Difference of opinion with MDs - page 2
Hi everyone, I just wanted to pose a question, since I ran into a situation at work the other nite. Well, we had a young woman on our floor who was about 38yrs old, chronic migraines who came in... Read More
May 16, '02A quick update.....
When I went back into work the other nite, the patient was being discharged. Another nurse's comment was - She's whacked. She's a psych case, "faking the whole thing". Unbelievable. I guess cause all the tests came back negative they thought her pain was just in her head. So that makes her a "psych" case????
May 31, '02I learned a valuable lesson about how easy it is to label patients as drug-seeking a couple of years after I registered - young woman presented with vague but severe abdo pain and some unusual symptoms. AXR, CT NAD, somewhat elevated ESR and WCC. Her boyfriend was a reg on another unit and had come in to write up a couple of extra things on her drug chart (antimigranoids from memory) which really put peoples' backs up and didn't help he situation.
Anyway, I came on, got handover on her, and was told by an experienced nurse that "they can't find anything and she still wants lots of meds - I think there's something psych going on."
As it happened, I knew her - she'd trained a group behind me (at the same hospital we were at), and I'd gone to school with her sister. I'd never seen or heard anything to suggest that she was odd, or likely to drug seek, and her history was pretty benign - no multiple admits or anything. I went in to the patient and told her that I understood if she'd rather have someone else look after her, and she said she'd rather have me (which was very nice to hear )
For the next few days she kept being given the low end of her ordered dosage of pain meds, while the docs went on doing tests (all NAD) and the nurses kept saying "drug-seeking".
Turns out she had retrograde bleeding into her pouch of Douglas, and a fortnight after she was discharged she was diagnosed with SLE, which explains the atypical symptoms.
Such an unpleasant experience anyway, made worse by her colleagues, really made me realise that the adage 'pain is what the patient says it is' is true - it might not always be physical pain, but I don't dismiss physical pain just because we haven't found anything wrong. Yet.
May 31, '02My heart goes out to that patient. A year and a half ago, out of nowhere, I developed trigeminal neuralgia. I thought I had an eye infection; I went to my ophthalmologist! The pain was excrutiating; it was the first time I'd called in to work in two years. When I was referred to a neurologist and the MRI, MRA and every other test known to man was negative (except my ANA, which was 1:600!) I'd about decided that I was crazy myself! The Neurontin and Amytriptyline combination did help, but I still require Darvocet for breakthrough, and I'm ashamed that it's now taking 2 of them to knock the pain out instead of one. I was busy and stressed, but have a great job, great family, and I am NOT depressed, so I had a tough time accepting the Amytriptyline at first. I still hate and resent that the pain often gets in the way of my life and what I have to give to my job and family. And yes, sometimes I do still question whether it's all in my head.
May 31, '02Some good posts regarding this VERY subject in the other thread regarding " Pain Meds for the Addicted"........like I said there, PAIN IS WHAT THE PATIENT SAYS IT IS.....not what we make it to be. If that were my mother/sister/dad/grandparent/best friend, would I want to doubt it? NO WAY! So why do this to ANYONE ELSE? Like I said in the other thread, there are NON -PHARMACOLOGIC things we as nurses can do; soothingly talking to the patient/LISTENING/hand-holding/repositioning/applying heat or cold as needed/ distraction or diversion; it goes on and on. To simply write a patient in pain off is, IMO , criminal and unethical. Leave the diagnosis of addiction or being "whacked" to the dr/psychiatrist. We are not in that business as nurses.Last edit by SmilingBluEyes on May 31, '02
May 31, '02Whenever a patient insist they are in excrutiating pain and they exhibit physical signs and symptoms (your patient's numbness and tingling on the right side of her body; her headache, etc.), their pain shouldn't be questioned. As far as I recall, pain is "subjective" and not something for anyone but the patient to be able to relay on a pain scale level. As health professionals, we can 'objectively' say our patient's body language SUGGEST they are in a great deal of pain, but only the patient can truthfully tell us the level of their pain, where it's originating from, etc.
