The Difficult Patient

I recently took care of a "difficult patient." He was a medical records researcher who had a lot of physicians in his family. He presented with a recurrent deep vein thrombosis and he knew a whole lot about DVTs and anticoagulation. He would argue with us; "last time I was here, I got a higher dose of heparin." When we came to see him, he liked to regale us on pharmacokinetics, interrogate us on the orders we were putting in for him, and challenge our decisions. It wasn't bad; it's kind of nice having an over-educated patient, but at the end, he began overstepping the boundaries. One morning, when the phlebotomist came by to draw blood, he ordered himself a "CBC" and "Chem-10" (standard labs for blood counts and chemistries). Our resident was paged to see if she wanted to co-sign the patient's order. Then later that day, he somehow directly paged our attending to ask about medications. This was totally inappropriate; I've never even paged my attending. I have to admit, he's pretty resourceful and he's working the system. But I hope if I get hospitalized, I never end up like that.