Pt demanded a stronger pain med - page 2
:angryfire I'm a little steamed. The other night I had a pt present with an "ankle sprain." Yep, that's it. When I went to discharge this "fine, upstanding, well-groomed" individual :no:, his... Read More
Dec 7, '06Occupation: cardiology R.N. Specialty: 25 year(s) of experience in cardiac med-surg ; From: CA ; Joined: May '03; Posts: 8,489; Likes: 147Quote from SiamCat1verra verra phunnyYou made me giggle, so true!!
Dec 7, '06Occupation: travel Specialty: 16 year(s) of experience in ICU,CCU,Trauma, neuro, geriatrics, telem ; Joined: Jul '04; Posts: 971; Likes: 349I think the entire USA needs a lesson on proper behavior.
Dec 7, '06Occupation: Former ED RN, disabled Specialty: 15 year(s) of experience in ICU, ER ; From: US ; Joined: May '06; Posts: 893; Likes: 745I recently handed a script for naporoxen to a pt for back pain (with no signs of distresss). "What? I'll pay hundreds of dollars for this visit and I don't get a narcotic?"
Dec 7, '06Joined: Apr '03; Posts: 7,569; Likes: 2,297My first response is, "This is the script that the doctor wrote, he will not write another." If that doesn't work and the pt or companion keeps yapping, I'll go back to the doc to get the official "NO!" I then go back and tell the pt that this is all he is getting, and that the only way to get something else is to see his own doc. If he tells me he doesn't have one, I give him a list of local MDs. If he keeps on ranting I tell him he is more than welcome to file a complaint with our manager and I give him her name and number. I open the curtain and stand there until he leaves. Then I give my boss and the ER med director a heads up, but they rarely hear anything.
Dec 7, '06Occupation: LPN, EMT-P Specialty: 9 year(s) of experience in Hospice, Med/Surg, ICU, ER ; From: US ; Joined: Dec '05; Posts: 851; Likes: 162Quote from mortei would hazzard a guess that it wasnt even for HIM.......
Exactamundo! This is the case w/ several of my pts at the Urgent Care.
Dec 7, '06Occupation: RN in a Level II Trauma ED Specialty: ED-CEN/PACU/Flight ; From: US ; Joined: Mar '06; Posts: 109; Likes: 84That situation usually irritates the living daylights out of me. I'd phrase it exactly how I feel, but I don't want to get booted off the board!
I give them the "I'll be happy to ask the doctor for you, but they will not add on anything after they have written what THEY want you to have." I go check, get the doctor's response (also a hell no over here), and go back with the standard, "I'm sorry, but he feels this is the best for your situation. He also told me that if you do not want that prescription, then for safety sake, I need to destroy it so no one will pick it up and fill it under your name."
If at that point they continue to whine and rant about their entitlement ( :angryfire ) then I usually reply with something along the lines of:
"I'm sorry, your visit is now over. Your Non-emergent, non-urgent, non-life threatening, non-limb threatening, non-vision threatening situation has been diagnosed as STABLE. Your chronic pain will be best managed with your doctor (and I hand them their paperwork with referral numbers on it), or find a doctor for your follow up care."
If they still piss and moan, then I smile and say, "You now have two choices; first, take your leave and follow up as directed, using the given number for any questions or concerns, or security will be happy to assist you to your vehicle."
This will sound horrible, but I almost enjoy irritating them some days...Last edit by andhow5 on Dec 7, '06
Dec 7, '06Joined: Jul '06; Posts: 161; Likes: 29Quote from mortei would hazzard a guess that it wasnt even for HIM.......
Dec 8, '06Occupation: PICCs/outpatient infusion, ER Specialty: ER, ICU, Infusion ; Joined: Feb '03; Posts: 1,047; Likes: 445Quote from mortei would hazzard a guess that it wasnt even for him.......
ya know, the thing about sprains and strains is that they really are defult diagnoses. pt comes in with pain and/or swelling, maybe a hx of mild/moderate trauma. if there isn't any radiologic evidence of a fracture, then they get dx with a sprain or strain. you really can't rule out a sprain with the typical tests done in the er. i mean, who is going to order an mri for ankle pain????
in other words, very easy to fake. of course, i'm not saying that everyone who comes in with sprain-like complaints is faking it, but the dx does lend itself to abuse. i've suspected it in the past when i thought someone was looking for a work/school excuse. but i can see where that would eventually evolve into people seeking pain meds. i mean, i've had plenty of ankle sprains in the past, and never has so much as an er visit, let alone a script for narcs.
that being said, a bad sprian is more painful than a minor fracture. and they tend to take longer to heal. i sprained my ankle several years ago, and it still hurts every once in a while. but narcs? naproxyn works just fine, thank you.
Dec 8, '06Specialty: 23 year(s) of experience in Emergency ; From: US ; Joined: Apr '04; Posts: 1,320; Likes: 336Personally I would have went to the doc, said something like they are not happy with the T3 rx. Get him to write one for motrin or naproxen and then enjoy walking back to the room asking to see the narc rx. Then saying oh i'm sorry he did give you the wrong med as I rip up the T3 rx and hand them one for the others. Have a nice day.
Dec 8, '06Occupation: rn-er,nicu Specialty: 12 year(s) of experience in ER, NICU, NSY and some other stuff ; Joined: Aug '00; Posts: 1,939; Likes: 232I usually tell them that since the physician wrote the script he had obviously decided what he felt would be the appropriate medication for the c/o. Rarely will I bother the doc again since I don't believe he accidently wrote tylox but REALLY meant to write for mepergan fortis...lol
I also let them know really quickly that we do not base our pain med decisions on their payor source.
Of course I do this in the gentlest, kindest way with a big smile on my face.
Dec 9, '06Occupation: ED Nurse Joined: Mar '03; Posts: 49; Likes: 2Quote from AstrosFanI've stopped working with regard to Press/Gainey. I provide the best care I can, and, as far as I'm concerned, Press/Gainey can kiss my sit spot. What would I have said? How about "here are your discharge instructions, here is the medication that has been prescribed to you, there is the door, if you continue to argue, security will be happy to escort you to your car. Have a nice day and thank you for choosing our facility." (Okay, that last part was for Press/Gainey):angryfire .... If my ER director wasn't so eaten up with PressGaney, I wouldn't have even taken the request to the Doctor. I would have said, "here are your discharge instructions, here is the medication that has been prescribed to you, there is the door, if you continue to argue, security will be happy to escort you to your car."
Dec 16, '06Occupation: Registered Nurse Specialty: 2 year(s) of experience in Emergency Department ; Joined: May '06; Posts: 126; Likes: 26Quote from andhow5I guess I am meant to be an ER nurse after all! Sometimes I really enjoy being able to tell people NO!
This will sound horrible, but I almost enjoy irritating them some days...
Dec 16, '06Occupation: ER Nurse Specialty: Emergency ; Joined: Sep '02; Posts: 497; Likes: 16Sometimes I consult the doc, sometimes I don't. If we are packed and he/she is busy treating "real" patients, it seems foolish to waste his time and mine.
I just usually tell them that the doctor prescribed what he felt was appropriate for the patient's injury. If their pain continues after TRYING the medication first, they need to consult with their primary physician.
I often speak in very simple terms: "This is what the doctor prescribed for you. Do you want it or not? It is all you will be getting today."