This week, I have officially become sick, tired, and disgusted with the drug-seeking behaviors and, in addition, the Press Ganey-brainwashed administration that condones them.
Patient comes to ED for "torso" pain (trying to be vague), straightfaced in a gown standing @ TV in room flipping through channels and going on and on on her cell phone about how someone owes her money. Seeing me, she comes over to the bed, sits down, and says "Go ahead," sticking out her arm while still talking away on her cell. I kindly explain that I need to ask questions and assess prior to pain meds, and will wait until she's finished with phone conversation. Of course, phone is hung up pronto. Upon sticking her arm out for me, multiple track marks, red infected areas that look like brown recluse bites (from dirty needle use), OK. I ask if there is IV drug use, and get a shocked-meets-almost-offended "Oh god, no. I've been in the hospital and stuck so much, they can't ever get a vein."
Long story short, friends show up (that my patient actually wants in the room), and they ask if they can talk to me. I go in the privacy room and they start going ON and ON about the patient's heroin and now pain med addiction, and that she needs help, and we need to make her get help, etc etc etc. During this, I share no info, only nodding and saying, "Ok..." Upon asking patient about contradicting info, she is again very surprised and denies ever having used heroin, as well as everything else.
So, she wants friends in room. Friends go in, and in front of me, confront her. Eventually she admits to issues, and still wants pain meds. Thankfully, goes home with an rx for Motrin. :) STILL. Gave her Dilaudid and Toradol prior to Intervention. And I've given her 10mg Dilaudid over the past 2 weeks in various visits. And we have another patient that comes in with back pain, pain is a 9/10, gets Dilaudid 2mg + Zofran 4mg IV, pain is then 8/10, gets another Dilaudid 2mg IV, pain is 6/10, and is discharged. EVERY TIME. Like 14-15 visits since 8/1/08. Other patients, same stuff. Dilaudid, dilaudid, dilaudid.
Similar patient went to administration because pain was not treated how she thought it should be... doc got chewed a new a-hole, and what good does that do? Do whatever you can to please your patient, even if it means feeding a drug addiction? I honestly HATE this. I chart like the queen b-tch, noting facial expressions, behaviors, grimace, guarding, moaning with no tears, laughing with friend in rm, watching tv and drinking mountain dew though nauseated and in severe abdominal pain, etc -- still, our docs are just as fed up but in talking about this, have literally said, "After Dr. Got-chewed-out got called in to whoever's office the other day, I'll put them in a Dilaudid coma if I have to. Whatever will make the patient happy, right?"
Since when did pain become so freaking terrible? I personally would rather be in some pain than be completely numb to my life as a whole. Me and most of the ER staff:
Sorry, and thanks for listening! As the title says, I feel like a legalized dope dealer, and it makes me incredibly uncomfortable. Hrm!
