Liar of the Year
Late night telephone call to the ER:Caller: "Who is the doctor working tonight?"
Secretary: "We don't give out the physicians' schedules, sir. If you'd like to come in we'd be happy to evaluate you."
Caller: "OK, thanks."
Five minutes later:
Same caller: "Is Dr. Wonka working tonight? I saw her last week, and she told me to come back if I was having any more problems."
Secretary: "We don't give out the physicians' schedules, sir. If you'd like to come in we'd be happy to evaluate you."
Caller: "OK, thanks."
Five minutes later:
Same caller: "My 70 year old mother is having back pain. If I bring her in, will y'all be able to see her pretty quick?"
Secretary: "We don't give out waiting times, sir. But if you'd like to bring her in, we'd be happy to evaluate her."
Caller: "OK, Thanks."
Fifteen minutes later, the guy checks in complaining of back pain. I had seen his 70 year old mother one month before for her back pain, but this time her son was the one checking in, contradicting his phone call. I recognized them both, because he had accompanied her on the previous visit. I was suspicious at the time because she requested an unusually high dose of narcotics, and he did most of the talking. Plus my spidey sense was tingling. I documented my suspicions in the chart on their first visit, making this visit a no-brainer.
Me: "I'm sorry, sir, but I'm not going to be able to help you. I suspect that you are diverting narcotics, and I'm going to document my concerns in the chart. I'll be happy to write you some non-narcotic medications for your back pain, but neither I nor any of the physicians at this facility will likely ever prescribe either one of you any more narcotics ever again. Goodbye."
Two months later, they had the nerve to return when I was on duty, for the same complaint. I made them wait two hours in the room before giving them the boot this time. He acted like he didn't recognize me, and he denied that our previous interaction ever took place, even after I showed him the notes. You would think that a guy would never forget an ER doc who basically called him a lying criminal to his face and kicked him out of the ER without treatment, but he denied it all the way out the door. His only concern was that I made them wait so long before refusing narcotics this time.
Maybe he really didn't remember me; they have probably perfected their scam in emergency departments all over the country, and I must not have been the first one to figure it out. To them a denial of narcotics is just a temporary setback, no more concerning than a slow day at the office. There are plenty of other ERs out there, and they realize that it's difficult for caring physicians to refuse a kindly old woman "the only medicine that helps her pain." But sometimes, we should.
To all of the "real" chronic pain patients who come into the ER seeking comfort, this is why we cast a wary eye at you.
Labels: ER, lying punks, pain, patients, rants
posted by scalpel at 1:00 AM
29 Comments:
It's really heartwarming to see how narcotics abuse can bring a family closer together. I once was in line to pick up a pharmacy prescription behind an elderly woman and her entire extended family. They were arguing with the pharmacist that she was out of her Duragesic patches and in terrible pain. The pharmacist explained to them that she had just gotten a refill of a month's supply in Florida three days before, and that they couldn't get more until the end of the month. It was clear that the whole family strongly empathized with this woman, and shared her pain (medicine).
My God, Scalpel, I don't know how you deal with this crap day in and day out without going postal.
MJ
OMG!!!
I think these two come into our ER too!
I can tell that I'm far better writing about docs than ever believing I could be one. This is a perfect case in point. I'd spend my shift wondering how to write those poor bastards out of my chapter.
We actually had one guy who we believed was "real"---and so he got what he wanted, a vicodin Rx. But then he blew it by asking me in all earnestness: "Is there a pharmacy around here which is real small, not a big grocery store chain, like...it's the only one of it's kind?"
Woops---he had just admitted that he was "known" on all the computer sytems of the bigger pharmacies.
The next time he came, he got Toradol and Skelaxin---and left exclaiming: "I waited all that time for THIS CRAP?" (We never saw him again, heh.)
I did not know pharmacies track prescriptions across the states, but it sure sounds like a good idea! Wouldn't that make it possible also for someone on vacation to get a prescription refilled?h
I don't understand how people can come to the ER once and then return a month later and think the same doctor will be waiting for them like their personal physician.
