Tips on how NOT to appear like a Drug seeker - page 4
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... Read More
Aug 30, '06A pain contract is very important for chronic pain sufferers. This provides a double-purpose system of checks and balances: the patient receives the needed meds and the provider stays out of trouble also.
IL is going to be going online for patients who utilize Medicaid. This will help to weed out those folks that fill meds from multiple providers.
I did have an enterprising young man who had Medicaid but who would pay cash for his narcotic scripts, thus avoiding the computer because Medicaid didn't pay for it. However, the pharmacy called me.
Aug 30, '06Something else that may help in the OP's case. The example was kidney stones. If we refer you to a Urologist see the urologist. Don't come to the ER for the 10th time with kidney stone and tell me/us that you have never seen one.
In the migraine example if we refer you to the neurologist see the neurologist, narcotics dont abort a migraine anyway they just mask the pain and alow you to sleep. By the way I have had more than one neurologist tell me that knocking one out for at least 10-12 hours of sleep and the right combo of anti-inflamatory meds will abort most migraines. This doesnt nessesarily equate to narc either.
Aug 30, '06Trust me - I truly believe in providing as complete pain control as is medically possible. I REALLY REALLY do. But a person who has a real problem can generally be assessed as such and isn't worried about looking like a drug seeker. In my experience that is the LAST thing they are worried about. They are worried about their PAIN and the problem at hand. When a person is more focused on "appearances" than their issue, that raises red flags with me all over the place. Pure n simple. They are not calling the office at 430 pm on Friday hoping the MA will feel sorry for them when they tell her their dog ate their prescription, they are not calling the on call doc after hours and arguing with him about what he wants to prescribe - never mind that they got a prescription earlier that day called in for them. They aren't verbally abusing your office staff. And they generally are willing to come in and be seen because they really are that miserable.
I wasnt making a judegement call here - just a simple observation. Absolutely junkies have kidney stones - and to deny them adequate pain control would be criminal! Yes they know what works for them - but even a junkie - at that point in time - would be less worried about looking like a drug seeker - and more concerned about their PAIN.
THAT was what I was saying. Sorry it got so twisted.
Aug 30, '06Quote from TazziRNExactly - so if a person truly is in pain, then they should not have to be concerned about appearing to be a drug seeker. If they are worried about that - then I have to be at least a little suspicious.I know none of the comments were directed at me, but I feel as though I should defend myself here. Experienced AND CARING ER nurses and doctors can tell when someone is in genuine pain versus looking for a fix. Usually.
Aug 30, '06Quote from gauge14ivExactly - so if a person truly is in pain, then they should not have to be concerned about appearing to be a drug seeker. If they are worried about that - then I have to be at least a little suspicious.
I think that this may perhaps be why the OP and others with similar concerns are asking this question now, rather than waiting until they are writhing in pain. And those that have experienced inadequate pain coverage are trying to find methods of lessening the chances of it happening again.
Does this mean that drug seekers never try to learn new "tricks" for covering their butt? Nope. But does it also mean that we cannot imagine there are legitimate concerns out there? Nope to that too.
I've never given birth, nor had a kidney stone, but when I remember the most painful experiences that I have had to date, I do fear that pain and suffering. Making a plan now for how one would cope in the future can give a sense of control and perhaps calm some of their fears now about what will happen to them in the future if they are ever in such a position.
Having a plan that includes backup, such as the doctor's note suggested above (an MD/practitioner might be more willing to take another practitioner more seriously than a stressed and in pain patient), a list including health history, previous hospitalizations/ER visits and their reasons, allergies, and current meds w/side effects can offer legitimacy as well as "backup" for the ER practitioner to call and get confirmation of the patient's health status.
Aug 30, '06Quote from gauge14ivI thought the same thing, till that happened to me last year. Here i was in a fetal position crying, begging for relief from the worst migraine i'd ever had, and got treated like a FF drug seeker, when i'd never been to that ER (or facility) ever. It was frightening, wondering if i actually had a migraine, or worse, and being treated like i was asking for a narc hit.Exactly - so if a person truly is in pain, then they should not have to be concerned about appearing to be a drug seeker. If they are worried about that - then I have to be at least a little suspicious.
So thanks to that, i get the joy and pleasure, if i'm ever in that kind of pain again, of wondering if i'll be taken seriously next time.
Aug 30, '06What is a shame - truly - is that people even NEED to be worried about being taken seriously, or that providers have to worry about being used as a source. Both suck. There just aren't any easy answers for that unfortunately. As nurses we can do a good job of assessment, of being compassionate and sensitive, and also sensible - that requires that people slow down enough to get the whole picture.
Marie I hope you and your doc were able to plan ahead for future migraines - nobody needs that kind of stress when you are in that kind of pain.
