What do the drug seekers coming into your ER ask for most? In our ER it seems to be Vicodin or oxycontin.
What is their usual complaint? In our ER it usually is back pain with pain radiating down the leg. Sometimes they will limp.
Do you have ANY ER Doctors with the Balls to order a non Narcotic? We do. Its cut down on our repeat offenders! Can lead to some very entertaining and loud discussions behind those pt curtains....
Ever have a repeat offender that went really bad? We did. Came in as an overdose after a year of weekly visit for refills of Vicodin for uncontrolable back pain and spasms. Died. Found out later his main income was reselling his pills to those in the area and online. Family sued the Dr and facility for allowing him to become addicted..... and won.
Years ago, at a small community hospital I worked at, a GP routinely admitted patients with "Flu Syndrome" and gave them IV Dilaudid and Phenergan q 2 hrs. Our ER was also overrun with his other patients who were addicted to Percodan. This nonsense continued, until a Resident who was covering for this Dr. got fed up and filed a complaint with the Medical Board.
Ten years ago, a local Dr. was busted by the DEA for illegally prescribing narcotics. No one did anything, until this Dr. diagnosed one of his patients with "hemorrhoids". The patient died of colon cancer and his wife turned him in to our State's Attorney General. :angryfire
I guess "seekers" will do whatever they have to do to get the "fix" ?!?!?
I know some patients take the ER for granted, but I get really mad that the attitudes by the ER staff change so much regarding pain........they start to think every person walking through the door, without visible blood, is a seeker.
Isn't ACUTE pain THE sign and symtom that something is WRONG ?!?!?!?
Sometimes it is real.
I have worked ER, and I have seen the repetitive patient come in with h/a, back pain, looking for a shot, and getting mad when not given what requested...
but I also have seen the repetitive pt with a h/a come in and be treated multiple times like an addict.. she wasn't very neat, or clean, sometimes wearing the same clothes, and always begging that something was wrong, and then when medicated, seeemed ok. The ER staff...quickly "labeled" her, within 3 visits in 2 weeks....... and she visited for about 3 months. She really had a brain A/V malformation, that wasn't detected with CT, and came in for the last time, with a hemmorrhagic CVA, died. NO O/D here.
I guess "seekers" will do whatever they have to do to get the "fix" ?!?!?
I know some patients take the ER for granted, but I get really mad that the attitudes by the ER staff change so much regarding pain........they start to think every person walking through the door, without visible blood, is a seeker.
Isn't ACUTE pain THE sign and symtom that something is WRONG ?!?!?!?
Sometimes it is real.
I have worked ER, and I have seen the repetitive patient come in with h/a, back pain, looking for a shot, and getting mad when not given what requested...
but I also have seen the repetitive pt with a h/a come in and be treated multiple times like an addict.. she wasn't very neat, or clean, sometimes wearing the same clothes, and always begging that something was wrong, and then when medicated, seeemed ok. The ER staff...quickly "labeled" her, within 3 visits in 2 weeks....... and she visited for about 3 months. She really had a brain A/V malformation, that wasn't detected with CT, and came in for the last time, with a hemmorrhagic CVA, died. NO O/D here.
My guess is this should be the lawsuit case....
and that's just ONE.
That's why they need a primary care doctor and not be seen in the ER.
I guess "seekers" will do whatever they have to do to get the "fix" ?!?!?
I know some patients take the ER for granted, but I get really mad that the attitudes by the ER staff change so much regarding pain........they start to think every person walking through the door, without visible blood, is a seeker.
Isn't ACUTE pain THE sign and symtom that something is WRONG ?!?!?!?
Sometimes it is real.
I have worked ER, and I have seen the repetitive patient come in with h/a, back pain, looking for a shot, and getting mad when not given what requested...
but I also have seen the repetitive pt with a h/a come in and be treated multiple times like an addict.. she wasn't very neat, or clean, sometimes wearing the same clothes, and always begging that something was wrong, and then when medicated, seeemed ok. The ER staff...quickly "labeled" her, within 3 visits in 2 weeks....... and she visited for about 3 months. She really had a brain A/V malformation, that wasn't detected with CT, and came in for the last time, with a hemmorrhagic CVA, died. NO O/D here.
My guess is this should be the lawsuit case....
and that's just ONE.
How sad for that patient and her family. Due to the ER staff's prejedices, she died. Seekers cause the medical staff to assume which clouds their judgement.
