What kind of pt am I?

Trauma Columnist · Apr 21, 2011

Whether you are a drug seeker or legitimate complaints - you should get treated the same: courteously.

If you have problems with a specific ER, I would take it up with the adminstration of the hospital.

Its not for us to judge.

Esme12, ASN, BSN, RN · Apr 21, 2011

I am so sorry you are dealing with this......unfortunately....many medical professionals....but especially Emergency departments treat seeking behavior and legitimate chroni pain equally poorly. Some Emergency departments feel anything less that a trauma/heart attack/or code should go to the ED because if you aren'tdying you arenot an emergent patient. Tolerance to narcotics from long term pain IS NOT seeking behavior...........We in the medical field are so judgemental sometimes...

BUt everyone should be treated respectfully......Everyone has a RIGHT to be treated politely.......I would let the management know of your treatment and explain to the manager how you felt an how the stff made you feel......

systoly · Apr 21, 2011

When I worked ER, albeit in the military, I wouldn't have had the foggiest what to do for a chronic pain patient. I think, unfortunately, it's lack of training and perhaps lack of willingnes to listen/invest time in the absence of clinical signs. I am basing this on several personal experiences where I went to the ER and was all but ignored until my c/o was evident on the monitor, boy did they come running.

nfdfiremedic, BSN, RN · Apr 21, 2011

Everybody should be treated with respect and dignity when they come to the ER.

Exacerbations of acute pain are a difficult problem to have. Many ER clinicians will provide you with a dose of pain medication sufficient to ease your suffering, but few will write for anything at home. Generally speaking, the scope of practice of the emergency department is to take you out of your acute crisis and direct you to whatever provider is managing your chronic pain (PCP, pain management physician, anesthesia, or whoever else.) One thing we don't want to do is mess up whatever system your established care providers have in place for your pain management. If you continue to have breakthrough pain despite whatever pain management regimen your doctors have you on, you need to bring that to their attention so they can make changes to your treatment and prevent those severe pain exacerbations before they happen. Continued reliance on the ED to treat your pain may cause your long term providers to not realize that their treatment is inadequate and cause repeated episodes of pain and suffering.

The bottom line is that the emergency department should really only be used if you have exhausted all other options, including talking to whoever manages your chronic pain to adjust the treatment in response to your increased symptoms. Many pain management centers or primary care docs ask their long term pain sufferers to sign narcotics usage contracts which explicitly state that you will not go to anyone else for pain meds, and that includes the ER. If we assist you in violating that agreement, we are really doing you a disservice in the long run.

classicdame, MSN, EdD · Apr 21, 2011

I think it comes down to the individual healthcare provider, not the hospital. Some people have no idea what chronic pain is about.

**canoehead, BSN, RN** · Apr 21, 2011

Sometimes patients with an extensive history come in with guns blazing ready to fight it out with that sour nurse they had to deal with last time, but they get me, the nurse that hasn't seen them before, ever. That's a bit off-putting, and I might assume they are jerks instead of seeing past the behavior, even though I know they must have already been through the wringer with the medical system.

Yes, as the nurse, I'm supposed to be the understanding one. You can help me by having a list of meds and allergies, and health issues, in writing. If it comes from your doc, all the better, but just on a piece of paper that I can hold in my hand and read is good. I recognize the effort, and the fact that you've written it all tells me you've seen enough hospitals to be tired of telling the story again. If you or a friend tells me orally it can be confusing, and if you are worried and in pain it lengthens the triage process...I might not find out about a critical fact til the end, and I have to review the last 10 minutes of conversation to fit it in.

Drama...no drama please. I SEE that you're in pain. Really, I do. I have to fill in these stupid blanks, I'm sorry, or the computer will melt, and my charge nurse will deny access. I hate it. Let's get it over with.

Pain may be what the patient says it is, but the person who pauses and thinks after I ask about the 1-10 scale gets my respect. Someone wincing, restless, and vomiting at 7/10 scores higher than the immediate screamed "Ten!" The partner states "ten! she's really hurting!" gets points for caring, but demerits for being an *******.

Tell me what's worked before. If you know that 100 demerol will do it then I want to know. Don't worry about looking like a drugseeker unless you go "umm that drug that starts with d..." You've had a chronic illness for years, you KNOW what you need. Plus your home med list tells me you'll need a high dose of something potent anyway. We'll have to draw labs to rule out bad things even if you know you just need the shot, so hang in there with us.

Hardest one- don't cuss anyone out, even if they deserve it. Tell them what works better for you, but with a 5 item list we might require you send your friend to fetch the blanket and water. If someone is being a jerk they won't listen if you tell them that, but if we're really trying to help we'll make an extra trip so you'll feel respected. Say "thank you" because that's what keeps us going.

