Your ER policy on giving rides home

MassED, BSN, RN · Sep 1, 2011

Practically you can kick her out and tell her she is discharged and the Social Workers job is no to get her a ride. Social Workers are there for more important things. I would have talked to the S/W and ensured that she didn't waste their time.

I would have told her the social worker was not in and she was being discharged. And next time to plan ahead for a ride home.

MassED, BSN, RN · Sep 1, 2011

I hear what you're saying. The ED can't become the major transportation hub for the looney, annoying, or mildly decrepit....but what about those who are too embarrassed to say they don't have cab fare, and the bus takes an hour to get to within 2 blocks of their home- and they have ambulation issues (and live alone, with an elderly parent across town from the hospital as the only potential resource, after daybreak- maybe- when he's home)? I do all I can to keep 15-20 bucks in my wallet for cab fare in an emergency (disability sometimes requires that money be used for rx's so not available- or be "convicted" of non-compliance if I don't get the meds, and end up in the ED for sure ).....
I''m sincerely asking what to do.... I know you don't know the EDs here (especially since I won't name them-lol)- one is great (the one I primarily go to - but haven't needed in over a year- yeah:)- but further away from home), and one is definitely run by the Marquis de Saad's direct descendants.... I have NO one. Suggestions are welcome- and to avoid highjacking the thread (not my intention - PM is fine). Thanks :) It's embarrassing to be an RN , on disability, but needing ED services-- fortunately less now than years ago...but it's still something I have to be prepared for. I've been PUT in cabs without being able to stand up- literally crawled on the ground from the w/c to the cab... (later found out it was a drug interaction that was causing TIAs from severe hypotension)... etc- the stories go on. During the worst time period, I'd be treated enough to regain consciousness, and turfed home alone. I had NO problem paying for the cab- when i had the money.
But I also learned to sink my own NG for gatorade boluses (with stuff I got from eBay) because of how I was treated by the nurses.....
I've been a nurse for a long time- longer than MANY of those who took "care" of me had been alive- I never asked for anything, didn't use the call-light (mostly from learning it most likely wasn't going to be around), never c/o pain- no mater what, etc. I never knew why I got the attitude. So, it was safer to risk dealing with the hypotensive episodes at home. My PCP knew- and had an MD from that ED who was decent tell her that if I said anything about how they treated me, he'd seen it.
When I figured out what meds were interacting, and got them changed, things changed a lot...I had other issues, but at least I wasn't getting B.P.s of 56/38 at home, with a heart rate of 48....I have dysautonomia to begin with- the meds really messed things up- but I was treated like a total psych case (no psych diagnoses in the mix at all).
Anyway, I'm sorry.... sometimes it's not that easy to tell who can or can't get home. And with a BP that low, I couldn't drive myself.
Hopefully, it won't be an issue since meds were changed years ago, and it's been better- but it was demoralizing and frightening to feel so hated, for some reason I didn't understand. But what do you do in that situation??? :)
I don't need medical advice- just how to plan on getting home IF the cab situation isn't an option .... that money is a LAST resort- and I'm not 'out' that often- but it does happen, and makes me nervous..... I was seen as "fine" when I crawled into the cab. It scared the snot out of me when I couldn't pick out my apartment and had to walk around in the dark looking for it.... but I was "stable" to discharge?????

case by case issues, we can get patients home. If I fight hard enough, the nursing sup will send one down.

Get this: had a paramedic tell an elderly woman, around 80, who lived alone, independent and a/o - called the ambulance for her left shoulder pain. The medic told her to NEVER call an ambulance again for anything like that.

I was MORTIFIED. Truly mortified. This little lady was so ashamed and upset and embarassed and asked to go home right away since she didn't need to be there. I nearly cried. I told this sweet little soul that she had every right (and WAS right) to come in by ambulance for ANYTHING she needed. I told her that it is correct to think of your heart, and that medic SHOULD have known better and I told her NO ONE could ever tell her not to or refuse her. I have never felt so protective of a sweet little elderly lady in my life.

I still want to kick that guy's hiney.

psu_213, BSN, RN · Sep 2, 2011

nope, You can take this lovely pillow and blanket

You mean I can take it home? Thanks! :lol2: (please note the sarcasm)

Anna Flaxis, BSN, RN · Sep 2, 2011

I'm one of those bleeding heart lefties that believes that access to health care is a right, not a privilege. I don't mind my hard earned tax dollars going to help those less fortunate than I am. And honestly, I don't think we have a problem with access to health care, what we have is a problem with access to PRIMARY care.