I, too, am a chronic pain patient. I've been to an ER exactly three (3) times in the last ten years for pain. I have a long history of nine Cerivial and Lumbar surgeries from a birth defect. I have no use of my left arm or hand; I can't stand for more than 3 minutes, I have foot drop on the left and of course, unrelenting pain which is at a 3/4 level with medication.
But, sometimes, something goes wrong, very wrong and the pain is intolerable and the meds I have will not help. You are at a point where you can't quit screaming from the pain, so your only choice is to go to your hospital's emergency room for help and care. I'll never go again except on a stretcher and half dead. The staff treat you like an addict and a drug seeker; they humiliate you; they ignore you; and if the Doctor believes you, the nurse will give you the least amount of pain relief possible because she/he can. They'll do whatever it takes so you'll never go back. Well, I haven't as well as many of my Doctor's patients who absolutely refuse to go to the ER.
Today, while in my Doctor's office he was seeing his patients with the Head of the ER at the hospital and he wanted me to tell this Doctor why none of my Doctor's patients would not go to his ER.
Well, I was as about as direct as I could be. I told him all the horror stories that I had experienced as well as other patients that I personally know about. In my experience, it wasn't the ER Doctor as much as it was the support staff who treated me with no respect, no kindness, no caring, and were very aggressive in their feelings that I was just a "drug seeking addict" that they had no time for. I've actually been called that in front of others within hearing range and I was so humilated by that remark because others had heard what that nurse had said. But, at that point, I was in so much pain, the kind of pain that you can't even close your eyes, you can't breathe, you pray to die and then I have a nurse that labels me. She even said, you might be able to fool the Doctor, but SHE knew I was a liar and making it up. I just cried in pain and in humiliation because my family was standing right there to hear this. God only knows what she documented on my chart. Her notes will be reviewed at some time during my future care and they will lead those medical personnel to "assume" the same thing before I even have a chance to be examined. Her incorrect charting will destroy my chances of ever getting proper care or kindness in the future, so why would I subject myself to that again?
So, there you have it. Will I ever go to another ER, ABSOLUTELY NOT! Like I said, only on a stretcher and probably knocked out and when I awakened, I'd limp like hell out of there with my walker never to be seen again......
I hope what I've written will open some eyes. I do know it must be very difficult to try to figure out who is really in pain and who is not. A nurse on this site put it very clearly, she said, "A patient's pain is what they say it is", and you go on from there. God bless her, I wish she was my nurse many times over. As matter of fact, many nurses on this site have been kind and caring because they lived up to their oath to care for the sick and people who are in pain.
So please, when a chronic pain patient appears in your ER, and I mean those that show up rarely, not every day or every week, give them the benefit of the doubt before you immediately "assume and cast accusations" at them.
Your kindess goes a long way when someone is suffering.
I do know it must be very difficult to try to figure out who is really in pain and who is not. A nurse on this site put it very clearly, she said, "A patient's pain is what they say it is", and you go on from there. God bless her, I wish she was my nurse many times over. As matter of fact, many nurses on this site have been kind and caring because they lived up to their oath to care for the sick and people who are in pain.
So please, when a chronic pain patient appears in your ER, and I mean those that show up rarely, not every day or every week, give them the benefit of the doubt before you immediately "assume and cast accusations" at them.
Your kindess goes a long way when someone is suffering.
I am very sorry for your experiences. I just hope in all the time I've worked in the ER I've never treated anyone in the way you've been treated.
That being said, if anything will cause me to leave the ER after 25+ years it will be the drug seekers. I never want someone in pain to not be treated appropriately, but is it not just as inappropriate to facilitate someone's drug addiction? I sometimes have days where I feel like the pusher and that's about it.
Sometimes I think that Lorcet and Soma (a couple fave drugs of abuse in my neighborhood) should just go over the counter so that the addicts can get what they need without overburdening the health care system. Tax it like heck then put the money into effective rehab. I mean, how many times does an alcoholic come to the ER begging for a drink?
Okay, it's just a thought when I'm feeling frustrated.
How sad for that patient and her family. Due to the ER staff's prejedices, she died. Seekers cause the medical staff to assume which clouds their judgement.
