Pt demanded a stronger pain med - page 3

:angryfire I'm a little steamed. The other night I had a pt present with an "ankle sprain." Yep, that's it. When I went to discharge this "fine, upstanding, well-groomed" individual :no:, his... Read More

  1. by   Jennifer, RN
    Last night, we had a pt demand a stronger pain med, the doctor would only give her tramadol, the pt then left after discharge, went out to her car and called EMS from the parking lot to take her to another hospital in the area. At least they didn't bring her back to us.
  2. by   lyraesullivan
    The thing about Press-Ganey is they only call a very small percentage of the patients so the odds are not really good if one or two of them were drug seekers that didn't get what they were looking for.

    It is sad that hospital administration place a lot of emphasis on this kind of nonsense. Instead of looking at the patient making the complaint and seeing that they visit the ER 14 times a month for back pain and have never yet made any attempt at paying their bill, they immediately censure the ER nurse. How about telling the pond scum that they are in the wrong and please do not ever darken our doorway again?

    I like the nurse that answered that she would get a motrin RX and then tear up the T3 RX. You are my kind of nurse!
  3. by   Freedom42
    Student here. This is a very interesting thread. Would someone mind telling me what Press-Ganey (sp?) is? Thanks.
  4. by   CritterLover
    Quote from freedom42
    student here. this is a very interesting thread. would someone mind telling me what press-ganey (sp?) is? thanks.


    press-gainey is a company that hospitals pay to conduct customer-serivce surveys.

    they ask about things such as er wait time, how courteous the employees are, how well they were kept informed of their status/tests, etc, and overall how satisfied they were with their stay.

    the problem is that while good customer service might be what the customer thinks/says it is, good nursing care is definatly not always what the patient thinks/says it is.

    patients will complain because they "waited 5 hours for my sore toe, and the doctor didn't even spend five minutes with me! he just gave me a prescription and sent me home." (this, by the way, is an actual comment i once read on a survey). ok, problem #1: you came to an er for a sore toe, hence the long wait. problem #2: unrealistic expectations. what did you want the doctor to do? how much time needs to be spent on a sore toe?
  5. by   Freedom42
    Quote from critterlover
    press-gainey is a company that hospitals pay to conduct customer-serivce surveys.
    thanks for enlightening me. i plan to find out if our local hospitals use this company. it's troubling to think that nursing care can be judged by the uninformed on the basis of customer service.
  6. by   nurse4theplanet
    Quote from AstrosFan
    :angryfire I'm a little steamed. The other night I had a pt present with an "ankle sprain." Yep, that's it. When I went to discharge this "fine, upstanding, well-groomed" individual , his rolly-poley little wife advised me that the APAP#3 wasn't going to be good enough. She stated that he was a 250lb. man that needed much stronger pain medication. I replied that it was a sprain and that we don't normally prescibe a narcotic for a sprain. His wife was adamant that I go ask the doctor for something stronger. She was that type of person that doesn't know half of what she's talking about and you can't get a word in. She developed a quick case of diarrhea of the mouth. So, I walked out and advised the doctor of the situation. He responded exactly as I expected. Yep, you guessed it, they're not getting anything stronger. I went back into the room with the bad news. She became angry and proceeded to orally defecate some argument that since they were paying cash for this visit that they should be able to get whatever they requested. The pt advised that he didn't have a regular doctor and that this would be his doctor visit and so he needed medication. To tell you the truth, they both went off on a tangent and I sort of quick listening. They yapped the entire time while leaving, but did leave. I know I shouldn't have (you know the old saying about argueing with a fool), but I argued with the two of them about how it was just a sprain and that I had never had anything for the many sprains that I had had, yadda yadda yadda. I just don't get it with this entitlement attitude of these folks. I've been putting up with this for a few years, but it still pisses me off. If my ER director wasn't so eaten up with PressGaney, I wouldn't have even taken the request to the Doctor. I would have said, "here are your discharge instructions, here is the medication that has been prescribed to you, there is the door, if you continue to argue, security will be happy to escort you to your car."

