not a lot of continuity of care in the ED.  That's kinda by design.  But there are some patients who are seen quite frequently, and some of them are what I would call the boy on the hill.  They come in with the same complaint multiple times, and each time the workup reveals nothing, they get sent home, and shockingly, don't spontaneously combust.  Then a week later, they return with the same complaint, the workup is negative, and they get sent home again, and shockingly don't spontaneously combust.  And they come back again, and again.  Why?  I'm sure it varies.  Drug seeking, secondary gain, real symptoms, who knows.  But they keep coming.  And in reality, people stop taking them seriously.  They still get the workup, because there's always the chance that they WILL spontaneously combust (or get eaten by the wolf), but they lose credibility.  We wait for the wolf to come, even thought it probably never will.

I had one of those today.  He was a 26 year old guy who had been seen in multiple hospitals multiple times for abdominal pain.  In fact he was seen YESTERDAY in the gastroenterology clinic, and they wrote a nice note about the visit.  It said he'd been seen many places many times, had had multiple x-rays, CT scans, scopes, and blood tests all of which revealed nothing.  He'd been given pain meds on many occasions, and was once caught in the ED trading pills with another patient.  Today he left AMA (against medical advice) from the ED after a minimal workup again revealed no problems.  We did it.  We checked him out.  And it again was negative.  Maybe he went home and spontaneously combusted, I don't know. 

All I know is I hope the kid never gets appendicitis. 

The moral of the story:  Don't cry wolf unless there really is one... or something bigger, like a charging moose, out of control Hummer, or a falling star.

Cheers,
Kari

PS.  I'm in the process of reformating this bad boy, and plan on adding a "fun fact of the day" section.  Be excited.