I'm sorry if I haven't answered exactly what you need. Hope this helps a bit.

misswhitney · Apr 21, 2011

Sometimes patients with an extensive history come in with guns blazing ready to fight it out with that sour nurse they had to deal with last time, but they get me, the nurse that hasn't seen them before, ever. That's a bit off-putting, and I might assume they are jerks instead of seeing past the behavior, even though I know they must have already been through the wringer with the medical system.
Yes, as the nurse, I'm supposed to be the understanding one. You can help me by having a list of meds and allergies, and health issues, in writing. If it comes from your doc, all the better, but just on a piece of paper that I can hold in my hand and read is good. I recognize the effort, and the fact that you've written it all tells me you've seen enough hospitals to be tired of telling the story again. If you or a friend tells me orally it can be confusing, and if you are worried and in pain it lengthens the triage process...I might not find out about a critical fact til the end, and I have to review the last 10 minutes of conversation to fit it in.
Drama...no drama please. I SEE that you're in pain. Really, I do. I have to fill in these stupid blanks, I'm sorry, or the computer will melt, and my charge nurse will deny access. I hate it. Let's get it over with.
Pain may be what the patient says it is, but the person who pauses and thinks after I ask about the 1-10 scale gets my respect. Someone wincing, restless, and vomiting at 7/10 scores higher than the immediate screamed "Ten!" The partner states "ten! she's really hurting!" gets points for caring, but demerits for being an *******.
Tell me what's worked before. If you know that 100 demerol will do it then I want to know. Don't worry about looking like a drugseeker unless you go "umm that drug that starts with d..." You've had a chronic illness for years, you KNOW what you need. Plus your home med list tells me you'll need a high dose of something potent anyway. We'll have to draw labs to rule out bad things even if you know you just need the shot, so hang in there with us.
Hardest one- don't cuss anyone out, even if they deserve it. Tell them what works better for you, but with a 5 item list we might require you send your friend to fetch the blanket and water. If someone is being a jerk they won't listen if you tell them that, but if we're really trying to help we'll make an extra trip so you'll feel respected. Say "thank you" because that's what keeps us going.
I'm sorry if I haven't answered exactly what you need. Hope this helps a bit.

I think this sums it up. I want to add, too, that don't give them a list of medications you are allergic to, when they really are pain meds that don't work for you. When you come in and say you are allergic to morphine, zofran, lortab, tylenol, motrin, ativan, etc (basically everything except Dilaudid or Fentanyl and IV phenergan), it looks really suspicious. I treat all of my patients the same, regardless of if I think their pain med seeking or not, but I can tell you other nurses are not so nice.

jfpruitt · Apr 22, 2011

Thx so much for your replies. I did want to say that I NEVER get nasty w/ anyone, just not in my nature. & I also never say 10/10 since I'm not in labor or had an amputation. I also RARELY ask for a rx for home b/c I've already got a cabinet full @ home & having a bad exacerbation. For example, the last time I went to the ER was 2 yrs ago when I had broken my lower leg during a seizure. it made NO sense b/c I was going down my hallway & that's the last I remember until the ambulance ride. Luckily, mom was behind me & watched me go down. She thought I was having another Addison's crisis & called 911 . When I arrived, I was in really bad leg pain & was treated like crap. they did an xray of my leg & sent me home! then, 2 hours later I get a frantic call from the ER saying THEY READ MY XRAY WRONG & MY LEG WAS BROKEN!! The MD wanted me to return asap. so, my 2nd trip was entirely different. everyone was nice & sympathetic & then loaded me up w/dilaudid. another prob I have, is that I'm severely allergic to tylenol. not nsaids, toradol, etc, just tylenol. my last pain MD was the worst MD I'VE EVER SEEN! I would set for 8 hours for less than a minute consult. no exam & no questions. I was on fentanyl patches for 2 yrs & was planning on staying on those. my first visit, he discontinued my fentanyl & started me on vicoden! I explained MULTIPLE times how sick it made me. his answer, "give it a try". well, I did, after 2 doses I ended up in his ICU for 2 weeks. I switched pain MD's asap after d/c.

Anna Flaxis, BSN, RN · Apr 23, 2011

You have chronic pain and it's predictable that you will have exacerbations. You should have a plan in place for handling those exacerbations, such as a quick release pain med for breakthrough pain, and extra prednisone or hydrocortisone injection that you can self administer should you feel an adrenal crisis coming on. This is all stuff that your PCP/endocrinologist/pain doctor need to handle. If they are not, then you need to find new doctors.

If you were to actually develop symptoms of adrenal crisis, then that would be a reason to go to the ED. Hell, that would be a reason to call an ambulance.

I think sometimes it can be hard for ED staff to hide their frustration when they've just watched a kid die or had to deal with a gruesome, senseless trauma, and there are all these Not Very Sick people packing the department, many of them coming in by ambulance because they think they won't have to wait, wanting juice and blankets and more medication and asking how long it's going to be, and their family members are all hounding you about every little thing, and you want to tell them the reason the doctor is taking so long is that she's sticking a tube down a three year old's throat so they can breathe, or that he's giving comfort to the grieving family of the 18 year old that was killed in a car wreck- but you can't say that because it's "poor customer service" and possibly a HIPAA violation. Sometimes it's hard for us, who see tragedy and death and grief and suffering every single day, to have much sympathy for those who are not very sick and choose to use the Emergency Department as an after hours clinic for stuff that their PCP should be handling.

Doesn't make it right, but it is what it is.

Regardless of that, you should still be treated courteously. No one should treat you like crap. You should be made more comfortable and discharged home to follow up with your appropriate provider in a compassionate and dignified manner.

Knoodsen · Apr 28, 2011

You are the kind of patient that would post a question about pain control on an emergency nurses' site. Speaks volumes.

Knoodsen · Apr 28, 2011

By the way, I'll be nice to you because I treat people the way I like to be treated. With respect to pain meds, or any other type for that matter, I will give them to you if they are ordered if I believe the order is appropriate. Sorry. Can't give anything without an order. And, by the way again, no personal guilt here about "failing to understand and treat pain adequately in the ER". We give people narcs for twisted ankles. My stars. What has this world come to?!