When you can't get in to see a doctor, because they're not taking new patients, or they won't see you without payment up front, and you have no money to spare or you work a cruddy minimum wage job and can't get the time off to go to a doctor without an act of congress, I can see why people get desperate and go the the ED for primary care, or put off taking care of chronic health problems until they reach a point where they need urgent medical attention.

There are people that truly do not have a support system to get them home, or have any money to spare for cab fare. Poverty is a real problem, and not easy to overcome. Poverty should not be equated to character flaws, IMO.

I have walked a mile in those shoes, where I needed help to keep a roof over my head and food in my childrens' bellies. It is demoralizing and humiliating, and it is NOT easy to lift oneself up out of it.

When I was on public assistance, I was urged to get a minimum wage job in order to "get off the dole" and be "self sufficient". I did the math. A full time minimum wage job would bring in exactly what it would cost me in day care to work outside the home. I would have been working in order to put my kids in day care. One cannot pay rent, utilities, buy food, pay for daycare, let alone have anything left over for unexpected expenses on minimum wage. My case worker told me not to worry, the State would continue to subsidize day care, housing, and food for me and my family. So in other words, I would have a job and STILL be dependent on public assistance. The idea of having a minimum wage job and no longer being dependent on public assistance was a lie.

When I told my case worker that I wanted to finish my high school education and earn an Associate's degree (in a field unrelated to nursing) so that I could become truly self sufficient and no longer need any public assistance at all, he told me that if I did go to college, I would be "cut off" from all benefits. In other words, the system was set up for me to remain dependent.

Well, I hate being told I can't do something, or threatened with hardship if I make my own choices, so of course I went to college. I got Pell grants for my first degree, and my case worker's threat turned out to be empty. I was able to attend college and earn a degree and still receive public assistance. Once I graduated, I was able to obtain a family wage job and leave public assistance behind permanently.

In my case, public assistance worked like it was supposed to (despite the efforts of my case worker to scare me into remaining dependent). It was a safety net for me until I was able to get back on my feet again.

So, as you can imagine, I can really identify with those who are at the very bottom rungs of the socioeconomic ladder, and I make a practice of treating *everyone*, no matter their socioeconomic status, with basic human dignity. That pregnant teenager, that unwed mother of five, that unemployed high school dropout, each one of them could be someone who could, with help and support, change their lives and become self-supporting, if they just know it's possible.

The thing about poverty is that it can feel like a trap. It can feel hopeless, like there is no escape, so why even bother trying? Everywhere you turn is another obstacle. It's easy to become cynical and embittered, especially when others look down on you with disdain.

I do get irked by the "work the system" mentality. When I feel like I'm being used, scammed, or manipulated, I get irritated. It's especially irksome when it's by someone who is not emergently ill attempting to monopolize my time while I'm taking care of others who ARE emergently ill.

But, I can understand how a person might need to use the ED for something as minor as a sore throat, and not have any resources or funds to get themselves back home. I can empathize with what it must be like to be in that situation.

What makes the difference to me is the person's attitude. There are some people who, no matter how down on their luck they are, still treat others with basic respect, who still know how to say please and thank you, who would still rather give something to their community and not just take.

Still, I don't get to decide who "deserves" a taxi voucher based on their attitude or whether they rub me the wrong way. If a person has no resources, no money, no support system, I'll at least try to get them a bus token.

I try to remember that just one bad lift, one stupid mistake by me or the other driver, one bad genetic link in my family history, and I too, could be once again dependent on the taxpayers.

I often liken working in the ED to the Stanford Prison Experiment. It's really easy to develop biases, to become irked by certain "types", and to adopt certain attitudes as one adopts the role of ED Nurse. I'm no angel. My absolute least favorite patients are the ones with Borderline Personality Disorder. They irritate the living bejeezus out of me with all the manipulation and drama. I have to remind myself that BPD is an illness brought on by emotional trauma and lack of nurturing in childhood, and the behaviors are symptoms of the illness. I work to remain aware of my bias and temper it with objectivity.

And yes, if they really need a taxi voucher, I'll get them a stinkin taxi voucher whether I like them or not.

Sorry about the novel!

xtxrn, ASN, RN · Sep 2, 2011

it's called state run health insurance. They DON'T pay for it. We do.