I got a call once in our observation unit, it's staffed by ER nurses but the doctors are hospitalists, asking for Dr J. He had apparently prescribed dude some Vicodin, but when he followed up with his primary he was told he didn't need the narcotic, so now he had to talk to our hospitalist for another scrip. What part of "he is not your doctor and he is not available twenty four hours to take your call" did he not get?
And this is why several patients lodge complaints with the joint commission-- over doctors who refuse to dish out narcotics and pretend like non narcotic pain meds actually work better--- patients aren't stupid. I know you have your drug seekers, but you also have people who are in legitamate pain that you are screwing out of good care, and it's the good patients who lodge the complaints.
"...it's the good patients who lodge the complaints."
Not so much. It's usually the pompous assholes or psychotic ne'er-do-wells who file complaints. Complaints that are obviously regarding narcotic issues are generally summarily disregarded by the way, often not even generating the obligatory "Dr. X. has been counselled about his bedside manner" form letter that is supposed to make the complainer feel like something is being done.
Drug seekers aren't even worth the trouble.
"Drug seekers aren't even worth the trouble."
So are people in chronic pain also not worth it?
Just wondering.
And so no one makes any assumptions, I don't have a chronic pain problem (thank Ghod) so I have never been assumed to be a criminal for having a medical condition.
In getting other medical conditions treated, I have noticed a strong correlation between a lack of empathy for another's pain by a doctor and poor outcomes.
JK
A complaint about an ER physician not prescribing opiates for a chronic (noncancerous) condition would not be worth the paper it was written on.
Such treatment is not an emergency, and is not something required of emergency physicians. That would be like someone complaining that we didn't give out lollipops or that the crackers we served were just plain old crackers and not Ritz crackers.
That sort of thing goes straight into the circular file. Fuck JCAHO.
Educating jk and anonymous would be a difficult and unrewarding task at best. Suffice it to say that chronic pain, by definition is not a sudden and unexpected event or condition posing an immediate threat to life or limb. It is, therefore, not something that should be treated in an ER. If you are interested, educate yourself. If not, STFU. No pain specialist, treating a chronic pain patient with narcotics, would continue prescribing narcotics to a patient that visits ER's or other doctors seeking narcotics.
My mother broke her hand yesterday.
She is quite literally allergic to most narcotics (rash ..tongue swells up, shortness of breath ...throat starts feeling like it's closing ... eyes start to swell ... not pretty ..first time it took time, second time, it happened fairly fast, we're not trying for a third ....)
The only ones she can take (still in the same class, but she's not reacted to ...thank GOD!!!
Ultram ... Morphine and Phen ..somtehting patch ...(she got those after her knee and hip replacement)
Thankfully, she actually thinks the Ultram is a miracle drug. Personally, I think chocolate works better. But, she thinks it's a wonderful drug, better than the vicodin that made her tongue swell up. (shut up daughter dear, as long as SHE thinks it works ... it works right?)
Morphine she actually didn't have any reaction to ...none ...zip ..zero ..zilch .. she didn't get groggy
she didn't get loopy
she didn't get fuzzy brained
she didn't get pain relief
she didnt' get anything
might as well have given her a placebo. So that one is out for procedure.
No way is she taking the pain patch for a broken hand, nor would any sane doctor Rx it for her.
So, my mom, who already has post polio and arthritis and diabetes ... gets to have a broken hand with Ultram and Tylenol ...
These drug seekers ...annoy me.
Try going through real pain without being ABLE to get pain relief because your body rejects it all.
Growl!
Personally ...having lupus, I know what chronic pain is ... I know what acute pain is from injuries and surgeries ... I'm incredibly grateful for doctor's who understand my situation ....
whoever mentioned the torodol ..thanks .. I've been trying to remember that for 2 weeks. ;) IT Does help my headaches ... but I don't always remember I can have it.