In cases such as this in TODAY'S WORLD OF HMO...my first inclination is to think they are shamming one over on the patient(s) who continue to say they are in pain when the docs are saying their tests proved "nothing" present. Docs and hospital medical staff are being PAID to say "Nothing is wrong" with certain patients. We need to keep this theory in mind, whether it ever pans out to be right or not. EVERY avenue must be investigated. I hope that patient doesn't let up until someone listens to her. Won't they feel like crap if that same patient returns via ambulance from a stroke, an aneurysm, or dead on arrival due to their negligence and stupidity??? DUH!!!
May 31, '02At our medical center we (pushed by JCAHO) have implemented the "Pain as the Fifth Vital Sign" campaign, educating the nursing staff to assess it (level: 0-10, and character: stabbing, sharp, burning, constant, etc) with the vital signs and treat it as whatever the patient says it is. All documentation is being revised to reflect this focus on taking the pt seriously (shucks, even ASKING about it!) in this area. I for one am very glad we have an active Pain Service in the medical center. I had a pt transported to Radiology for fluoroscopic PICC line insertion recently. She was, briefly, beside herself w/pain and anxiety r/t the pain (can't remember source but it was not something subtle), and she was (cruelly) undermedicated. I offered verbal reassurance, medicated her for anxiety AND for pain (per Radiologist) and spoke to her MD about a referral to the Pain Service, told him she said the meds she was getting didn't even touch the pain, could she get eval. by Pain Service? He gave a verbal order and apparently they saw her within 24 hours. I happened to see her in the dept two or three days later: calm, awake (not gorked out), and she stated her pain was 2/10 now - in otherwords, tolerable! I also tell pts whom I interview before giving (po) meds for anxiolysis for MRI-induced claustrophobia (most of L- C- and T-spine MRIs are for chronic pain) how helpful Pain Service can be. A lot of patients with chronic pain tell me they have stopped most pain meds on their own "because I don't want to be out of it" or "I don't want to get addicted." I tell them about all the advances in pain control that improve the pain without the grogginess, and to consider discussing this w/their MD (depends on the MRI findings, too, what the next treatment direction will be). I want someone to take MY pain complaints seriously!! It is true, micro, mind=body - they are SOOOO connected! Weeeeeeellllllll, I must admit . . . sometimes my mind leaves for awhile . . . -- Diana
Jun 1, '02Originally posted by dianah
Sorry micro, misquoted you. "Mind=brain." My bad. -- D
:kiss :kiss :kiss
Jun 1, '02I may have posted this elsewhere but it bears repeating.
As a house supervisor on nights 2 youngish women came into the ER c/o vague symptoms and pains but it scared them enough to come to the ER. The ER doc on duty was one of those who didn't take women's complaints seriously...he couldn't find anything wrong so discharged them home.
I heard later one returned to the ER several hours later with her very angry husband... when she then was admitted for evolving MI now evident on 12 lead, but too late to TPA. .
The other one? Well, her SO found her dead in bed next to him in the morning. Autopsy showed massive MI sudden death. He sued. I NEVER ignore complaints particularly of women...their symptoms of MI are so much different than mens....better safe than sorry.
Jun 1, '02im so glad to see so many nurses who truly advocate pain management.
amy...you should feel so good about yourself ...you are what nursing is all about.
everyone that comes in is "seeking" ...well some are ...some arent. i always ask their nurses this question:
why the hell do you care?
how long is the average hospital stay? two days? will patients become addicted in that amt of time?
if they already are addicts how will this affect them ...in two days?
i have seen more patients undermedicated for pain due to their nurses perception of their motivation than i have seen actual seekers.
if my pt tells me they are in pain, they are in pain and i medicate them. the end.
all the other stuff...psych consults...addiction treatment...all that...is on the doc not me.