But the patient DOES get billed for it- repeatedly. BTDT :)

xtxrn, ASN, RN · Sep 2, 2011

you obviously don't work in an ER.
They tell their friends, and they tell their friend and so on and so on. It is not much easier. All of their drug addicted friends all end up coming in at 0200 on a Saturday night creating more havoc than we already have, so no, it is not "just easier" to give in. It's encouraging the bad behavior.
Just like docs give in and prescribe Oxycodone like there's no tomorrow, just to "treat their pain" and get them out the door. Um, doc, how about Ibuprofen and Tylenol? What's so wrong with that?

Nothing wrong with that if it works. :) I'm a big advocate of using the least CNS-depressing meds possible. :up:

Picture this- someone at home for several days with intense pain, and history of chronic pain. Called the doc- did what they should-, who wants to see them NEXT week...and this is on a Thursday...patient hangs on until 3 a.m. Sunday, when they can't take it any longer. They are not an addict. They may have tolerance and some dependence (way different than addiction), and thought they could just grit their teeth and suck it up- and had been rationing the few pills they had left to get to the appt date. The bulging discs and spurs in their c-spine are unrelenting. Finally, they have to go to the ED because they're having vasovagal symptoms from the pain.

So, the only way they can get there is 911.... not life threatening- but if they try and drive it could be. They don't know their BP is hovering around 80 systolic, or that their heart rate is dropping- they're decompensating. But a telephone pole might just clue them in- if they remember it. They get to the ED, and are immediately met with snarls, doubt, and disrespect (BTW, I've never gone to the ED for this sort of thing- so a true hypothetical ). You decide (along with the doc) that the pallor and clamminess are from withdrawal...NOT vasovagal symptoms. You think the BP is from taking too many narcs...They are given a couple of Tylenol, a neck x-ray (no scan- someone asking for pain CAN'T actually have something wrong- but an x-ray might shut them up ... :eek: ), babysat for a couple of hours, and then shown the door.

They get home and go lie down on the couch ..a few hours later (with NO pain relief for days at this point) they get up, and pass out from the vasovagal stim from the intense pain. Hit their head on the corner of the coffee table, and lay on the floor, out cold, for an hour or so. When they wake up, their head hurts now, along with their neck/shoulders. But they're a bit tired, and decide to go to bed. And never get up. The autopsy shows an epidural hematoma, herniation, and a moderate non-displaced skull fracture. All from passing out because of inadequate pain relief.

I realize this isn't the 'norm'- but is it worth risking it because of some preconceived idea about people asking for pain meds? Only 1% of those prescribed narcs become addicts- and the 99% who don't, get 100% of the grief for that 1%.

JMHO :)....worked alcohol/drug rehab, med-surg/ortho, neuro, head injury rehab/coma stim.... the above isn't too far fetched. And with healthcare access being incredibly difficult for those who don't have insurance or the cash to pay, they have to put up with things until it gets nuts (that I HAVE done).

MassED, BSN, RN · Sep 2, 2011

But the patient DOES get billed for it- repeatedly. BTDT :)

makes no difference if they get billed. That is why our state (un-named) is going broke from our state health insurance. They can TRY to bill, but won't be reimbursed.

Same goes for Massachusetts.

MassED, BSN, RN · Sep 2, 2011

Nothing wrong with that if it works. :) I'm a big advocate of using the least CNS-depressing meds possible.
Picture this- someone at home for several days with intense pain, and history of chronic pain. Called the doc- did what they should-, who wants to see them NEXT week...and this is on a Thursday...patient hangs on until 3 a.m. Sunday, when they can't take it any longer. They are not an addict. They may have tolerance and some dependence (way different than addiction), and thought they could just grit their teeth and suck it up- and had been rationing the few pills they had left to get to the appt date. The bulging discs and spurs in their c-spine are unrelenting. Finally, they have to go to the ED because they're having vasovagal symptoms from the pain.
So, the only way they can get there is 911.... not life threatening- but if they try and drive it could be. They don't know their BP is hovering around 80 systolic, or that their heart rate is dropping- they're decompensating. But a telephone pole might just clue them in- if they remember it. They get to the ED, and are immediately met with snarls, doubt, and disrespect (BTW, I've never gone to the ED for this sort of thing- so a true hypothetical ). You decide (along with the doc) that the pallor and clamminess are from withdrawal...NOT vasovagal symptoms. You think the BP is from taking too many narcs...They are given a couple of Tylenol, a neck x-ray (no scan- someone asking for pain CAN'T actually have something wrong- but an x-ray might shut them up ...), babysat for a couple of hours, and then shown the door.
They get home and go lie down on the couch ..a few hours later (with NO pain relief for days at this point) they get up, and pass out from the vasovagal stim from the intense pain. Hit their head on the corner of the coffee table, and lay on the floor, out cold, for an hour or so. When they wake up, their head hurts now, along with their neck/shoulders. But they're a bit tired, and decide to go to bed. And never get up. The autopsy shows an epidural hematoma, herniation, and a moderate non-displaced skull fracture. All from passing out because of inadequate pain relief.
I realize this isn't the 'norm'- but is it worth risking it because of some preconceived idea about people asking for pain meds? Only 1% of those prescribed narcs become addicts- and the 99% who don't, get 100% of the grief for that 1%.
JMHO :)....worked alcohol/drug rehab, med-surg/ortho, neuro, head injury rehab/coma stim.... the above isn't too far fetched. And with healthcare access being incredibly difficult for those who don't have insurance or the cash to pay, they have to put up with things until it gets nuts (that I HAVE done).