I had a nurse treat me like a drug seeker once. Let's put it this way. I had endo and adhesions. Didn't know that at the time. But every month during ovulation and a couple of days before my period started through the end of the period were excruciating. WORSE than labor. Started complaining after my daughter was born. She was born in June 05. By October, I was taking Lortab left over from a severe uterine infection and d&c. January I was out. (I think I had like 15 total left in October when I started). I was also taking massive amounts of Motrin. Saw my ob for an annual exam in Jan 06. He blew it off and said the best he could was motrin. Two days later I was in the ER with excruciating pelvic pain. They ran all of the tests and called my obgyn. He advised them to go ahead and discharge me and to give me a rx for Darvocet. He was really good when I came in and followed up the next day. Told me that no matter where I was (I travel alot) he could call in a rx for me as long as I gave him the pharmacy name, number, and address. Even if I was in another state. So I called every month for the 10 darvocet that I got. It basically took the edge off of it. I still ended up in bed each month unable to move. In May, he changed the BCP I was on. Upped the Darvocet to 15 a month. This was much better, but Darvocet only took the edge off and I had to take two at one time to get any sense of relief. August, I see him again. Tells me not sure what else he could do but change the pill. Changed it again. At the end of August, I had forgotten to refill the Darvocet rx. He had me call in for it. I was in excruciating pain, so I called. The nurse said he was out of town. Now he has two CNM that work in the offic that have rx privileges. She told me take two motrin and call back in the morning if it was REALLY that bad. I had already made an appt to again (after the last one) to talk with my dr because I knew I needed a lap. However, he would not be back in the office till September. The nurse had seen that I had an appt in the computer. That was when she went off on me. She told me to take two motrin and call back in the morning if it was REALLY that bad. She also told me that my dr had told me to followup in 4 months, not 3 weeks. She basically went off on me on the phone. She told me that even if I had called the office that no there would prescribe it anyway. I was extremely upset. I had already taken 3200 MG of motrin that day in order to kill the pain. It didn't help. I was doubled over in tears. I had to pick up my daughter from daycare. Daycare called my dh and told him I needed to go to the ER. I get home and he didn't even let me get in the house. Immediately put me in the passenger seat and took me to the ER. Fortunately, I had a very kind ER dr. I live in a small town that has a small community hospital. You know who works where. She took one look at me, curled up in a fetal position, tears streaming down my face, and said you are Dr. xxxx's patient. He is out of town and that is ok. She asked what he usually gave me. I told her. She said well I am going to give you something similar to Darvocet. They came in and gave me a couple of shots, one was Toradol which she said would help with endo pain. She was fairly certain after hearing my story it was endo. Then she gave me something else. I thought omg, this is nothing like Darvocet. I could barely even walk out of the Er, but I had pain relief. She also gave me a rx for 30 Darvocet. Before I left she told me I needed to get that lap done to help the problems I was having. I agreed. She also said to keep up on the Darvocet so it didn't get that bad. I saw my dr a week later. Everyone in the office could not have been nicer to me. My dr was extremely nice. We went over the ER visit. He wanted to send me for an US, because of the ER dr and I talking, I just told him why bother with that stuff. Just go in and do the lap. He said it was a reasonable enough request. He wanted to set it up within the next couple of weeks. I had to delay till October because of work. I sent the ER dr a card that day. I thanked her for talking with me and believing me. Because I had called my dr's office and the nurse treated me as if I was some low life drug seeker. That sad part about it was I had gone through a high risk pregnancy and emergency induction due to pih with my doc. She was fabulous for that. But this she was terrible and I lost a trust in her that I still havn't regained. But this ER dr, she believed me. She didn't out me through a ton of tests. She went straight for pain relief and I thanked her for it. I even sent her a card thanking her, thanking her for believing me when the nurse passed me off, and I let her know I was having the surgery. Oh and the second drug that I was given was Nubain. It was on the ER report that my dr had gotten faxed to him the day after my ER visit. He said that was some heavy stuff. Well he didn't see how bad it was. I ended up having adhesions that had made my left ovary, left tube, peritineum wall and bowel stuck together. Pain has been much better since the surgery. My obgyn told me that no I hadn't been crazy. I am on a regiment of continuous bcp and promtrium to keep it from growing now. I plan to ttc at the end of the year and I am terrified of coming off the continuous bcp. My obgyn says that we'll cross that bridge when we come to it. The ER dr that treated me. Well she treated my daughter a couple of weeks ago. She said you look familiar. I told her who I was. She said you know we never get cards like that. I still have yours. She is still grateful to this day for me thanking her. She asked how the pain was now and I told her good. She was glad to hear it.
