Do most ER's (Im sure they do) have this overwhelming problem???
I've only been a RN for 9 mos and I'm so tired of the same people coming in with BS excuses to get their fix. Then, treat us like crap if they don't get the drug of their choice.
It's been a struggle to be compassionate, even though I put on a good front...
I guess it's a personal thing because I've struggled with a few family members who were horrible prescription drug addicts and screwed me over to get money for drugs, etc. I guess I can't help it.
Anyway, do doctors in other ER's always just give in to get them what they want or do they ever try to get them help??
We had a girl come in yesterday, (who always comes in) saying her ovarian cysts is killing her and she's allergic to everything but dilaudid. She brought her husband in too so he could get his "toothache" looked at. Of course, he got his norco script and was pressuring us to hurry up with her care so he could get it filled I guess.
I told the doc about it and he said, "yep, I know she's here for the dilaudid, but watch-- the one time out of 27 visits this year I don't do a CT of her abdomen, she'll have an appendicitis"
Its sad... the money, the time...I feel sorry for the docs! They're scared to death of losing their license b/c these patients have them by the balls! I just had to vent. Something has to be done to stop this problem and no one seems to try and help these people the right way...
It really sucks that the nurse who was supposed to care for you assumed you were a seeker for no reason except that you had a headache (?)
HOWEVER
No one has advocated treating anyone "like trash" and if you read the previous posts you will see that most take great pains to treat even our more frequent visitors with respect.
Again, we are trying to discuss the very real problem (or predicament!) of people abusing the system in order to secure their fix. They do exist and it is a problem.
Frankly, I'm getting tired of being told I'm a bad nurse because I'm pointing out a simple reality in most ERs. You have no more right to assume this about me than that nurse who treated you badly did in her assumptions about you.
Wow! I was a little worried for a second! (So much so, that I went back and reread my post.) I'm not seeing anywhere in my post where I directly or indirectly compared you (or anyone else for that matter) to the nurse that I dealt with. I'm sorry that you were so personally offended. It really was not my intention. I just naturally ASSUMED that anyone who read my post would realize that it was addressing a collective "you"; not a specific person. But, again, my apologies.
I was not trying to say that I don't think that there are those who abuse the system (as a matter of fact, I believe I said that in my pp). What I was trying to say is that you (collectively) never know what the real reason is that causes someone to seek medications. I personally know someone who became addicted to pain killers simply because their primary doc was too quick to write scripts instead of trying to get to the real root of the problem. Luckily, they have been able to get off those drugs, but some are not so lucky. I'm certainly not saying that every person who comes in seeking fall into this category, but it certainly gives one something to think about, does it not?
I don't work in an ER, so I would never begin to try to act like I know what it's like to deal with these people on a daily basis. All I am saying is that you (collectively) shouldn't be so quick to pass judgement on someone just because they are an addict (or not, as in my case).
How awful. It does sound like someone dropped the ball in the diagnosis of this patient. But it's one of those difficult calls because if someone comes in dx'd with a UTI with abd pain is it feasible to do the "million dollar work up?" In hindsight, he may have benefited but how many others would have simply been burdened with a giant bill (or burdened the system with that bill.) It's a problem of finite resources.
You're right, though, there aren't any easy answers.
When the nurse came in to start my IV, she said (quite sarcastically I might add) "So, let me guess. You're allergic to ibuprofen, right?"...... I understand that there are a lot of people out there who abuse the system, but why do any of you care so much that you are willing to treat anyone who comes to you for help as if they are a worthless piece of trash?
I'm sorry that was your experience, but you are also making an assumption that those of us who have an opinion on the very real issue of inappropriate use of the ED behave in a less than professional way with any of our patients. These types of finger-wagging "shame on you" posts do nothing to contribute to the discussion in any constructive way, effectively derailing any productive discussion.
I was not trying to say that I don't think that there are those who abuse the system (as a matter of fact, I believe I said that in my pp). What I was trying to say is that you (collectively) never know what the real reason is that causes someone to seek medications.
The thing is, any nurse with half a brain knows this. These types of "reminders" are patronizing.
I am sorry about the unfortunate experience of your patient with metastatic cancer. Blaming is a part of dealing with such a devastating diagnosis, and I have no doubts that he blames health care providers.
The thing that many people seem to lose sight of is that the purpose of the ED is for stabilizing treatment and for diagnosis and treatment of *emergent* threats to life and limb. That the first 2 ED docs checked for the most obvious cause of his pain rather than do elaborate workups to find a needle in a haystack does not mean they are substandard doctors or that your patient was treated poorly. In my opinion, it is the role of the PCP to do further diagnostic workups once the ED docs have ruled out anything immediately life threatening. Additionally, we instruct our patients at discharge that if their symptoms worsen or persist, they should return to the ED. On any subsequent visits for the same presentation, the ED doc will look at what was done last time, and may look deeper this time.
