Tips on how NOT to appear like a Drug seeker - page 13

by WillowBrook

68,324 Views | 150 Comments

Having read through some of the threads regarding Drug seekers in the Emergency Department I must admit I now feel quite nervous of being misperceived in this way. I take medication which causes some urinary retention and... Read More


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    Quote from geniann
    I too know what it is like to not be believed. It is beyond frustrating- and of course we must deal with the pain. kk2000, I had almost the same situation. Then I see an ortho doc and he tells me "I know nurses know what to say to get drugs and they know how to act". I was shocked and apalled- I told him "I have NO insurance- If all I want are the pills I can buy them off the street cheaper than coming to you. I spend $200-$300 dollars to see you plus the cost of the scripts. I want a professional to help me so I get the best treatment. Yes I am in pain and I do need narcotic meds but I want them to help me- NOT rule my life! Needless to say that doc later changed his tune, but the words still hurt. Another poster said "wear a suit,have insurance and be articulate"- a drug addict can be as well dressed and well spoken as anyone and still be a DRUG ADDICT- and the doctors will see past all this- They have probably seen it ALL before- and they DON'T fall for fancy clothes or good insurance.
    You give the doctors too much credit. Don't you know that the first thing they are taught is that all patients are liars and are seeking to get the doctors ruined by forcing them all to prescribe pain meds?

    The other night, I was in sudden, excruciating pain, called my PMD, got his idiot colleague after 3 calls and waiting for more than an hour for him to call back. He asked what was wrong, I told him agonizing pain. Did he take a history? Did he recommend alternatives? Did he prescribe a small amount of meds, just to get me through the night? No. His response was, without so much as determining the source of the agonizing pain, I can't give pain meds in the middle of the night. Period. Thank God I had some leftover Rx from the dentist in the house. It enabled me to avoid the ambulance, the ER, all the mess, until I could get to a doc's office the next day. Of course, the MRI tech there told me I should be up walking with this particular ailment. Also said I should go to t heir other office, where they had a plastic chair that would wheel right up to their MRI machine. Too bad no one had informed me before I made the trip to the office I had gone to! And God forbid anyone there offer to help me get from the doorway to the table. I crawled and scooted and dragged myself, in case you are wondering how I made it. She wouldn't even let my husband help me - the magnet might get him, after all. She said he'd have to fill out the MRI questionnaire, which he did but she still wouldn't let him in. Oh, yeah, pain and suffering are real, people can be so ignorant, so cruel, so completely ridiculous. they lose sight of the forest for being suspicious of the trees.

    And just for the record, may the day never come when we lose any more of our privacy than we have already lost in this country. The last thing we need is computers containing all of our information talking to each other. Foolish of me to think that day isn't already here, though. Those who think it's great to be able to police everyone and have government and ER's and whoever knowing all your business - I know you mean it for a good reason. Unfortunately, not everyone has your benevolent outlook. Knowledge is power, it's control. Let freedom ring.
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    Quote from EDValerieRN
    If you have a chronic condition, the pain is best managed outside of the ER.
    Sometimes it is impossible to get a pcp doc to prescribe anything for chronic pain. Ultram and 800mg Motrin just don't cut it.
    Simplepleasures likes this.
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    Quote from Valerie Salva
    Sometimes it is impossible to get a pcp doc to prescribe anything for chronic pain. Ultram and 800mg Motrin just don't cut it.
    Still doesn't negate teh fact that the best way to manage pain is through PCP. Acute pain is one thing but chronic pain is a whole other ball game.
    nuangel1, ERRNTraveler, and Altra like this.
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    Our seekers are usually in the ED several times a month some of them have even been in trouble for trying to alter their scripts yet they cont to come back. We also keep cards w/ these patients names the dates they are in the ED, who the doc is, and what meds were given. If we don't see you weekly or biweekly then you're probably not an active seeker. I also have seen many pt's w/ stones working on a surgical floor and now in the ED and believe me you can't fake that!
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    Quote from jmER
    I also have seen many pt's w/ stones working on a surgical floor and now in the ED and believe me you can't fake that

    Oh come on now ...

    Do a little dance, add in some agitation, diaphoresis and nausea from narcotic withdrawal and BINGO ... you have what looks like a kidney stone presentation. In my ER, there will already be some Dilaudid on board by the time that UA comes back.