Not everyone is a drug seeker. Shame on the nurse that treated me like one, especially when I had a documented problem in my chart and my obgyn had prescribed the med every single month for 9 months.Thank God I got a dr that totally believed me.
Joints,
Educating people like you who don't understand the concept of "pain bad" is, as you said, "a difficult and unrewarding task at best".
Unfortunately, it is also a necessary one as you have a legal monopoly on serious pain relief.
Is the emergency room the best place to treat chronic pain? No, but sometimes people don't have have any other options. They may not be able to get in to a regular doctor for days or weeks.
Should they just shut up and suffer? I'm genuinely interested in your answer unless it involves spouting off another profanity like you did in your last post or just calling me stupid.
Do people abuse the system to get their jollies from drugs? Yes. Do doctors with attitudes like yours allow people to suffer unnecessary pain? Yes on that one too.
I'm not saying "hand out pills like candy". (Something that would be ... unwise in our current political climate.) I'm saying have a little compassion. I'm saying understand that pain is one of the major things that motivate people to seek care.
I have to add that I have been on the receiving end of a lot of medical care over the years (about 16 surgeries and a chronic condition caused by one of the surgeries) and I've noticed one strong correlation. The more insensitive the doctor was to pain, the more likely it was that I would get a poor outcome.
JK
There seems to be some misunderstanding amongst some of you about the types of chronic pain patients we despise. Even the most hardened and cynical among us would not likely condemn a patient or refuse treatment for the occasional episode of breakthrough pain requiring an ER visit.
But when patients lie to us in order to try to obtain narcotics, when they come into the ER over and over again (often dozens of times per year) seeking narcotics without even attempting to find other avenues of care (because the ER is "free" right?), when they use our DEA numbers to call in narcotic prescriptions for themselves (which is a felony), then they do not deserve our compassion. They are contemptible, and they are the ones that cause the honest pain sufferers to occasionally get less than optimal treatment.
looks like jk 's got the rap nailed.
I would say to Joints, that unless you or a loved one has lived with severe pain, you really don't understand. There's more to your job than just averting "threats to life and limb". Do you really think that all y'all's intuitions, sluething and spidey-senses are preventing the addicts from getting drugs? Why does that futile quest take precedence over relieving legitimate suffering? Thank God my wife has finally found relief from a decade of suffering via a neurostimulator and we no longer have to deal with the sidelong glances, pointed questions, fabricated delays, and outright denials from those who are incredulous that someone could be on MS, fentanyl patch, hydrocodone, toradol, etc., all at the same time and still needing additional relief. Personally, I was interested in my wife's quality of life and I didn't give a rat's ass how many addicts got their juice if delaying them meant more suffering for her. I think y'all are engaged in one of the noblest professions so don't get me wrong, just explaining how it looks from the other side.
I've really been very lucky, in that my pain level has rarely been a serious problem. For the record, I have had five back operations and have a chronic C6 and L3 radiculopathy, and have passed 29 kidney stones of which I am aware. Most have been small, in the 2 mm. range. The one last week was more difficult. Care to guess how many ER visits I have had in my lifetime?
If you guessed two, you were right. Both were for serious infections, one involving both eyes, and nearly costing me my eyes. I firmly believe, for reasons stated earlier, there is no need to visit an ER for a chronic pain problem. For the record, if I prescribe narcotics to an addict, I may lose my DEA number, and will be unable to prescribe for legitimate patients.
Oh Jesus fucking Christ. It's you pompous ER docs that are contemptable.