while I would never judge a person who has true pain and has TRIED other measures and then comes in for unrelenting pain and needing further interventions. What irks me is the other 99% of those seeking pain meds and the doc gives in. Here's my example, which is just another in a plethora of ones just like him: patient comes in for tooth pain, likely a dental abscess. Running all around the ER, me telling him to get back to the fast track waiting area if he wants to be seen or get out. Sure, he may have an abscessed tooth, but with him chewing chips and laughing and running back and forth to his girlfriend who is in another room, how does this look? He was like a rabid squirrel, acting just like a junkie - twitchy, not listening, running around. So what does the doc do? After I tell her the above scenario? I tell her, how about an antibiotic and some Vicodin? She says, no, because he could overdose on Acetaminophen. Really? So you give him Oxycodone now and some to go AND a script. So this naive doc, I then explained to her about our Oxycodone abuse in this specific state, but EVERY doctor prescribes Oxycodone as their first drug for pain. The other rationale, from another doctor, is that they were just preached about under treating pain. Why Oxycodone, considering this state's real problem with using/selling this drug? Why not give a lesser pain med, especially, when a person has stable VS, eating, smiling, in no acute distress, etc. Offer the most important drug, which is the antibiotic in the case of an abscess, NSAID (which is important also for pain), and perhaps Tyenol. This particular attending isn't the sharpest tool in the shed, by far, which is why I felt like she should think about what she's prescribing, only to prescribe the very drug that makes these patients come back in so frequently. Rather than focus on just giving them something for pain control and going to the STRONGEST pain med, offer them the lesser of all pain meds and go from there. If Tylenol/Motrin are ineffective, then come back.

Doctors are so worried about being labeled as one that doesn't treat pain, but actually they WOULD be treating it, just not letting patients dictate the narcotic of their choice. I just think these docs want to get these patients out without a fuss.

This is when I want to keep prescriptions in the chart and write "patient forgot"

xtxrn, ASN, RN · Sep 2, 2011

while I would never judge a person who has true pain and has TRIED other measures and then comes in for unrelenting pain and needing further interventions. What irks me is the other 99% of those seeking pain meds and the doc gives in. Here's my example, which is just another in a plethora of ones just like him: patient comes in for tooth pain, likely a dental abscess. Running all around the ER, me telling him to get back to the fast track waiting area if he wants to be seen or get out. Sure, he may have an abscessed tooth, but with him chewing chips and laughing and running back and forth to his girlfriend who is in another room, how does this look? He was like a rabid squirrel, acting just like a junkie - twitchy, not listening, running around. So what does the doc do? After I tell her the above scenario? I tell her, how about an antibiotic and some Vicodin? She says, no, because he could overdose on Acetaminophen. Really? So you give him Oxycodone now and some to go AND a script. So this naive doc, I then explained to her about our Oxycodone abuse in this specific state, but EVERY doctor prescribes Oxycodone as their first drug for pain. The other rationale, from another doctor, is that they were just preached about under treating pain. Why Oxycodone, considering this state's real problem with using/selling this drug? Why not give a lesser pain med, especially, when a person has stable VS, eating, smiling, in no acute distress, etc. Offer the most important drug, which is the antibiotic in the case of an abscess, NSAID (which is important also for pain), and perhaps Tyenol. This particular attending isn't the sharpest tool in the shed, by far, which is why I felt like she should think about what she's prescribing, only to prescribe the very drug that makes these patients come back in so frequently. Rather than focus on just giving them something for pain control and going to the STRONGEST pain med, offer them the lesser of all pain meds and go from there. If Tylenol/Motrin are ineffective, then come back.
Doctors are so worried about being labeled as one that doesn't treat pain, but actually they WOULD be treating it, just not letting patients dictate the narcotic of their choice. I just think these docs want to get these patients out without a fuss.
This is when I want to keep prescriptions in the chart and write "patient forgot"