I, too, am a chronic pain patient. I've been to an ER exactly three (3) times in the last ten years for pain. I have a long history of nine Cerivial and Lumbar surgeries from a birth defect. I have no use of my left arm or hand; I can't stand for more than 3 minutes, I have foot drop on the left and of course, unrelenting pain which is at a 3/4 level with medication.
But, sometimes, something goes wrong, very wrong and the pain is intolerable and the meds I have will not help. You are at a point where you can't quit screaming from the pain, so your only choice is to go to your hospital's emergency room for help and care. I'll never go again except on a stretcher and half dead. The staff treat you like an addict and a drug seeker; they humiliate you; they ignore you; and if the Doctor believes you, the nurse will give you the least amount of pain relief possible because she/he can. They'll do whatever it takes so you'll never go back. Well, I haven't as well as many of my Doctor's patients who absolutely refuse to go to the ER.
Today, while in my Doctor's office he was seeing his patients with the Head of the ER at the hospital and he wanted me to tell this Doctor why none of my Doctor's patients would not go to his ER.
Well, I was as about as direct as I could be. I told him all the horror stories that I had experienced as well as other patients that I personally know about. In my experience, it wasn't the ER Doctor as much as it was the support staff who treated me with no respect, no kindness, no caring, and were very aggressive in their feelings that I was just a "drug seeking addict" that they had no time for. I've actually been called that in front of others within hearing range and I was so humilated by that remark because others had heard what that nurse had said. But, at that point, I was in so much pain, the kind of pain that you can't even close your eyes, you can't breathe, you pray to die and then I have a nurse that labels me. She even said, you might be able to fool the Doctor, but SHE knew I was a liar and making it up. I just cried in pain and in humiliation because my family was standing right there to hear this. God only knows what she documented on my chart. Her notes will be reviewed at some time during my future care and they will lead those medical personnel to "assume" the same thing before I even have a chance to be examined. Her incorrect charting will destroy my chances of ever getting proper care or kindness in the future, so why would I subject myself to that again?
So, there you have it. Will I ever go to another ER, ABSOLUTELY NOT! Like I said, only on a stretcher and probably knocked out and when I awakened, I'd limp like hell out of there with my walker never to be seen again......
I hope what I've written will open some eyes. I do know it must be very difficult to try to figure out who is really in pain and who is not. A nurse on this site put it very clearly, she said, "A patient's pain is what they say it is", and you go on from there. God bless her, I wish she was my nurse many times over. As matter of fact, many nurses on this site have been kind and caring because they lived up to their oath to care for the sick and people who are in pain.
So please, when a chronic pain patient appears in your ER, and I mean those that show up rarely, not every day or every week, give them the benefit of the doubt before you immediately "assume and cast accusations" at them.
Your kindess goes a long way when someone is suffering.
I am afraid you are failing in your attempt to educate. The only way to educate is to change the way that students are taught about acute and chronic pain management and what drug addiction is all about. Research has shown that most programs devote three hours to pain management and it is mainly focused on acute. Not only requiring that patients be assessed properly but also that all nurses undergo re-education would be a step in the right direction. Do I think it will happen------no but I can hope.
Like you, I am a chronic pain sufferer. I avoid going to the ER for the same reason you do. And I think that it is a shame that you and I have to put up with such things. I sometime wonder how those who judge, would like being judged, if they found themselves in our shoes.
That's why they need a primary care doctor and not be seen in the ER.
Not everyone can afford a primary care doc, and in some states like mine, if you are over 18 no matter how poor you are or why you are poor, you do NOT get any medical or dental benefits. We have young folks coming in with horribly infected teeth who can't see the local dentist because they owe him money. So what should we do?say oh well suffer? We don't, antibiotics and pain med is needed and prescribed. Some people think we should treat dogs better than poor folks.
Can you imagine the kind of emotional/physical/spiritual pain that drives you to be an addict and then to submit yourself to the sneers and snickers of many ED staff(not all)? I will not allow that in my ED. We do our best to get these folks the help they need and we do find that many of the ones formerly called frequent flyers did have underlying medical problems that needed treatment.
We have started a pain clinic and some of these people have begun to find relief for the first time in many years. A kind explanation as to why continued narcotics is not the best way to handle their pain, prescriptions for alternatives and meds to prevent serious side affects of withdrawal and an appointment at the pain clinic(gratis) goes a long way with most and the others, maybe the sellers just move on.