I went through about three months of severe pain with a broken TMJ disc due to a raquetball accident that had the left side of my jaw swollen as large as a golfball (no shit). I was on the roster for surgery at the Medical University of SC but had to put up with about three weeks of this until I could get it taken care of. During that time there were occasional days/nights when the pain medicine I was taking would not control the pain enough for me to even think about getting to sleep.
I ended up going to the ER one evening and waiting about three hours to have some dipshit walk in and give me a 800mg motrin tablet to take -- now he was aware that I was taking Indocin and Vicodin already and these weren't enough. I told him that I really didn't think that was going to help me at all considering what I was already taking and that wasn't working. He then announced that "Anti-inflamatories are the treatment for this -- NOT NARCOTICS!" when I hadn't asked for anything but some help. Now.. please explain to me how you justify his logic there.
I asked if he would please contact my family doctor and consult with him as I knew that if I were able to go into his office he would be able and willing to help me. He indicated that he would and came back in about a half hour to inform me that my Doctor concurred with his opinion. So I left the ER in as much pain as I was in before spending all night trying to get some relief.
I went to see my doctor the next morning who decided that since I was 4 days out from surgery that the best thing was to hospitalize me due to intractable pain until the damage could be repaired.
Here's the kicker. He asked me if the ER doc helped me the prior night and I informed him that he indicated that he (my doc) concurred with his opinion. My doctor was pissed and informed that it was late but he knew what the hell he told him. He had told him that a) My complaint was valid, b) I was NOT a drug seeking patient, and c) To give me a shot of Dilaudid to kill the pain until he could see me in the morning.
He contacted the ER doctor and his supervisor that same day. I do not know what the outcome was.
Now.. how many of you are willing to disregard a patient, screw him out of the proper treatment, and lie like a dog because you made an ass out of yourselves?
Oh.. I was also charged for an ER visit that evening.
What a crock of shit.
Your case, if true, has no bearing on this discussion unless you had a history of frequent ER visits for toothache, migraine, low back pain, etc. Or unless you lied about some part of your history in order to try to obtain narcotics.
I'm unclear why your surgeon would abdicate management of your condition to a family doc or an ER doc, however. It sounds like that feature of your story along with the "three week waiting time" are the more controversial issues with your care.
And of course you were charged for an ER visit. I hope you paid it. The duty of an ER physician is to evaluate patients for life-threatening or emergency conditions. You didn't have one. Mission accomplished.
I see.
I do feel my argument is relevant to this discussion because a number of patients are deal with unjustly and are denied proper treatment because of this attitude among ER physicians.
"The duty of an ER physician is to evaluate patients for life- threatening or emergency
conditions."
I do not dispute the fact that the ER and its physicians have that as their predominate mission.
However, is it also your argument that in the absence of other available healthcare (i.e. no other facilities available after 5:00pm in the area) and when experiencing intractable pain that a patient is to "tough-it-out"?
It would seem to me that a patient presenting with a condition that is so straight-forward and with the verbal direction of his family physician should not be met with a) feeling like a felon for seeking aid for a legitament reason and b) be lied to by a physician to save his pride.
I found the general attitude of this doctor in particular and based on my reading of this thread, in general to be suspect.
It is very evident to your (read ER physician) patients that:
1. You feel that anything other than a trauma or similar life-threatening emergency is beneath you and your clearly make this know to the offending bum that has dared to waste your valuable time.
2. Anyone possibly requiring pain medication must first be assumed to be a drug addict with no regard for their present condition or treatment plan (the doctor in question had no idea why I was in as he did not even review the notes the RN had made).
It is not only the pateints that feel this way. I have found no one who's family doctor did not think the local ER was a complete waste of time for their patients and verbally complained about the level of care their patients received during their visits there.
Now, in fairness, I do not pretend to understand the pressure and demands that are placed on you and your colleagues. I am very happy that you are there in the event that I do have a life-threatening condition that requires attention, but with a severe lack of other healthcare facilities after hours I do believe it is necessary to also treat those patients that present without a life-threatening illness.