Aug 30, '06We had planned ahead, and that still happened. We can try and plan ahead for that again, but the next time could be worse.
Aug 30, '06I am not proud of this and he was not my patient. We had a man come in with a headache. He was shuffled off to a quite corner until his cat scan. Can you say subdural bleed. He was flown out within the hour. We didn't think he was seeking, just a wimp.
We also had a fella who dropped an greasy engine on his arm acouple of different times, on purpose, for the drugs. He never broke anything and it was superficial damage not requiring sutures.
Then we had a guy come in for little toe pain. Okay no problem let's try toradol or nubain, nope had to be dilaudid. No dilaudid he got loud and whiney and obnoxious refusing our treatment. He did this several times. The last time I saw him we xrayed his chest for some reason. Thw twit has a spot on his lung. We admited him started a line and gave him his favorite, within ten minutes twity gave us the positive gown sign (he amscraed with his heplock)
The idea of a letter is terrific, leave it to medic to come up with the right idea.
Willowbrook, I hope things go well for you, you have delt with a lot of difficulties and you seem to be handleing your business well, I admire your resolve and courageumpiron: :bowingpur
Aug 31, '06Quote from stevielynnThank you so much for using the very line I used when talking about this subject with my wife.I work in an emergency room and disagree with the idea that someone asking a question about how to NOT appear like a drug seeker IS a drug seeker looking to buck the system.
Especially if a person has hung around allnurses reading about drug seekers, who, granted, are a frustrating lot. It can make a person in pain a bit apprenhensive about presenting to a ER.
We can get jaded and judgmental working around folks who try to trick the system. And that can show up when a person, in real pain, comes into our ER. I work very hard not to get jaded.
Plus, even "junkies" can get kidney stones . . . .
The fact that seems to elude many posters on this thread is there are far more people that come into your ER with actual pain than people who come in seeking medication for recreational use.
How many of these posters have actual experience in pain management? I read one post speaking of having elevated VS and not laughing with whomever you are with. In reality elevated VS are a classic symptom of someone in withdrawal. A person who has chronic pain will not exhibit elevated VS even with an exacerbation.
Regarding laughter or smiling, different people and cultures handle and express their pain in different ways.
In the hospital I work at, we can bring up a patients records in a keystroke and be able to tell when the patients last visit was and what it was for. Unfortunately in my hospital there are many who don't use this information. I recently witnessed a NP cut a scrip for Tylox, and when the patient stated that it made her sick and asked for Vicodin told the patient that the drugs were virtually the same and that she could either fill the scrip to Tylox or wait to see her dentist (this young lady was well dressed and had a nastily abcessed tooth). I was astounded at the way this girl was treated and as a new nurse I said nothing at the time.
I still can't understand why we are so afraid of treating the "5th" vital sign as we do the others. If someone is in pain aren't we supposed to treat it? I've seen in my time as both a student and as a nurse so many instances where a nurse will roll their eyes, or comment on a specific patient when that patient asks for pain medication. The bottom line that people that ask for pain medication are all med seeking, it's that the vast majority are seeking meds to alleviate their pain not get high.
Aug 31, '06Also - people forget to make the distinction between dependant and addicted. Dependant is sometimes necessary for people with chronic pain, they will become dependeant on a medication to have their pain controlled and that is a known fact and it is acceptable - in fact sometime you have to explain this to the patient because they dont want to use medication adequate for pain control. Addiction without pain is another case.
When I worked in the ER, anytime we could pull up prior records we did. But then we had a few seeker types who would try to change their names in the hopes nobody would recognize them.
Aug 31, '06Quote from gauge14ivThis comment just shows one of the reasonings that people are worried about it. That there are others out there who judge them because they ARE in pain and have been in pain multiple times and haven't suffered quietly. That they have attempted to get the treatment they deserve for their pain has lead so many people to be unfairly branded as drug seekers.Exactly - so if a person truly is in pain, then they should not have to be concerned about appearing to be a drug seeker. If they are worried about that - then I have to be at least a little suspicious.
I have a different take on it. To me, and of course there is always the exception, if a person looks to be in extreme pain AND is worried about being a drug seeker, it signals that they aren't being treated adequately and need something now to ease the pain. Then they need to talk with their PCP about a different approach to have stave off attacks.
Quote from gauge14ivThis just sums it all up for me.What is a shame - truly - is that people even NEED to be worried about being taken seriously, ......
Aug 31, '06QUOTE: "The idea of a letter is terrific, leave it to medic to come up with the right idea."
I only came up with the idea bc my wife is a chronic pain sufferer (migraines) and we do everything we can to avoid the ER. Sometimes it's just unavoidable though.
getting ready for a nap