    So, now to a question. How would some of you respond to this situation? What would you have said to a pt demanding a narcotic for a minor injury?...Beside, "Suck it up, wuss!" Oh, how I wish I could say that.

    Thanks in advance for your replies.
    Oh I am so glad I am not an ER nurse! I really don't have those kind of patience on some days. It's amazing what people constitute as an emergency and feel they are entitled to, isn't it?

    I think you did the best you could. The cash comment was unreal, I would have made it clear in no uncertain terms, "Ma'am, we meet a high standard of care regardless of the method of payment a patient is able to make. Cash customers do not get better medical treatment in comparison to those who have insurance or cannot pay at all. If they did, it would be considered bribery, which is illegal."
  7. by   HisTreasure
    Quote from EmerNurse
    I'd have handled it (and have) just as you did. Ask the doc as a formality, then tell them nope, doc said no.

    I discharged two obscure abd pains (all neg tests) who both demanded pain med prescriptions - didn't get 'em either. The attitude seems to be "I waited all this time (for my BS complaint), so I better get what I want". We're *cough cough* customer service oriented too, unfortunately.

    Anyone has a good answer to this kind of crap, I'm all ears!
    Why are all abdominal pain considered BS? I had a LOT of abdominal pain near my ovaries-radiating to the middle of my abdomen. I put up with the excrutiating pain because I was afraid to go to the ER because of this board and comments like this. I was afraid of how I would be received. One day the pain became so intense...went away for a second...and came back full blast. I made an urgent care appointment because it was after hours. I waited over 2 hours until my appointment doubled over in pain. My mom drove me to the appointment. I had an elevated BP and pulse, but no temp. The nurse kind of rolled her eyes. Dr. came in palpated, blah, blah. Didn't request a urine until the end of the appointment~AFTER he said maybe it's PID we should do a pap. No, sir, I don't I think so! Urine dipsticked for pregnancy as a formality because I'm tied up. Faintly positive...maybe not... let's get an ultrasound. The story ends with my left fallopian tube removed>>>>>>Wow. Dumb ass abdominal complaint people.:trout:
  8. by   CritterLover
    Quote from kiyasmom
    why are all abdominal pain considered bs? i had a lot of abdominal pain near my ovaries-radiating to the middle of my abdomen. i put up with the excrutiating pain because i was afraid to go to the er because of this board and comments like this. i was afraid of how i would be received. one day the pain became so intense...went away for a second...and came back full blast. i made an urgent care appointment because it was after hours. i waited over 2 hours until my appointment doubled over in pain. my mom drove me to the appointment. i had an elevated bp and pulse, but no temp. the nurse kind of rolled her eyes. dr. came in palpated, blah, blah. didn't request a urine until the end of the appointment~after he said maybe it's pid we should do a pap. no, sir, i don't i think so! urine dipsticked for pregnancy as a formality because i'm tied up. faintly positive...maybe not... let's get an ultrasound. the story ends with my left fallopian tube removed>>>>>>wow. dumb ass abdominal complaint people.:trout:

    ok, i'm trying this again....i keep losing my response (will i ever get the hang of my laptop "mouse"?)
    [color=#483d8b]
    [color=#483d8b]absolutely not is all abd pain considered to be a "bs" complaint.
    [color=#483d8b]
    [color=#483d8b]however, like the ankle sprain/pain that i mentioned in an earlier post, it is a complaint that is ripe for abuse. meaning, it is very difficult to compleltely rule out, but can't always be definitivly diagnosed, either.
    [color=#483d8b]
    [color=#483d8b]they eye-rolling you experienced may not have been one of "i think this isn't real" but more of a "it is another abd pain tonight!" (though when a patient is laughing, smiling, snacking on potato chips and coke and has to be summoned from the cell phone to triage, it makes it tough to not be suspicious)
    [color=#483d8b]
    [color=#483d8b]some nights, abd pain constitutes fully 2/3 of the patients waiting to be seen in the waiting room. it can be just about anything from gall stones to pid to menstrual cramps to uti to pancratitis flair up to constipation to crohns disease to food poisoning to well, absolutely nothing.
    [color=#483d8b]
    [color=#483d8b]yes, we have a tendency to groan when a pt checks in with abd pain. why? it is usually a pretty extensive work up, especially if you are female. not only that, it is an unplesant work-up, and the patient isn't very happy about it.
    [color=#483d8b]
    [color=#483d8b]it starts when you put them in a room and tell them to undress and put the gown on, opening in the back, please. i usually get "i have to take my clothes off?" well, yes, if the area you are complaining about is covered with clothing, then you have to take them off to be examined. and it all just goes down-hill from there. they don't want to be stuck for iv/labs, they don't want to drink the contrast for the ct scan, they don't want the pelvic exam or the cath u/a. they want you to tell them what is wrong, but the don't want to go trough the testing. and, they don't want to wait for the test results. (and they usually start complaining that the wait has been so long, that we need to feed them. so we then have to explain why it is that they can't eat with a c/o abd pain, n/v)
    [color=#483d8b]
    [color=#483d8b]and to top it all off, fully 1/2 of these patients end up with "abdominal pain, uncertain cause" as the result of this extensive and expensive (and negative) work up. they are told to follow up with their pcp, but they don't. they just return in a week or so telling you "i was here last week for the same thing, i'm not sure what you did, but whatever it was, it didn't work."
    [color=#483d8b]
    [color=#483d8b]the problem being that even though much of what checks in with c/o abd pain really is a bs complaint, abd pain can be so serious that you have to do a full work up on them every time -- kind of like chest pain. only the chest pain work up is a little shorter, especially if they have recently had a treadmill test. and the chest pain work up is "easier" on the patient -- doesn't involve speculums and quick caths and culture swabs , so the patient isn't as grumpy with it.
    [color=#483d8b]
  9. by   Rio
    Quote from AstrosFan
    :angryfire I'm a little steamed. The other night I had a pt present with an "ankle sprain." Yep, that's it. When I went to discharge this "fine, upstanding, well-groomed" individual , his rolly-poley little wife advised me that the APAP#3 wasn't going to be good enough. She stated that he was a 250lb. man that needed much stronger pain medication. I replied that it was a sprain and that we don't normally prescibe a narcotic for a sprain.
    What ever happened to Motrin 800 mg TID ? Let's guess ... allergic to NSAIDS ?
  10. by   Katnip
    Quote from Freedom42
    Thanks for enlightening me. I plan to find out if our local hospitals use this company. It's troubling to think that nursing care can be judged by the uninformed on the basis of customer service.
    Press Gainey isn't the only company that does this. If your hospital sends out satisfaction surveys, then you'll never hear the end of customer satisfaction.
  11. by   new er nurse
    [color=#483d8b]it starts when you put them in a room and tell them to undress and put the gown on, opening in the back, please. i usually get "i have to take my clothes off?" well, yes, if the area you are complaining about is covered with clothing, then you have to take them off to be examined. and it all just goes down-hill from there. they don't want to be stuck for iv/labs, they don't want to drink the contrast for the ct scan, they don't want the pelvic exam or the cath u/a. they want you to tell them what is wrong, but the don't want to go trough the testing. and, they don't want to wait for the test results. (and they usually start complaining that the wait has been so long, that we need to feed them. so we then have to explain why it is that they can't eat with a c/o abd pain, n/v)

    oh how true!!! i recently had a female with a "migraine". the doctor gave her fluids, toradol and reglan. her husband was furious! he demanded something stronger for her. told us that if he had insurance she would get something better. guess what she got what she wanted - dilaudid (press-gainey anyone?). less than five minutes after her dilaudid she was asking for her discharge instructions.
  12. by   gauge14iv
    funny thing is....

    A drug seeker won't get a call from from Press-Gainey anyway - wanna know why? They probably won't put their real phone number on their admission paperwork - and if they do, they won't answer a call from a number they don't recognize!
  13. by   CritterLover
    Quote from gauge14iv
    funny thing is....

    a drug seeker won't get a call from from press-gainey anyway - wanna know why? they probably won't put their real phone number on their admission paperwork - and if they do, they won't answer a call from a number they don't recognize!

    unfortunalty, our hospital system uses written surveys, in a postage-paid envelope.

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