A little less attitude, a smile, and some relief from the pain that I had presented with would have been very appreciated.
It is very difficult for most of us to make the decision to go to the ER. The long wait times, the incredible expense over the normal cost of an office visit. Deciding to go, at least for me, means that I am in enough discomfort to seek aid in spite of the cost. It is very upsetting and disheartening to be treated like a criminal because the person seeing you has had a bad day.
I did indeed pay for my visit there, but refuse to return to that hospital regardless of how I'm feeling.
My $0.02.
However, is it also your argument that in the absence of other available healthcare (i.e. no other facilities available after 5:00pm in the area) and when experiencing intractable pain that a patient is to "tough-it-out"?
Hardly. But as I have mentioned, your story does not seem to make sense. Why was your family doctor even involved in a surgical case? If he was, he obviously wasn't managing your pain very well up until that point. If he was going to admit you anyway for 4 days for pain control (which never ever happens, btw) why didn't he just admit you that night and write orders? He can't order meds for you as an ER patient unless he comes in himself, but he can if you are his admitted patient.
But a prescription for stronger narcotics (which would have required a triplicate Rx that most docs don't even bother to add to their arsenal) would have been the more standard and appropriate route. Insurance isn't likely to pay for a four day admission for "pain control" for a TMJ problem.
What did the ER doc have to gain by lying? It seems just as likely that your own doctor was lying to you, and once faced with your confrontation he admitted you to save face.
Just MY .02.
I'm sorry, but your assumtions are all wrong.
Why was your family doctor even involved in a surgical case?
I originally saw my family MD for this problem and after referral to a dental surgeon it was decided between the two of them that he would manage the symptoms until such time as I was able to have the problem corrected. The surgeon was over 150 miles away in another city.
If he was, he obviously wasn't managing your pain very well up until that point.
I felt he was doing his best up to that point and I had only experience a few instances of breakthrough pain that required anything in addition to what I was already taking.
If he was going to admit you anyway for 4 days for pain control (which never ever happens, btw) why didn't he just admit you that night and write orders?
I'm unclear as to why he decided to proceed the way he did, but, suffice it to say, he did indeed admit me as described. I would suggest that indeed it does happen (it is this type of black and white thinking that I find so narrow minded).
He can't order meds for you as an ER patient unless he comes in himself, but he can if you are his admitted patient.
How true. And he indicated this in our discussion the next day.
But a prescription for stronger narcotics (which would have required a triplicate Rx that most docs don't even bother to add to their arsenal) would have been the more standard and appropriate route.
I would suggest that state laws are different in TX than SC. From my experience with my MD obscene amounts of paperwork are not necessary here. I have put my trust in my MD and thus far it has not been unfounded. What is standard and appropriate is highly subjective.
Insurance isn't likely to pay for a four day admission for "pain control" for a TMJ problem.
My insurance company found the hospitalization to be medically necessary and paid without argument or complaint. This was also not a typical TMJ issue, this was a fragmented disc that required surgical intervention to remove the offending particles.
What did the ER doc have to gain by lying? It seems just as likely that your own doctor was lying to you, and once faced with your confrontation he admitted you to save face.
The ER doc had made an assumption about my intentions that were unfounded. I would suggest that when confronted with the fact that indeed my complaint was valid, that I was being seen by a local MD for symptomatic management, that a course of treatment and surgery date had been set, and that he was requested by a fellow colleague to treat his patient accordingly he instead decided to stay his prideful course rather than lose face in front of a patient he had all but called a liar.
As far as your assumption about my family MD. Both my wife and I have used this doctor for over 8 years. In that time he has proven to be honest, compassionate, and committed to assisting us when we had need of him. In the past if there was a mistake made on his part he would tell us so and appologize. I don't see why he would turn into a deceitful bastard overnight -- that just doesn't make sense.
Now, whether or not you choose to believe the scenario that I experienced is really not the issue. The point I am trying to make is that there are a number of patients who present to the ER with legitament claims that may seem far fetched to some ER docs (this I can understand), however if they are proved to be true (as it was in my case by a phone call to my MD) why send a patient home with no effective treatment just to avoid having to appologize to them for being an ass?