I truly believe if we standardized the way we deal with chronic pain patients in the clinic and ED settings, like we do for Acute Coronary Syndrome, there would be no place for the truly devious to move on to.
I know they can be frustrating to deal with but they deserve to be treated with human compassion and dignity.
Not everyone can afford a primary care doc, and in some states like mine, if you are over 18 no matter how poor you are or why you are poor, you do NOT get any medical or dental benefits. We have young folks coming in with horribly infected teeth who can't see the local dentist because they owe him money. So what should we do?say oh well suffer? We don't, antibiotics and pain med is needed and prescribed. Some people think we should treat dogs better than poor folks.
Can you imagine the kind of emotional/physical/spiritual pain that drives you to be an addict and then to submit yourself to the sneers and snickers of many ED staff(not all)? I will not allow that in my ED. We do our best to get these folks the help they need and we do find that many of the ones formerly called frequent flyers did have underlying medical problems that needed treatment.
We have started a pain clinic and some of these people have begun to find relief for the first time in many years. A kind explanation as to why continued narcotics is not the best way to handle their pain, prescriptions for alternatives and meds to prevent serious side affects of withdrawal and an appointment at the pain clinic(gratis) goes a long way with most and the others, maybe the sellers just move on.
I truly believe if we standardized the way we deal with chronic pain patients in the clinic and ED settings, like we do for Acute Coronary Syndrome, there would be no place for the truly devious to move on to.
I know they can be frustrating to deal with but they deserve to be treated with human compassion and dignity.
Eeyore
Yes, yes, yes. :balloons: to you and your facility. And their forward thinking policies.
I'm sorry for your experiences in the ED. To be honest, I think it is purely a lack of education. My mum, for instance, lives on Dihydrocodine just to be able to walk, if she were to attend the emergency department with acute pain, it is doubtful that the nurses would believe that most painkillers would not touch her pain, they would think that she was making it up. I'm an ED nurse, I know collegues would think that.
The problem lays firmly with the fact that some drug seekers come in and say "such and such doesn't touch me", believe me when I say that there is quite a number of people who attend and say such things. This is what undermines Chronic pain sufferers and their treatment.
I'm not sure what the answer is, other than carrying your prescription forms to prove you are regularly on strong painkillers regularly. I know ED nurses have looked at my mum as mad because she tells them she had a fracture of three places of her cervical spine, purely because she can walk!
It's a sad state of affairs when people with non-genuine problems make nurses not recognise the real sufferer. When training, we are told that "pain is what the patient tells you it is".... in conjunction with knowledge, I hope I still recognise the patient who is truely suffering.
I hope the last few replies have helped a few nurses to understand how hard it is with chronic pain. I am fortunate enough to have a kind and caring doc that helops me. I am a nurse in ER and what the lst few folks have just written is true. I won't go to the ER for help I will call my Doc first. I have a rare genetic rhematoid typ of arthritis and it hurts all the time and never relents. There are days I would love to just give up. I also do other things to help the pain I meditate every day and believe it or not that helps, maybe just clearing my head and trying to get above the pain, but it helps. Before you label try to see them as what they are. Even the drug seeking addict has a disease. It is the disease of addiction. Nobody grows up saying I want to be a drug addict when I grow up.
I truly believe if we standardized the way we deal with chronic pain patients in the clinic and ED settings, like we do for Acute Coronary Syndrome, there would be no place for the truly devious to move on to.
I know they can be frustrating to deal with but they deserve to be treated with human compassion and dignity.
Eeyore
This does not mean there addiction to meds has to be fed. I do not know of one state that does not have medicaid NOT ONE. People who are frequent flyers to the ER for migraines, backpain and what not who demand their shots are treated with suspect. The ER is not for primary care and you would agree if the hospital cut your check by 25% to pay for them.
I'm sorry for your experiences in the ED. To be honest, I think it is purely a lack of education. My mum, for instance, lives on Dihydrocodine just to be able to walk, if she were to attend the emergency department with acute pain, it is doubtful that the nurses would believe that most painkillers would not touch her pain, they would think that she was making it up. I'm an ED nurse, I know collegues would think that.
The problem lays firmly with the fact that some drug seekers come in and say "such and such doesn't touch me", believe me when I say that there is quite a number of people who attend and say such things. This is what undermines Chronic pain sufferers and their treatment.