Stable VS, talking, smiling, etc are NOT indicators of degree of pain (I would question crunching on chips with dental pain:uhoh3: :), especially with chronic pain- chronic pain is that patients' normal.. all acute markers are invalid when someone lives with constant pain.... And, if you intentionally do not give rx to patients, you're practicing medicine without a license by intentially withholding the ordered rx-- illegal in any state.... :eek: How it looks is irrelevant to what he says- I've seen too many patients suffer needlessly because of docs who won't treat pain. It's uncalled for- but I also see where ED folks see a lot of things that seem incongruent with pain....but nobody knows what someone else feels. That's just fact......Yes- patients can "look" just peachy while complaining about pain- you just can't say they're fine if you're not in their skin.

I have chronic pain (and NEVER have gone to the ED because of it- I end up with the vasovagal reactions that make it unsafe to stay home- but putting up with snarky ED folks is also horrible- so I stay home and have put down my own NG for fluids to get my BP back up while lying down- since sitting up to drink leaves me with the beginnings of blacking out- since my BP will tank into the 50s systolic- but if I can avoid those ED judges, I'm not going in... I'm not saying all are- but at one facility here, they are absolutely cruel....but who believes the patient???? Even my own PCP hasn't asked me what else I've tried for pain (you name it, I've tried it, from PT, TENS, chiropractor, epidural injections-useless, fentanyl patch-yuck, NSAIDs (when not on Coumadin), Toradol- good for some pain, not headaches for me, .... Theragesic cream, Icy Hot Patches, ice, heat (which triggers my dysautonomia), etc.... But I've NEVER had an ED ask about those when I've been there for other things, and the idiotic 1-10 pain scale questions come up -for chronic pain, those are absolutely useless.

They wouldn't be treating it if the meds don't work!!!....that just makes those who don't like pain meds given out feel better- absolutely nothing for the patient. I had an ED doc (who wasn't assigned to me) call my PCP and tell her that if I said anything about the ED nurses/doc- that he'd seen it- they were crappy, and worthless for why I was there.

I understand not wanting the ED to enable addicts- yet having even one patient with legit pain not treated is more reprehensible in my book. Junkies will get meds- period. People with actual pain don't have any legal options other than PCPs, or EDs if after hours or they don't have the insurance or cash to get care. It stinks- no doubt about it. :)

I do agree that Oxycodone is a problem (but can be life changing if used correctly) , and not a first line drug for pain anywhere !! THAT is bad news. Docs do get dinged a lot for under treating pain- and they get dinged for too many schedule II narcs or 'too many' schedule IIIs ... I can see MAYBE giving them a dose while they're in the ED, but a rx for something weaker, along with a oral surgery referral- and some sort of triage area check of recent visits for the same complaints to avoid hitting up the same ED for the same problem just to get meds without following up with their own doc. JMHO :)

FWIW, I've seen junkies hold down full time NURSING jobs, have successful dental practices, be lawyers, doctors, celebrities, homeless but neat and clean, be rich and filthy, etc-- junkies don't have a code of conduct or a dress code You don't know that the pristine middle aged woman with perfectly manicured nails, and designer clothes isn't taking 60 Vicodin a day (had one just like that in rehab).

Ruby Vee, BSN · Sep 2, 2011

ok, we get it. you have legitimate health issues, have never misused the er, believe everyone who says they're in pain whether they appear to be uncomfortable or not and sometimes need a ride home. now can we go back to our regularly scheduled rant?

xtxrn, ASN, RN · Sep 2, 2011

ok, we get it. you have legitimate health issues, have never misused the er, believe everyone who says they're in pain whether they appear to be uncomfortable or not and sometimes need a ride home. now can we go back to our regularly scheduled rant?

i apologize .....