I see this kind of thing frequently. A person comes to the ED because they have been trying to get a diagnosis from their PCP for a persistent problem, so they come to the ED expecting not only to get their diagnosis, but to get it quickly. They want the doc to pull out all the stops and do the million dollar workup, and are disappointed when they are discharged without their diagnosis. In the meantime, all he## is breaking loose, and the ambulances will not stop with the CVAs, MIs, MVAs, and people with truly emergent life threatening injuries or illnesses.
The stable patient with the nonemergent situation feels neglected because they haven't seen their nurse for nearly an hour, and the doctor still hasn't come back to tell them their test results. Then when the test results all come back negative and they are discharged with "Abominal Pain-No Diagnosis" and instructed to follow up with their PCP if they're not feeling better in a few days, they are disappointed and think they received poor care.
The purpose of the ED is not to find the needle in the haystack. It is to stabilize and treat for emergent life threats.
To elaborate further (and tewdles, this is not directed at you) how many ED nurses have had this conversation?
"So, what brings you in tonight?"
"Well, my belly hurts really bad."
"How long has this been going on?"
"Six months."
"What made you come in tonight?"
"Well, I have an abdominal ultrasound scheduled for tomorrow, but I just couldn't wait. How long is this going to take?"
Except that the conversation is rarely that straightforward. It's usually like pulling teeth to get the person to tell you what is going on in a concise way, without going into their entire medical history starting when they were 2 years old and had an ear infection.
Does any of my above commentary mean that I am in any way, shape or form, cold and callous or less than professional with my patients? Absolutely not. However, it is my experience, and I do have opinions on such matters. While I should temper my opinions when dealing face to face with people who are in my care and vulnerable, I do have every right to express myself here on AN, and I resent any implications that such discussions are equivalent to a lack of compassion. Once you mention the "C" word, you've lost me. That tells me that you do not understand at all.
I'm sorry that was your experience, but you are also making an assumption that those of us who have an opinion on the very real issue of inappropriate use of the ED behave in a less than professional way with any of our patients. These types of finger-wagging "shame on you" posts do nothing to contribute to the discussion in any constructive way, effectively derailing any productive discussion.
Why? Because my opinion doesn't happen to agree with yours?
Specializes in PICU, NICU, L&D, Public Health, Hospice.
i appreciate your thoughtful response, virgo_rn. i think that ultimately this man was most disgruntled with his pcp for slow diagnosis and with the eds for not providing adequate pain relief.
for him it was a tortuous process that took too many painful, sleepless nights before he felt that he was taken seriously by a kindly emergency doc that thought this duck was quacking oddly and not only made him comfortable but also did what his pcp should have...sought a clear diagnosis.
there is no perfect system available for any of us...we have to do the best we can...
Unfortunately, the subjective nature of pain makes it especially tricky to treat appropriately at times. We cannot just snow every person who comes in with pain with narcotics. And, when it comes to kidney pain, if that's what the docs were suspecting, Toradol is amazing. Treating pain adequately can be a big challenge for even the best of us. You can only support this person and let them vent and acknowledge their feelings. I am glad he got his diagnosis and is being treated appropriately. I'm sorry it's such a crappy diagnosis.
No. It's because in the context of this discussion, it is a red herring.
Hmm....OK. I'm not sure I'm following you on that one. The OP started a discussion about drug seekers, and how ER staff deal with them. In addition to sharing one of my own personal experiences with this very issue, I simply tried to give a different perspective in which to view seekers. I have my opinion on this matter, and you can flame me for it as much as you like; it will not change anything. And, as I stated previously, I was not referring to anyone in particular. If you have chosen to take what I have said personally, then that is on you.
Hmm....OK. I'm not sure I'm following you on that one. The OP started a discussion about drug seekers, and how ER staff deal with them. In addition to sharing one of my own personal experiences with this very issue, I simply tried to give a different perspective in which to view seekers. I have my opinion on this matter, and you can flame me for it as much as you like; it will not change anything. And, as I stated previously, I was not referring to anyone in particular. If you have chosen to take what I have said personally, then that is on you.
No, you didn't. You posted a "poor me, they thought I was a drug seeker" story, the type of which we have seen ad nauseum any time the topic of drug seekers in the ED comes up. These types of posts contribute nothing of value to the discussion, IMO, and only serve to distract from the actual discussion, hence the term "red herring". And, I haven't flamed you. I apologize if it appears that I have. You have every right to your own opinion. However, the topic is about drug seekers in the ED. Since you said yourself that you don't work in the ED, I don't think you have a dog in this fight.
screamin mimi
13 Posts
animal1993-
It really sucks that the nurse who was supposed to care for you assumed you were a seeker for no reason except that you had a headache (?)
HOWEVER
No one has advocated treating anyone "like trash" and if you read the previous posts you will see that most take great pains to treat even our more frequent visitors with respect.
Again, we are trying to discuss the very real problem (or predicament!) of people abusing the system in order to secure their fix. They do exist and it is a problem.
Frankly, I'm getting tired of being told I'm a bad nurse because I'm pointing out a simple reality in most ERs. You have no more right to assume this about me than that nurse who treated you badly did in her assumptions about you.