Pt demanded a stronger pain med - page 4

: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   rjflyn
    Quote from critterlover
    unfortunalty, our hospital system uses written surveys, in a postage-paid envelope.
    yes but when the pt is homeless or just gives you the address of the local vacant lot they dont get mail either.

    yes abd pain is a major work up. at least now a days we are a little more patient friendly. i can remember when belly pains didnt get pain meds until the surgeon/ob doctor saw them as you didnt want to mask that pain.


    rj
  2. by   gauge14iv
    Quote from rjflyn
    Yes but when the pt is homeless or just gives you the address of the local vacant lot they dont get mail either.
    Exactly! These people don't WANT to be found - you're fortunate (or not) if they even give you their real names. Drug addicts tend to be a paranoid lot.
  3. by   CritterLover
    Quote from rjflyn
    yes but when the pt is homeless or just gives you the address of the local vacant lot they dont get mail either.

    yes abd pain is a major work up. at least now a days we are a little more patient friendly. i can remember when belly pains didnt get pain meds until the surgeon/ob doctor saw them as you didnt want to mask that pain.


    rj

    ours are handed to the patient by registration when getting their insurance info. then they can either give them to registration when they checkout, or they can mail them in once the get home.
  4. by   TrudyRN
    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.
    How would I respond? I think I would NOT have assumed that the pt didn't need a stronger med. He was, after all, pretty heavy and he had, after all, injured his weight-bearing body segment.

    I would have NOT gotten angry, looked down my nose at him and his wife, and been impatient and judgmental, I would NOT have taken what you seem to have taken, which is a one-size-fits-all, holier-than-thou attitude. I would have figured the guy knows his own body, I would have assumed the best about him, that he was being sincere, and I would have figured that he was ENTITLED to proper pain relief. Don't be mad. You asked.

    Oh, something else - I would have the doctor go deliver his message to them himself. Why should I do the dirty work? He gets paid the big bucks so he can just go in and face the heat himself. While he's at it, he could explain himself to the patient. After all, the word "doctor" means "to teach".
    Last edit by TrudyRN on Jan 13, '07
  5. by   TrudyRN
    Quote from tddowney
    BINGO :spin:
    And you know this how?
  6. by   Anjann
    Wow, this is kink of a sticky area. I'm a second career/new nurse (passed NCLEX yesterday! and we were always taught in school about pain being the 5th vital sign and it is what the patient says it is and blah blah blah... But some people are just so obviously playing the system.

    I wonder though, if that makes us less empathetic when we come across patients that are justified in needing a higher level of relief and are not getting it? Not everyone deals with pain as well as others. When I had my pancreatitis and a lap chole with ERCP done I definitely saw the brief flicker of judgement pass over my nurses faces when I asked them for my PRN meds. The guilt vibe I was getting from them was so stressfull I wondered if I should just lay there in pain so they would not classify me as a weenie!

    With Migraines, the way I can tell what's up is how the patient reacts to being administered a Triptan. Because if you are a true Migraine sufferer, no narc will kill any migraine the way a triptan will and they are always so relieved to feel better.

    I just try not to judge. Good advice on how to deal with the frequent flyers though!
  7. by   gauge14iv
    But triptans truly do not work for every patient. And not all triptans work for every patient. Brand X may work for one patient and Brand Y may work for another but niether of them may be effective for the third patient.

    You can't count on triptans to relieve all migraines. And then there are rebound cycle migraines...

    Some migraines truly do need narcotic pain medication.
  8. by   canoehead
    Quote from kiyasmom
    Why are all abdominal pain considered BS?
    She said abd pain where all the tests were negative.

    TrudyRN; Judgemental statements don't appear to be confined to the OP in this thread.
    Last edit by canoehead on Jan 14, '07
  9. by   NicoleRN07
    I would have handled it just as you did, and I'd probably tell them that if the APAP #3 didn't control the pain, they could use OTC Motrin in between doses.....LOL.....drug seekers always love that answer.
  10. by   htrn
    Quote from rjflyn
    Personally I would have went to the doc, said something like they are not happy with the T3 rx. Get him to write one for motrin or naproxen and then enjoy walking back to the room asking to see the narc rx. Then saying oh i'm sorry he did give you the wrong med as I rip up the T3 rx and hand them one for the others. Have a nice day.

    Rj
    :roll :roll :roll

    OMG - I would love to be a fly on the wall next time you do that!!!! Call me and I'll just slip in behind the curtain with a video camera so we can send it into Funniest Home Videos and we can split the winnings
  11. by   htrn
    Quote from Anjann
    I wonder though, if that makes us less empathetic when we come across patients that are justified in needing a higher level of relief and are not getting it? Not everyone deals with pain as well as others. When I had my pancreatitis and a lap chole with ERCP done I definitely saw the brief flicker of judgement pass over my nurses faces when I asked them for my PRN meds. The guilt vibe I was getting from them was so stressfull I wondered if I should just lay there in pain so they would not classify me as a weenie!
    If a patient has a hx of narcotic use, i.e. chronic pain, they usually reveal this during the H&P and the MD will realize that pain may need to be treated with something stronger than T3. The OP has described either a case of an overprotective, harping wife trying to control yet another part of her hubby's life or a wife with just enough knowledge and probably hx of narcotic abuse that thinks she knows how to get ahold of some more without being identified as a 'seeker' herself. Either way, she handled it very appropriately.
  12. by   cheshirecat
    I would have stated that if I gave stronger analgesia the patient would not know if he was overusing the strained limb and may cause himself further injury.

    Forgive my ignorance, but what is PressGaney? I have heard it mentioned frequently on these posts.
  13. by   Myxel67
    Press Ganey is a company used by many hospitals to send out patient satisfaction surveys to discharged patients (random) from each area of the hospital. The pt rates "service" on a 5 point scale. Areas surveyed include efficacy of pain control, courtesy level of staff, cleanliness of area, waiting time, even difficulty of finding a parking space & finding your way around hospital. Many hospitals give or deny bonuses based on survey results. Last quarter our small department was rated lower because it included as valid the pt's complaints relating to his recent treatment in X ray department.(and mgr of xray was going all over hosp crowing about her dept's improved results). Pt had had two recent visits (1 to x ray & 1 to Diabetes Care Center). He responded to his disatisfaction with x ray department on the survey he got for our department. Surveys are random, so he probably did not get one for x ray visit. My biggest complaint about relying so heavily on this survey is that it basically equates a hospital visit to a hotel stay (I think it was modeled on Hilton Hotel policies of service excellence). We're not hotels, many people don't want to be here in the first place, and results are affected by so many variables: pts mood that day, traffic, depression, etc.
    Last edit by Myxel67 on Jan 28, '07 : Reason: typo

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