I'm not sure what the answer is, other than carrying your prescription forms to prove you are regularly on strong painkillers regularly. I know ED nurses have looked at my mum as mad because she tells them she had a fracture of three places of her cervical spine, purely because she can walk!
It's a sad state of affairs when people with non-genuine problems make nurses not recognise the real sufferer. When training, we are told that "pain is what the patient tells you it is".... in conjunction with knowledge, I hope I still recognise the patient who is truely suffering.
I hope you have better experiences in future.
I appreciate all the posts regarding people who suffer from pain. Your educated responses does help me to understand the other side of the coin when trying to treat people in pain.
I'm sorry about your Mum, it must be hard on you to watch her suffer, because I know it is hard on my 20 yr. old daughter when she hears me cry in agony when the pain has gotten out of control. I have no idea why I can go from functioning to pain so bad that death would be better, nor does the Doctor. He just says the disease is getting worse or the nerve root has become inflamed and irritated , etc, etc.
Your idea of bringing my prescription bottles to an ER is a good idea to have proof that I'm in a pain management program, but all they really have to do is bring me up on their computer and see all the surgeries, physical therapy, blocks and acupunture to see that I am a long time patient. I guess they don't bother. I always go to the same hospital, the same Doctor, the same pharmacist which makes things easier all around.
During one of those three visits to an ER I spoke about earlier, I was taken to the ER by my husband because of weakness, stiffness and severe pain in my left shoulder, arm and hand. I had been stripping wall paper earlier in the day. I called my Doctor and he directed me to my hospital's emergency room for care and that he would try to stop in later to check on me as he would be at the hospital performing a surgery.
An X-ray was done along with a CT scan and I was told it was inconclusive. The pain was horrible and unrelenting. They gave me 10 mg. of valium in the IV and it didn't do anything to relieve the agony I was in. The ER Doctor came in and said to me in front of my husband that he gave me enough valium to knock out a horse and in his opinion I was just trying to get narcotics from him and he was not falling for it????? My husband wanted to strangle him, I just cried and we went home. For hours afterwards at home I was in agony the entire night.
At 5:30 AM the next morning, my Doctor called from the hospital and wanted me to return immediately for emergency surgery. He told me not to move my neck at all, just keep looking straight ahead. I don't know all the medical terms for this, but evidently discs at level 3,4,5, and 6 were either bulging and/or ruptured and pressing on the nerves in my spinal cord where I could have become paralized.
I was admitted, a metal rod with screws were put in during a six hour surgery. I didn't have feeling in my arm or hand for a month, nor was I able to lift my arm more than a few inches. To this day, I cannot lift my arm more than picking up a fork and feeding myself. I can't do my own hair because the arm won't go that high without dropping back down within seconds.
So, there you have it. A Doctor assumed I was a drug addict and only God knows if I had been treated sooner would I'd be able to lift my arm today.
My other point in this long post is that as soon as the ER Doctor made it clear how he felt, the nurses than treated me like I was a thorn in their side and wasting their time. That was the last time I went to an ER except once after having back surgery and sent home a few days later, I began to leak spinal fluid at the surgical site and was unable to walk and my head felt like it was exploding. But, my Doctor was standing there waiting for me to take me to surgery, which is what he did. I never had to deal with the ER personnel......thank God!
Oh, the ER Doctor that sent me home, an internal investigation was done and the Doctor was suspended for 5 days. Big deal....I could have lost entire use of my arm and hand due to is arrogance, besides the unnecessary awful pain that he put me through. Thank goodness the Lord was watching over me that day and night because that damn Doctor who thought he was god wasn't.
Sorry for going on and on, but just thinking about this is getting me upset all over again and that was fifteen years ago!
We don't, antibiotics and pain med is needed and prescribed. Some people think we should treat dogs better than poor folks.
CseMgr1, ASN, RN
1,287 Posts
Years ago, at a small community hospital I worked at, a GP routinely admitted patients with "Flu Syndrome" and gave them IV Dilaudid and Phenergan q 2 hrs. Our ER was also overrun with his other patients who were addicted to Percodan. This nonsense continued, until a Resident who was covering for this Dr. got fed up and filed a complaint with the Medical Board.
Ten years ago, a local Dr. was busted by the DEA for illegally prescribing narcotics. No one did anything, until this Dr. diagnosed one of his patients with "hemorrhoids". The patient died of colon cancer and his wife turned him in to our State's Attorney General. :angryfire