I would think it reasonable to assume that you have never personally been a patient in your own ER so it may be hard for you to see the other side of the equation here (as I think is the case with most ER physicians).
As a patient I literally roll the dice when choosing to make a trip to the local ER. I may wait for hours on end, I may get a physician that believes what I am experiencing is real or I may get one that does not. Either way, I'm going to incur a large bill. It's really enough to make the majority of people say "to hell with it" and suffer needlessly.
If this is truly the state of the American ER then you'd get a better go of it in a criminal court. "We who labor here seek only the truth". Somehow I find that you should feel like a convict on the stand when you are in need of some medical assistance is rather pathetic.
I would truly like to see a healthcare system that the American public can depend on and the treatment received justifies the extreme cost. However, I often wonder if that is really possible with our present system of healthcare.
In short, why would you not believe a patient's complaint and take it as the truth unless they had given you some reason to treat them differently -- your personal views of what is "normal" or "standard" not withstanding?
This attitude is not only prevalent in the ER but also in other specialties of healthcare as well. To turn a blind eye to this behavior and act as though it doesn't occur is really not a viable solution.
For some physicians it seems to me that there is an enormous power-trip being experienced by being the one thing between a person and the help they need. This situation has already been dealt with by some government legislation, but it still occurs to a great and disheartening extent.
From my own experience and reading the posts of others, it seems that a great deal of social profiling and predisposition occurs in the healthcare field that should not.
It is not my position to win an argument with you, but to inquire as to what can and is being done to ensure that the people who need assistance can reasonable be assured of obtaining it without feeling like a criminal for choosing to do so?
I'll give anyone the benefit of the doubt once, which is why your scenario is not the type of case that most ER docs would give you a hard time about, and why it doesn't apply to this particular post (or most of my posts about pain management for that matter).
Only when there is obvious evidence of lying, repeated visits, or purely subjective pain do most of us balk at giving narcs.
I would agree that it sounds like the care you received was suboptimal, but I would suggest that the care both by your own physicians and the ER physician could have been better.
I have actually been a patient in my own ER for a painful condition, and it did change my approach (I'm not opposed to giving toothache patients a shot on their first visit for such a complaint now). You might find the story interesting.
Yeah, an ER visit is expensive, and the waiting time is annoying, but where else are you going to go? We're the only place open, and there aren't an overabundance of docs lining up to work all night like I do. So the problem isn't going to get much better.
Do you think the "seekers" make it bad for the people with actual chronic pain? I have chronic pain caused by a bile duct that keeps narrowing and pancreatic duct pressure that fluctuates...I will NOT go to the ER unless I feel like I am DYING! I have been through countless GI procedures/scopes/surgeries and in and out of the hospital with pancreatitis, which by the way is excruciating...but, any time I have ever had to go to the ER, even when in horrible pain, I have always felt like I was being bothersome or being a "baby." It's nothing that the ER staff did to make me feel this way, but I guess I just felt that because my pain was not obvious on the outside like a wound or broken limb, then people might not believe it. Of course, my trips to the ER were not an everyday occurrence and I NEVER demanded or requested any specific medication, and I ALWAYS followed up with my GI specialist so I've never been accused of being a "seeker"...but I guess that by knowing these drug-seekers are out there and they are causing problems for ERs, it makes the people with REAL pain feel a little self-conscious when we go to the hospital. And for me, it has caused me to suffer through many episodes of terrible pain because I didn't want to go to the ER and risk looking like one of "them."
