A patient had moved to Oregon and was very excited about her new HMO insurance.  She loved the fact it had no deductible and her co-pay was just $10.00/doctor’s visit.  Being a successful Interior Decorator Sally was on her feet all day long, seven days a week.  When Sally came back to California she decided to look me up as the pains in her right leg were now constant, intense, and prevented her from working.  The story Sally related to me was she had fallen and cut her leg one year ago.  After the leg had healed she started to  have sharp stabbing pains.  She went to her Primary Care Doctor several times complaining about the pains and how they were getting worse.  But he just kept prescribing her pills and reassuring her every thing would be all right.  Sally was not all right, she was scared, in pain, and unable to work. Needless to say, her financial situation was not good at all.  She was disparate.  The last time she saw her HMO Doctor he gave her a saab to put on her leg.  Basically, she was being told we can’t find anything wrong with your leg.  Therefore, you are having psychological pains and the saab is just to make you think we are still trying to help you. 
       Sally walked into my office scared and uncertain but happy to see I was still practicing.  She said, “I am not sure if you can help me with this leg and its sharp stabbing pains.  But, I remember how much you helped me in the past with my back pains so I am hoping you can help me now with this horrible leg pain I have suffered with for a year now.”  I told her I would be more than happy to look at her leg and see what I could do.  After taking a thorough history, reading her x-rays, that she brought with her, and doing an examination of the leg itself I came up with a diagnosis.  She had an infection of the leg bone itself.  Since, this was not in my scope of practice I instructed her to go back to her HMO Primary Care Doctor and tell him she needed a referral to see a vascular surgeon who would resolve her problem and she would be able to work without any further problems with the leg.  We hugged each other and she then left with a grateful smile on her face.