Believing your patient

I work in ED and ICU and we have a saying... Rule #1, The patient always lies... The answer to your question, however, is that we as nurses(most of us) have a caring spirit about us. I will continue to care...

People lie period end of story. I believe very little of what comes out of anyones mouth. I do not take it personally. It is what it is and people are what they are.

How do I continue to treat people who lie? I do not think about whether or not they are lying while I am taking care of them. I try to see around the words that they are speaking and treat the true problem. I know I am not wording this right, but I guess I go by what their body language is saying. In my opinion, a person's body language can tell me a lot more about what is going on with a person than what they are telling me with words.

What about someone who is wanting pain medicine, who has a drug screen positive for opiate and cocaine that is still telling you that they need something for the pain......"Oh, it's killing me....the pain.......whhaaaaaaaaaa"

I KNOW most everyone lies, but you have to believe them, or at leasst that is what they tried to brainwash me into thinking in nursing school. I have a patient currently who has answered twice, when asked, "Do you use any street drugs?" "No." Even though I have her UDS that shows THC. I KNOW she is lying. It is hard to take anythingg she says as being true.

(sorry about the typos, this computer has probblems)

Pat

Do you honestly think that someone who has a substance abuse problem doesn't have pain? On the contrary, the substance abuse tends to create a high tolerance level for narcotics and they need more to achieve pain relief. Sure, there are some (many?) who will lie and be drug seeking, but unless you are working in a substance abuse clinic, the pain is what the patient says it is and should be treated accordingly. Some may not consider marijuana to be a street drug, as well, reserving that category for things like crack, heroin, meth, etc. Please don't become yet another jaded nurse. You don't have to believe them, you just have to treat them to the best of your ability.

I believe they have pain. I also believe they should get with a doctor and get it taken care of, not self-medicate with illegal substances, then come to the hospital sayinng they hhaven't taken anything, which could lead to an overdose.

Marijuanna is a street drug the same as every other thing you listed. I'm so sick of people saying, "It's JUST pot". It is illegal until it is made legal and no where here is it legal. Taking your moms oxy's is "street drug use" too.

I was a jaded EMT long before I became a nurse.

Pat

Thing is, you have to treat them for pain while they are under your care. That's all.

Other than the usual teaching... "get some help, here's how" on discharge, you can't legally give them "hard knocks" care. All you can do to protect yourself is to discuss lab results with MD for consideration. Assess before you give, during giving, and after giving - -always repeating that too much too fast can do more harm than good. Chart away.

I remembered something about a drug causing false positives for THC.

Turns out tthat Protonix can cause false positives on urine drugs screens. This pt. is taking Protonix.

So, I will admit, it could be wrong and I falsely judged. I'm human, it happens!

FYI: The patient recieved the same level and quality of care I always give, and I've never had any complaints.

Pat

Why do people assume that having opiates come up on a drug screen means that the patient is either, a drug seeker, or lying about their pain (I know that cocaine came up as well, and that's not the part I'm talking about). I am on a long-term extended release narcotic, so I will always have an opiate + drug screen. That doesn't mean I don't ever have pain, or that I'm doing something I'm not supposed to be.

That way of thinking makes me sad, and it also makes people fear seeking treatment for pain that's out of the ordinary, since they know they won't be believed.

If you are up front and when you are triaged say, "I'm on Oxycontin". Then when it comes back in your system (at leastt in my mind), I don't care. You have an RX for it. It isn't prudent to the situation.

You can't get an RX for marijuana in Indiana, and RARELY does anyone say "Yes, I smoke MJ". If they do, then I KNOW it is gonna be there. Be TRUTHFUL. If someone comes to the ER with back pain and says that they got a Percocet from their grandma, we might say, "You shouldn't do that." But we know it is gonna be there if a UDS is done, no surprise, no LIE. Medical folk and patients have a relationship that should be built on trust. Patients trust us to know what we are doing, (although suing has taken this oout of the equation) and we trust our patients to tell us the truth. This relationship doesn't exist anymore.

We need to know what you have taken to make sure we don't KILL YOU. (Chronic opiate use + Stadol = Narcotic withdrawl ~ death) Not always.

Also, the "opiate, cocaine" story was a story, it was an "if".

Why do people assume that having opiates come up on a drug screen means that the patient is either, a drug seeker, or lying about their pain (I know that cocaine came up as well, and that's not the part I'm talking about). I am on a long-term extended release narcotic, so I will always have an opiate + drug screen. That doesn't mean I don't ever have pain, or that I'm doing something I'm not supposed to be.

That way of thinking makes me sad, and it also makes people fear seeking treatment for pain that's out of the ordinary, since they know they won't be believed.

I don't care about this type stuff on a general basis. And it never affects the care I give.

I do my job very well, I treat it as more than a job. I don't WANT to touch these people, much less "hang out" with them.

You're there to do a job, to provide nursing services to people, not to become BFF :). People lie and manipulate to get their needs met (we all do, to some degree). Sounds like you (the OP) are maybe taking this a little too personally. Just stay professional, do your job, and "keep on trucking."

i think in many situations, it doesn't matter if the patient is truthful. you ask a question, you document the answer. the original poster did not express that the issue was about pain/drugs. if it is about pain, the same things applies--ask the question document the response. if the patient says they are in 9/10 pain while chit chatting, you are obligated to treat 9/10 pain. if a diabetic has a blood sugar of 450 and swears she isn't hiding food--she still gets her insulin.

now, there are possibly times when the lies you know or suspect need to be addressed or handled. that needs to happen in a planned setting & time. or, if it is simply something the person just can't deny: state in a non emotional tone, as though you were telling someone what color paint you wanted to buy and why. because i saw you ______, i am unable to give you what you are requesting). NEVER feel like you have to prove you know you are right or argue with a patient.document and....use your resources. don't dump the problem on the charge nurse or MD, but utilize their experience and ask for help. get pain management, social work, family if appropriate--careful with that--use the ancillary staff who can help. don't let them take it from you, that is not professional for you to allow that. but we nurses are not a one-man show.

it seems like it because PT wants us to help with ROM, RT wants us to help with nebs, CNA's want us to help turn, feed, etc....social work tells us we are capable of setting up home care ...transport doesn't have anyone right now, so you will have to bring the pt to x-ray yourself....no one is afraid to Just Get The Nurse To Do It are they? well--we can ask them for help too! this is not all on you. depending on them to tell the truth puts unintended value on the type of care the patient should get. you can mentally remove yourself a bit and still be very caring and involved.