“Did you assess rebound tenderness?”
“I don’t recall specifically.”
“Did you assess for guarding?”
“I don’t recall.”
“Rigidity?”
“I don’t recall the exact components of the exam.”
“Did you document them?”
“No.”
“Why not?”
“I documented what I considered clinically relevant.”
She let the silence hang for a moment. “You documented that the patient appeared to be exhibiting drug-seeking behavior. What specific behaviors led you to that conclusion?”
“He requested pain medication.”
“According to the nursing notes, he requested relief for severe pain after approximately three hours in the emergency department. He did not request narcotics specifically. Is asking for pain relief after hours of acute abdominal pain, in itself, evidence of drug-seeking behavior?”
“In my experience, genuine medical emergencies present differently.”
“Differently how?”
He hesitated, and everyone in the room felt it. “The patient’s demeanor. His appearance. His communication style. It suggested someone focused on obtaining drugs rather than treatment.”
“Could you be more specific about his appearance?”
Another pause. Too long. Fatal. “He had tattoos,” Vance said finally. “Piercings. An unconventional appearance.”