My ER experience....what do you think??

CritterLover, BSN, RN · Mar 28, 2008

a few semi-random thoughts on your post:

1. narcotics usually arn't the best treatment for headaches. however, some people (even those with actual headaches) expect narcs.

2. 0200 is a little suspect ... that is a prime "seeker" time. (not that real headaches don't occur during the wee hours of the morning)

3. by coming right out and telling patients that they arn't getting narcotics, she can avoid the potential argument later, which often ends in the patient leaving ama, causing all that work to be for naught.

4. i don't know if she automatically assumed you were seeking -- only she (or maybe her coworkers) can tell you that. it just might be her policy to let people know up-front what the plan for the er visit is. even if she did make that assumption, not every er nurse/doctor does. some do, some don't, some are remarkably accurate in their ability in telling the seekers from the non-seekers. some don't care one way or the other.

5. honestly? i'd try very hard not to worry about it. i worked with a paramedic in the er that hurt his back doing something at home. he was a great paramedic, i loved working with him in triage. he came into the er on day shift, and i picked up the assigment with his room on nights after he had been there several hours. they had given him a bunch of narcs, and his back was still spasming. he really needed more drugs, but he was so afraid of being seen as a seeker, that he was trying to get up and walk out of there through a ton of pain. the pain was so bad that he couldn't walk, and he almost fell.

others' perceptions just isn't worth suffering through that kind of pain.

hope you're feeling better!

snowfreeze, BSN, RN · Mar 28, 2008

Sometimes you have to remember that nurses and doctors are human also, if you were the 15th person that night bringing oneself to that ER for pain meds......Maybe a computer will be better at reading what the true needs of the patients are in the future. But at the moment you have to deal with humans. Sounds like you did a good job of presenting your problem and did get what you needed.

rita359 · Mar 28, 2008

I would agree that I would have felt they treated me as a drug seeker. From a larger perspective, this was a one time thing for you but patients coming to an ER for some kind of pain is an every day, day in and day out kind of thing for ER staff. Probably, too many of those people are repeats and repeats seeking narcotics so I am sure some ER staff get warped as far as people coming for such problems. Once they found out that you thought something else would work, seems like they did a good job and it worked plus you went home with something for the next time so your headache went away(immediate problem solved) and forearmed for the next time. Alls well that ends well.

queenjean · Mar 28, 2008

You want my God's honest true opinion? Someone who can drive themselves to the ER with a migraine for pain medication? I would probably find that suspicious. Usually when I think of intractable migraine pain, it's the "rolled up in a ball in a dark room, vomitting your guts out" kind of migraine pain.

When I think of drug seekers, I think of people who drive around during the noc, can't find their dealer, can't get a fix any other way they know how, and end up at the ER, making some complaint. They are healthy enough to be able to drive themselves around, walk in, chat on the phone, but they still need drugs RIGHT NOW.

I'm not saying that's what you did. I'm saying that's what nurses and docs see in the ER day after night after day. And so I would give them the benefit of the doubt. And like CL said, it's very likely that your ER doc was just setting boundaries with you straight up, before she could even form an opinion of whether you were legit or not. Probably she uses this as one means of determining whether her patients are indeed legit.

My dh gets very rare, really bad migraines. He only gets one every couple of years, but it's so bad he can't see, he can't stand to be exposed to light, and he can't keep anything down. They last about 10 hours. He hasn't ever gone in to the ER, but we have a plan if/when he ever needs to. His doc is well aware of these rare migraines, and he has a good relationship with her--she's been his doc for years, he is a totally compliant and otherwise healthy fellow--and if we ever need to go in for this, we are to page her and she will call the ER to let them know we are coming and to give a history of his migraines. Having your PCP do this will help prevent you being pegged as drug-seeking (unless your PCP also thinks you are drug seeking, I suppose). At your next appointment you might want to discuss your ER visit and how you and your doc could handle it next time, so that you can get good care and the ER staff can feel comfortable treating you without having much of a history on you. Does that make sense?

I dont' think I've ever had a migraine, so I dont' know how you felt--but I hate to watch dh with his; I hope you are feeling better and that you don't experience it again any time soon!

Altra, BSN, RN · Mar 28, 2008

Quite honestly, my opinion is that if you were able to drive by yourself, your headache did not warrant an ER visit.

If you have 4-6 of these episodes per year, can you & your primary doc come up with a plan for these episodes? Planning for chronic conditions is the realm of primary care.

Blee O'Myacin, BSN, RN · Mar 28, 2008

My feeling is the doc was just being upfront with you about narcs - nor no narcs right off the bat. Why do the "so what do you want for the pain"/"what can you give me?" dance when it isn't necessary.