    My heart goes out to true kidney stone sufferers.
    mrsmamabear2002 likes this.
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    After working 7 mos in an ER in a state that is ranked third in the top ten states with narcotic prescription fraud, I can honestly say I've seen my fair share of drug-seekers. I've also seen docs feed into the problem by just asking them which narc works best (lortab is a big one) and giving a script for a couple of days worth.
    I won't give tips out for not appearing to be a drug-seeker. What I will do is suggest that pain meds are not the only solution for what most drug-seekers and non-drug seekers but chronic pain sufferers come in for. If they cared so much about the pain, they would follow up with the outpatient care we arrange, rest whatever is hurting, and get the referrals that they need to see a specialist. The ER is for ACUTE cases only. Chronic abd pain or back pain a pt has had for months or years is not going to be solved at the ER.
    Having said that, while they are in my care, I try to take care of them, as best I can. I can't prescribe meds nor can I hand them out willy-nilly just because someone asks for them. I assess their pain, tell them I will let the doc know, and then I do. Whatever the doc prescribes is up to them. I try to be understanding and give people the benefit of the doubt. Everyone gets sick or hurt at some point, even junkies. I do my best to educate them when I discharge them, try non medicinal remedies, empathize with them, and then send them on. What they do when they get home is up to them. Sometimes the pain won't go away until whatever is causing the pain is treated, such as infection which doesn't respond to pain meds, only antibiotics.
    What a lot of people forget from their teaching is that pain is a symptom not an illness. You have to treat the underlying cause. Go back and look at your old school care plans. If someone had multiple fractures, their primary nursing diagnosis wouldn't be pain, but impaired orthopedic integrity. Pain might be a secondary diagnosis, but not primary. You take care of the underlying cause, you take care of the pain.
    Just because you don't give someone pain meds doesn't mean you don't address their pain.
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    Quote from lupin
    After working 7 mos in an ER in a state that is ranked third in the top ten states with narcotic prescription fraud, I can honestly say I've seen my fair share of drug-seekers. I've also seen docs feed into the problem by just asking them which narc works best (lortab is a big one) and giving a script for a couple of days worth.
    I won't give tips out for not appearing to be a drug-seeker. What I will do is suggest that pain meds are not the only solution for what most drug-seekers and non-drug seekers but chronic pain sufferers come in for. If they cared so much about the pain, they would follow up with the outpatient care we arrange, rest whatever is hurting, and get the referrals that they need to see a specialist. The ER is for ACUTE cases only. Chronic abd pain or back pain a pt has had for months or years is not going to be solved at the ER.
    Having said that, while they are in my care, I try to take care of them, as best I can. I can't prescribe meds nor can I hand them out willy-nilly just because someone asks for them. I assess their pain, tell them I will let the doc know, and then I do. Whatever the doc prescribes is up to them. I try to be understanding and give people the benefit of the doubt. Everyone gets sick or hurt at some point, even junkies. I do my best to educate them when I discharge them, try non medicinal remedies, empathize with them, and then send them on. What they do when they get home is up to them. Sometimes the pain won't go away until whatever is causing the pain is treated, such as infection which doesn't respond to pain meds, only antibiotics.
    What a lot of people forget from their teaching is that pain is a symptom not an illness. You have to treat the underlying cause. Go back and look at your old school care plans. If someone had multiple fractures, their primary nursing diagnosis wouldn't be pain, but impaired orthopedic integrity. Pain might be a secondary diagnosis, but not primary. You take care of the underlying cause, you take care of the pain.
    Just because you don't give someone pain meds doesn't mean you don't address their pain.
    Do you honestly think that for one minute I would have chosen to go to the ER? My doctor yelled at me and told me I HAD to go to the ER, also the type of pain that I went in to ER with was one in which I NEVER experienced before, it was NOT CHRONIC.

    I begged my doctor to allow me to wait to see him in the morning, he said NO, absolutely NOT.It is this dismissive attitude that gives the ER staff a bad reputation at times.As a nurse of 30 years, I KNOW my own body and its symptoms.

    I am 56 years old and have been to an ER two times in my entire life, one when I was in a car accident and almost died and the other was the event I described in this thread.
    Last edit by Simplepleasures on Feb 7, '08
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    <P>First of all INGELEIN, I never read your post, I don't know your case, and I did not write my post in response of your post, but in response to everything in general, so perhaps you should not take things so personal.&nbsp; </P>
    <P>&nbsp;</P>
    <P>&nbsp;Second of all, as to the "dismissive attitude", unless scopes of practice are different where you are, most nurses cannot write their own orders (legally) for pain meds.&nbsp; I can assess the patient, make the provider aware, even suggest things I might feel will help (which I do quite a lot), but what the provider orders is what the provider orders.&nbsp; I might not like it, the patient may not like it, but that is what is in my power to control.&nbsp; I try non-medicinal techniques a lot, like ice, immobilization, even just talking through the pain with the patient, but that is my scope of practice.&nbsp; I'm not going to work outside of it no matter what the patient has going on, pain or otherwise.</P>
    <P>&nbsp;</P>
    <P>&nbsp;Third of all, any patient that is sent by their doctor's office to the ER is right in being there.&nbsp; But the Primary doctor they see outside of the hospital is not generally the ER doc and they make up their own minds what they want to give to a patient, not always what the patient says their doctor wants or even what their doctor tells the ER doctor they want.&nbsp; In litigation, it will be the ER doc on the line, not your regular doctor.</P>
    <P>&nbsp;</P>
    <P>&nbsp;Fourth, I stand by my statement that pain medicine is not always the answer for pain, acute or chronic.&nbsp; Someone with chronic back pain who works construction and moves pianos is obviously not following the recommended course of treatment for back pain sufferers.&nbsp; Sometimes non-medicinal changes in lifestyles are needed to treat chronic pain.&nbsp; It stinks, it ruins careers sometimes, but someone's health has to come first.&nbsp; The more I work as a nurse the more that is driven home to me.</P>
    <P>&nbsp; For acute pain, Pain meds are usually used in conjunction with other treatments or types of meds, but they are not usually the ONLY treatment.&nbsp; </P>
    <P>&nbsp; Now I am done.&nbsp; Perhaps my other post was a bit short but after working 12 hours, one is not always able to fully explain oneself appropriately.&nbsp; </P>
  9. 0
    My advice as an ED nurse in Perth WA is to be honest (which you have said). Accept what meds or advice you are given. Paracetamol is a very effective but under-rated analgesic. When taken regularly (2x4 hourly) either alone or combined with opiates (morphine etc) it works.
    Also don't front up and state that you need "morphine" or similar. Personally, I will give what is needed and annoy the Drs to write up effective analgesia.
  10. 0
    and also once the ED gets your file it should be well documented in regards to your previous history, treatment and what works etc. If you move around a lot it may be worth going through the process of FOI and getting copies of recent admissions etc


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