I am way late joining this very heated conversation. I have read all the post and to be honest I am stunned. I never imagined that a doctor would admit to judging ANY patient so harshly and with such venom. I have a history that falls into your category of "drug seeker". In the past I made 20 plus visits to the E.R. within a 4 month period. The story is very , very long and although I have typed it out, I have decided not to include it in this post. I was judged by a doctor once and it had a profound impact on my life. That sums it up pretty well. I caution all doctors to take care with their judgments, don't be so quick to lump pain relieve seekers in a group. Pain is the bodies way of letting us know that something is wrong, and I'm sure even you have had a patient present with pain as their main symptom and with some investigation it was reveled that something much more complicated, maybe even life threatening was the cause of the pain. Imagine if someone visited the ER with a fractured wrist,rarely a life threatening injury, but many of these injuries are first seen in the ER. Would you say they were exhibiting Xray seeking behavior and refuse to give them an xray? After all, it could wait until the doctors office opens. They would, more than likely get a referral to an orthopedic doctor and get proper treatment there. Proof, is that it? An Xray can give you the proof that someone's word alone cant give. If that's the case veterinary medicine would seem a better fit for you than ER doctor. You have to believe every person that says they are in pain and treat them to avoid letting one legitimate pain patient leave your ER in real pain. So what if you give a drug addict a buzz. You say your license is at risk if you do this? That's a weak excuse. You believed the patient. And if there are no obvious signs that what they are saying is not the truth, you must treat them with care, compassion, and treat their pain as if it is exactly as they say it is. The drug addicts will become obvious over time. And as far as they are concerned, what makes them any less deserving of your care and compassion. They need treatment too,just a different kind. They need drug rehab. or at the very least an evaluation. Why do you have to show such disdain for them? Is their illness any less of a illness because it seems to be a choice they are making? May I suggest more medical school for you if you believe that. The ER doctors that treated me over that 4 month period took the time to listen to my story and they did everything they could to help me. I never felt as if they resented me coming there for help. I was in a situation with my Primary Care Doctor that left me with no other choice. These doctors even counseled me on how to get around this doctor that was incompetent. I am not angry as I type this, (sometimes it's hard to judge a person's demeanor when you can't get clues from their face or voice), I am sad mostly. My wish is that no one have to endure the ordeal that I have and am still living through today. And the only way I know to help insure this wish is realized is to speak up when I have the chance to caution a doctor to not be so quick to judge people that come to you in pain. Help them..because no matter the cause, anyone that comes to you in pain needs your help. Not your jokes, judgments, lectures, and especially not your intentional extra long waits in the ER. Show them, that regardless of what they are going through, you are a doctor and you can get them help. You are surly going to reply about the ones that lie straight out. I still believe they need your help. Yes, the guy having the heart attack needs your prompt attention and this lying bastard is wasting your time, but very quickly and with compassion, refer them to someone that can help them. I have a lot of experience being on the other side of your jokes and I believe that doctors are only showing what little their education really got them when they behave this way. And I am reminded what it is that they call the person that graduates last in their medical school class....Doctor.
Of all the patients who have commented on this site - none of you have proposed a solution to this epidemic. The most widely abused drug are prescription narcotics - do not be offended when the writer of this blog post is attempting to vent his frustration and illustrate an issue that occurs on a daily basis in our ER. I am a pain management physician - I should know. I attempt to give every patient a chance to tell their story and examine them as best I can. Seeing me does not guarantee a narcotic prescription. Nonetheless, I do not balk at providing them when appropriate - that is exactly what the ER doctor is trying to prove here. I agree that not all physicians act in this manner and could learn a thing or two about balancing screening "drug seekers" and providing respectable, empathetic care to those with real organic pain. It is a constant struggle for patients and providers alike - try not to get mired down in bickering. Let's find a solution that helps protects those in need and those who provide care while decreasing the ever growing population of seekers.
My wife has had SEVEN failed back surgeries in the last TEN years. Her current doctor implanted a neural stimulator in her back in July of last year. Now, tomorrow, even, he wants to remove it because he says her body is "rejecting" it. She has no outward signs of this supposed "rejection", but he DID bill us over 10k for the first surgery to put it in. And between the doctor and pharmacy, trying to get her pain meds filled is A NIGHTMARE. Dang doctors don't care about the patients and some of you on here seem to take utter joy in DENYING patients medicine that could make that patients live a LOT easier to bear...SHAME ON ALL YOU DOCTORS!@
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