Pt demanded a stronger pain med

  1. :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.
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  2. 78 Comments

  3. by   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!
  4. by   augigi
    If they kept arguing, could you get the doc to come and tell them him/herself? Sometimes the "voice of authority" has more of an effect with some people!
  5. by   Victoriakem
    I have the Doc come in & tell them & I stand there with her/him to make sure it's not a he said/she said situation. Give them their d/c paperwork & leave. End of story. It's what the Doc orders. I also tell them it's not in my scope of practice to prescribe medications & not worth putting my hard earned nursing license on the line to do something illegal. That's usually does the job.
  6. by   Altra
    It sounds like you handled it as best you could ... there's no reasoning with unreasonable people.

    I might have added that "paying cash" does not change what treatment/
    meds are deemed medically appropriate.
  7. by   santhony44
    You did fine.

    If there was a remote possibility shame would work, having a shocked expression on your face and saying something like, "Oh, no, our doctors are watched very closely on their pain medication prescribing; Dr. Stethoscope could lose his license!" However, since lots of people these days wouldn't know shame if it had 18 wheels, was bright red and ran over them in the parking lot, that probably wouldn't work.

    Just repeat, with a smile on your face, "I'm sorry, Dr. Stethoscope isn't going to give you anything else today." And repeat, as often as necessary, until they give up and go away. Don't discuss or argue further, just keep repeating the same thing.

    People do get tired of beating their heads against a brick wall and stop.
  8. by   dazey71
    I work on a floor with quite a few chronic pain med seekers. You know they're going to be a trip when the first thing they say is " i need phenergan and dilaudid now" before you can even get a word out. I hate being the person that relays the message from the doctor that no, you can't have 8mg of morphine to help you sleep tonight'
  9. by   Jabramac
    I sometimes explain that we don't expect too much pain and if the prescribed pain medication is not doing the trick it could be a sign of something worse and we want the pt to follow up with PMD (or return to ER if need be) to be reevalauted in that case.

    It sounds like this woman was an extreme case, though, and nothing would have worked but an Rx for percocet.
  10. by   morte
    i would hazzard a guess that it wasnt even for HIM.......
  11. by   PurrRN
    Quote from santhony44

    "However, since lots of people these days wouldn't know shame if it had 18 wheels, was bright red and ran over them in the parking lot, that probably wouldn't work."
    You made me giggle, so true!!
  12. by   RunnerRN
    I had a similar situation last weekend, but with a psych pt ("refusing" to be made involuntary....ummmm hello?) I think you handled it fine. My way of handling things like that is kind of a step by step...
    1) Go to the doc, get expected answer (hell no) return to the room.
    2) Of course, pt continues arguing. I don't argue with patients anymore (gives me bad karma ) I just smile and say "I'm sorry, but the doctor has made his decision. These are your discharge instructions. XYZ would be signs of a problem, and we would like you to follow up at that point." When they continue arguing...
    3) I would ask the doc to come in, explain again that there will be no other pain med script (although I did work with a moonlighter once who would offer 5 percocet or 20 APAP - it was interesting to see what these ppl would choose). I stay in the room so I can chart what is still continuing.
    4) Doc leaves, pt is told again that there will be no other script, and that we are asking them to leave now as their emergent condition has been treated. They are either to leave by themselves, or security can help them.

    I really try to not argue with these people - you aren't going to be able to convince them you're right. I probably - however - wouldn't have been "big" enough to ignore the "we paid cash" argument. I think I would have had to say something to that...something like "we treat everyone the same here, regardless of whether they pay cash, have private insurance, or have Medicaid/care. The fact that you are paying cash for this visit does not mean we are working for you or that you get to dictate your care." Oooh how I despise entitlement.
  13. by   AstrosFan
    Quote from santhony44
    However, since lots of people these days wouldn't know shame if it had 18 wheels, was bright red and ran over them in the parking lot, that probably wouldn't work.
    Now that Just makes me laugh

    Thanks for the reply
  14. by   AstrosFan
    Quote from RunnerRN
    I had a similar situation last weekend, but with a psych pt ("refusing" to be made involuntary....ummmm hello?) I think you handled it fine. My way of handling things like that is kind of a step by step...
    1) Go to the doc, get expected answer (hell no) return to the room.
    2) Of course, pt continues arguing. I don't argue with patients anymore (gives me bad karma ) I just smile and say "I'm sorry, but the doctor has made his decision. These are your discharge instructions. XYZ would be signs of a problem, and we would like you to follow up at that point." When they continue arguing...
    3) I would ask the doc to come in, explain again that there will be no other pain med script (although I did work with a moonlighter once who would offer 5 percocet or 20 APAP - it was interesting to see what these ppl would choose). I stay in the room so I can chart what is still continuing.
    4) Doc leaves, pt is told again that there will be no other script, and that we are asking them to leave now as their emergent condition has been treated. They are either to leave by themselves, or security can help them.

    I really try to not argue with these people - you aren't going to be able to convince them you're right. I probably - however - wouldn't have been "big" enough to ignore the "we paid cash" argument. I think I would have had to say something to that...something like "we treat everyone the same here, regardless of whether they pay cash, have private insurance, or have Medicaid/care. The fact that you are paying cash for this visit does not mean we are working for you or that you get to dictate your care." Oooh how I despise entitlement.
    Thank you for your reply. Believe me, I wanted to say something to her when she brought up the cash, but I couldn't get a word in. She was runnin off at the mouth. You know, I hate having to go back to the docs. I really try to handle these situations myself, but just felt for documentation reasons I should at least consult him. Then just as you, I documented all that they said. I wonder, too, if the meds were even for him. People think that every shift is our first and that we have never heard some of their excuses. Arrgh. Take Care.

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