"My Feet Are Bleeding From The Inside"

A middle aged black women came into the ER at about 4 am on a Wednesday night. Her chief complaint was "my feet are bleeding from the inside." I looked through her medical history, and she had been to the ER four times in the last week for the same thing.... so the "ok this lady is crazy" thought was going through my head.

When I went to go see her, she was a very pleasant but concerned smelly patient. She stated that her feet were bleeding from the inside. She knew this because they were getting darker and darker. She admitted to being seen multiple times for this....but no one had figured it out. Her symptom was accompanied with foot pain if standing too long at work.

I examined her feet. They were indeed very dark. So were her sandals though. So...being the astute young physician I am....I went to get some magic solution to get the "blood off." I grabbed some alcohol pads, and showed the patient that when I cleaned her feet with alcohol, her feet were no longer dark. She didn't quite understand this, so I had to tell her kinda bluntly that her feet were just dirty...not bleeding. After much teaching, I thought she understood. When my attending saw her next...it was apparent that I didn't do much good.

I couldn't find a billing code for dirty feet. I think we should make one though b/c we see a lot of this. I also wish we could bill for being dumb.

-ER Doc