Ever seen this??

  1. To those of you who may work in the ER, have you ever had an attending doc deny treatment to a pain patient who presented with a letter from a neuro/pain specialist?? What happened?
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    About vamedic4, EMT-P

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    Paramedic; from US
    Specialty: 23 year(s) of experience in EMS, Peds Cardiology, ER, PICU, IV Jedi

    14 Comments

  3. by   babynurselsa
    Was this a letter stating how to treat the patient?
    Did the Dr disagree with the plan of care in the letter.
    The question is a liitle to vague to anwer.
    Last edit by babynurselsa on Sep 20, '06
  4. by   andhow5
    I had similar episodes - the pain clinic patients would present; all in various forms of, "I'm a pain clinic patient", "I need to be a pain clinic patient", and, "No, I'm not a pain clinic patient" (and the last ones mentioned are always outed).

    I've never had a doc refuse treatment; just refuse to give any controlled substances. And the usual write up on the discharge form is, "Follow up with the pain clinic."
  5. by   ERNP
    Quote from vamedic4
    To those of you who may work in the ER, have you ever had an attending doc deny treatment to a pain patient who presented with a letter from a neuro/pain specialist?? What happened?
    Where I live and work there are no such letters. I have never seen anyone present with any such letter. I have seen the pain management contract in which the patient promises not to seek pain relief treatment anywhere other than the pain management specialist.

    I have also seen a pain management specialist (doing a few side shifts in the ER) discharge a patient from his practice for presenting to the emergency department with pain related complaint. Of course, he had to follow that with written communication and give a notice but I have no doubt that he did just that.

    What happened? The patient was summarily discharged from the practice and the ER. The whole thing took less than 5 minutes. But I was left with the feeling I should hide under something bullet proof.
  6. by   TazziRN
    I have never seen a pt with a letter from a pain clinic. I have seen many with letters from out of town docs. The ER docs usually will examine and treat with a single narcotic dose and Toradol if the pt has never been seen by us before. If they have, they are considered frequent flyers and are treated with nonnarcs and referred back to their pain doc.
  7. by   Larry77
    We have tons of patients on "pain contracts" as mentioned previously they are not supposed to seek pain tx from any other MD besides the one prescribing their pain meds for their chronic issue.

    But if these patients come in with a problem that requires meds (ie chestpain, fx etc) our docs will treat them. What our docs will not do is give refills or tx their chronic backpain with anything other than non-narcotics.

    We also have a lot of pt's with "careplans" that we keep on file that outlines the agreement in place when this pt presents with a specific c/o.

    When a pt presents to our ED and is entered in the computer their chart will come up flagged with "pain contract", "careplan", or "contact precautions" (for MRSA, VRE etc).
  8. by   babynurselsa
    I guess that is what I was wondering, whether we were talking about a pain contract. Nope I have never seen a patient show us this as this specifies that they are NOT supposed to be in the ER seeking treatment. They usually aren't real forthcoming about seeing a pain specialist.
    Now if what you are referring to is a letter stating "Please tret my patient with x amt of y drug, I have not seen this either. I have had some patients present and when we know they see a pain doc our doc would call them and confer with them.
  9. by   RunnerRN
    We have had patients present with a letter stating they are under the care of a pain specialist. Never have run into one with treatment directives - it reminds of when PMDs send their patients into the ER to get a CT. If one isn't warranted, our docs aren't going to order it. That's what outpt services are for.
    Back to the pain letter, we have discharged frequent flyers with a letter that states they will not be treated for nonemergent pain without a followup with the pain clinic. This is reserved for the most blatant drug seekers.
  10. by   MikeyBSN
    This reminds me of a similar situation I had a few nights ago. I had a patient with exacerbation of chronic pain come in in servere pain. I administered 60mg of toradol IM, but this guy was on percocets for chronic pain so I knew it wasn't going to touch him, he was tachcardic and hypertensive. He told me he wanted to be admitted for pain managment and the doctor at the time, who's one of the nastiest people I've ever worked with, discharged him (luckily I don't have to work with him much anymore). The patient told the med student that if she discharged him he'd go home and kill himself because he didn't want to live in so much pain. I advised the doctor that the patient wanted to die because his was not bearable. Instead of referring him to a pain clinic or trying to manage his pain he said, "I don't see what the issue is," and referred him to psych. :angryfire
  11. by   nuangel1
    its unclear what was in that letter and by whom.i have never seen a pain clinic pt bring in a letter pt might say i see so and so in pain clinic.we do have 1 pt where i work now that has a pain contract with his md ie how much how often so if he comes to ed we speak with pcp follow pain contract d/c pt with f/u to his own md.
  12. by   TrudyRN
    Quote from MikeyBSN
    This reminds me of a similar situation I had a few nights ago. I had a patient with exacerbation of chronic pain come in in servere pain. I administered 60mg of toradol IM, but this guy was on percocets for chronic pain so I knew it wasn't going to touch him, he was tachcardic and hypertensive. He told me he wanted to be admitted for pain managment and the doctor at the time, who's one of the nastiest people I've ever worked with, discharged him (luckily I don't have to work with him much anymore). The patient told the med student that if she discharged him he'd go home and kill himself because he didn't want to live in so much pain. I advised the doctor that the patient wanted to die because his was not bearable. Instead of referring him to a pain clinic or trying to manage his pain he said, "I don't see what the issue is," and referred him to psych. :angryfire
    Do you know the end result with this patient? I have personally had pain that, had it been anything but very short-lived, would have driven me to the end of my rope. I hope the doctor and med student you mention can experience this type of pain, too, so they will understand and be more realistic and compassionate. Some pain is unbearable, no matter what these morons are taught in school.
  13. by   TrudyRN
    Quote from ERNP
    Where I live and work there are no such letters. I have never seen anyone present with any such letter. I have seen the pain management contract in which the patient promises not to seek pain relief treatment anywhere other than the pain management specialist.

    I have also seen a pain management specialist (doing a few side shifts in the ER) discharge a patient from his practice for presenting to the emergency department with pain related complaint. Of course, he had to follow that with written communication and give a notice but I have no doubt that he did just that.

    What happened? The patient was summarily discharged from the practice and the ER. The whole thing took less than 5 minutes. But I was left with the feeling I should hide under something bullet proof.
    So what is the patient supposed to do if he is truly in pain?
  14. by   scrmblr
    I had a pt come in with a letter from her pmd that basically states "this pt is taking so many narcotics that she will require excessive doses of med's to help with her pain-if pt presents in ER please contact me to discuss her care" We called the primary doc and he attempted to help our ER doc decide what to do with her. End result was to refer to pain specialist (AFTER 4mg dilaudid and 25 of phenergine) pt left crying and waving her "letter" saying that she was still in 8/10 pain and needed another shot of dilaudid.

    This is a frustrating situation for everyone involved.

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