MassED, BSN, RN · Sep 2, 2011

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Stable VS, talking, smiling, etc are NOT indicators of degree of pain (I would question crunching on chips with dental pain:uhoh3: :), especially with chronic pain- chronic pain is that patients' normal.. all acute markers are invalid when someone lives with constant pain.... And, if you intentionally do not give rx to patients, you're practicing medicine without a license by intentially withholding the ordered rx-- illegal in any state.... How it looks is irrelevant to what he says- I've seen too many patients suffer needlessly because of docs who won't treat pain. It's uncalled for- but I also see where ED folks see a lot of things that seem incongruent with pain....but nobody knows what someone else feels. That's just fact......Yes- patients can "look" just peachy while complaining about pain- you just can't say they're fine if you're not in their skin.
I have chronic pain (and NEVER have gone to the ED because of it- I end up with the vasovagal reactions that make it unsafe to stay home- but putting up with snarky ED folks is also horrible- so I stay home and have put down my own NG for fluids to get my BP back up while lying down- since sitting up to drink leaves me with the beginnings of blacking out- since my BP will tank into the 50s systolic- but if I can avoid those ED judges, I'm not going in... I'm not saying all are- but at one facility here, they are absolutely cruel....but who believes the patient???? Even my own PCP hasn't asked me what else I've tried for pain (you name it, I've tried it, from PT, TENS, chiropractor, epidural injections-useless, fentanyl patch-yuck, NSAIDs (when not on Coumadin), Toradol- good for some pain, not headaches for me, .... Theragesic cream, Icy Hot Patches, ice, heat (which triggers my dysautonomia), etc.... But I've NEVER had an ED ask about those when I've been there for other things, and the idiotic 1-10 pain scale questions come up -for chronic pain, those are absolutely useless.
They wouldn't be treating it if the meds don't work!!!....that just makes those who don't like pain meds given out feel better- absolutely nothing for the patient. I had an ED doc (who wasn't assigned to me) call my PCP and tell her that if I said anything about the ED nurses/doc- that he'd seen it- they were crappy, and worthless for why I was there.
I understand not wanting the ED to enable addicts- yet having even one patient with legit pain not treated is more reprehensible in my book. Junkies will get meds- period. People with actual pain don't have any legal options other than PCPs, or EDs if after hours or they don't have the insurance or cash to get care. It stinks- no doubt about it. :)
I do agree that Oxycodone is a problem (but can be life changing if used correctly) , and not a first line drug for pain anywhere !! THAT is bad news. Docs do get dinged a lot for under treating pain- and they get dinged for too many schedule II narcs or 'too many' schedule IIIs ... I can see MAYBE giving them a dose while they're in the ED, but a rx for something weaker, along with a oral surgery referral- and some sort of triage area check of recent visits for the same complaints to avoid hitting up the same ED for the same problem just to get meds without following up with their own doc. JMHO :)
FWIW, I've seen junkies hold down full time NURSING jobs, have successful dental practices, be lawyers, doctors, celebrities, homeless but neat and clean, be rich and filthy, etc-- junkies don't have a code of conduct or a dress code You don't know that the pristine middle aged woman with perfectly manicured nails, and designer clothes isn't taking 60 Vicodin a day (had one just like that in rehab).

while I can understand that YOU are different from 99% of the other patients (which I did already state in my previous post), you are not how most people present. Your situation and what you have to deal with is NOT who I am referencing.

Do you work in an ER??? Do you know what it's like to have frequent fliers? AND, yes I can use MANY different ways to evaluate pain. Wong-Baker,for instance. I CAN and DO use this tool to evaluate pain - if what their stated pain does not match what you see/hear/can evaluate (such as VS, which is absolutely a predictor of the degree of pain). I DID NOT state to NOT give pain meds, but to start with lesser degrees to START, not go immediately to Oxycodone. We have a huge need to medicate patients (and young ones at that) with meds that we used to only give out for those with Cancer, and as such, we are now creating a culture of "ask for this and you'll receive it" - instead of a doctor practicing MEDICINE and stating, this is what we'll give you right now, if that doesn't work, come back and see us if you can't get into your PCP and we'll re-evaluate. I DO understand all of the extenuating circumstances, but I'm talking about frequent fliers of an ER that DO NOT have these. You tend to lose the belief of pain and real emergency when we see them over and over for the SAME thing. I understand many states don't have dentists, for instance, who accept state insurance (Medicaid, for instance) or have very long waits to be seen for an urgent issue, and therefore it's difficult to get that abscess fixed.

Come on, don't take this personally, as I stated before I wasn't referencing YOU.

And of course we know that access to narcs in our profession leads to addicts of ALL kinds. I'm sure we all work with a few right under our noses. I'm not blind to that. I'm not judging people having their issues, I just want people to take care of themselves and it's THOSE that don't even make an effort for NONEMERGENT issues that drives me bonkers. Even then, if they're nice, it doesn't bug me at all.....