If you are suffering 4-6 times per year, definately talk to your doc for meds you can take at home, rather than having to suffer through an hours long wait filled with the hacking coughs and projectile vomiting often found in the ED waiting room!

Blee

onyx77 · Mar 28, 2008

Quite honestly, my opinion is that if you were able to drive by yourself, your headache did not warrant an ER visit.
If you have 4-6 of these episodes per year, can you & your primary doc come up with a plan for these episodes? Planning for chronic conditions is the realm of primary care.

I don't know if you've ever suffered from migranes, but if it is 0200 (Dr's office is not open) and you feel one coming on (pt's with frequent migranes KNOW what is happening) and it is steadily progressing would you wait until morning when it will disrupt your entire family? Would you let it get even worse? (Remember - you KNOW that you are headed for loss of vision, nausea/vomiting, increased light and sound sesitivity, and inability to function as a normal person.)

My last migrane was the last week of clinicals in my fourth semester. I woke up with it and thought with enough ibuprophren and hiding under my covers that it would go away. It was a pm clinical so I brought my son to school in the morning (big mistake - it got a lot worse because it was a nice bright sunny morning!) and put myself to bed. In a couple hours I decided it was time to get ready for clinicals - I stood up and was seeing black spots and I almost puked. I had my mother come to bring me to the walk-in clinic. (Torodol is a wonderfull thing, isn't it?)I could have saved my mother some trouble and probably could've made it to clinicals had I brought myself in when I brought my son to school. And it WAS pretty bad at that time - I just wasn't seeing black spots!:dzed:

santhony44, MSN, RN, NP · Mar 28, 2008

My feeling is the doc was just being upfront with you about narcs - nor no narcs right off the bat. Why do the "so what do you want for the pain"/"what can you give me?" dance when it isn't necessary.

I agree. I've done the same thing, both in the ER and in clinic. If the patient is going to get mad and walk out because I won't give narcs, then go ahead and get it out of the way right off the bat. Let's not waste everyone's time, here.

I won't say that I assume every patient with c/o pain is a drug seeker. I do, however, always consider that as a possibility.

I don't know the size of the hospital or ER you went to. I cover ER for the small critical access hospital I work for, in addition to having a clinic. If you come in at 2 AM, then I had to get out of bed to see you. I try not to be rude, but I doubt I'm nearly as diplomatic at 2AM as I try to be otherwise (though I have the reputation for being pretty blunt).

KaroSnowQueen, RN · Mar 28, 2008

I don't know if you've ever suffered from migranes, but if it is 0200 (Dr's office is not open) and you feel one coming on (pt's with frequent migranes KNOW what is happening) and it is steadily progressing would you wait until morning when it will disrupt your entire family? Would you let it get even worse? (Remember - you KNOW that you are headed for loss of vision, nausea/vomiting, increased light and sound sesitivity, and inability to function as a normal person.)

I have driven myself to the local band-aid station (3 blocks from home), rather than my usual hospital (45 minutes away), when I felt one coming on. Last time it happened, everyone who lived with or near me was either asleep or at work. I drove the 3 blocks at 4 am, walked into the ER with sunglasses on :cool:and head down.

Doc says Headache? I nod Yes. He says, What do you usually take for this? I said Toradol and Phenergan. He walks out of the room, turns out the lights as he leaves, and let me lie there in blessed silence and darkness while the nurse prepared the IM. I drove myself home and pulled all the blinds and slept for hours. :aln:

If I had waited until 8 am when everyone was either awake or home, I would have been 4 more hours into the migraine and disrupted someone else's schedule, plus had to deal with DAYLIGHT!!!!!!!!!! :no:

mianders, RN · Mar 28, 2008

Quite honestly, my opinion is that if you were able to drive by yourself, your headache did not warrant an ER visit.
I have never had a migrane but I did work the ER for many years and have seen many people drive themselves to the ER in what must have been horrible pain. This includes migranes and other complaints. As a nurse and as a person that has been a patient before I think your attitude is very narrow minded. I hope you never have to be put in that type of situation.
If you have 4-6 of these episodes per year, can you & your primary doc come up with a plan for these episodes? Planning for chronic conditions is the realm of primary care.

This is always a good plan. Migranes may be a chronic thing but do not always happen 9-5 Monday thru Friday. Just like exacerbation of any chronic illness (ie..asthma, COPD)

onyx77 · Mar 28, 2008

There are primary docs that do not make a 'plan-of-action' for pt that only have migranes 4 times a year. My doc certainly didn't. Now my mother has them at least once a month - he jumped on that one! Don't always assume that people could be seen somewhere else for migranes. If they happen in the middle of the night where else do they go?