Earlier this week I had a patient that apparently comes into the ED frequently always with abd pain, they can never find anything wrong with him. He must have thought I was an easy target because I have never seen him before. (I only started on the unit in August) Chief complaint? Constipation x 2 days. Takes multiple narcotics, hx of abuse, ect. He is complaining that he has 10/10 pain, as he is sitting up calmly, and is asking for pain meds. I went to the doc and was like, this guy claims 10/10 pain, but look at him. So he goes and does the abd exam with no tenderness on palpation. I had 9 patients that night (some of them really sick) and his wife was harrassing me every minute for something, I was like (in front of the patient too) I have a lot of patients, many sicker than him, that I need to attend to right now, I cant get a pill/give him dilaudid/get him another blanket. The nice lady in bed 2 is about to be intubated and she needs my attention right now. Give me a minute please. He starts saying to me that he is very sick and dying and that I need to focus my attention to him mainly. Than he tells me that I need to order Klonopin for him NOW because he takes it at home and he missed his dose and if he doesnt take now it its "very dangerous". (The doc was getting the d/c papers as we were speaking). He than becomes mad when he finds out he was being d/c'd, he "demanded" to be admitted. Sorry, but a clear CT and x-ray is not going to buy you a day or two free drug stay!
Thank you all for listening to my vent!! I love this site, I can vent about this and you all have been there done that and understand!
Specializes in LTC, CPR instructor, First aid instructor..
I had a horrible experience this afternoon. I was being fitted with a new set of dentures when my most dreaded pain hit. It frightened the nurse and the dentist. The dentist asked me if he ever witnessed it, and I said, "Yes, and he thought I was having a heart attack. I was in so much pain then he asked me if I wanted a shot of Morphine. At that point, I didn't care what was given to me as long as the pain could be relieved. He started out the door, then he returned saying, "Wait a minute. You're allergic to Morphine. Then he asked me if I wanted some Dilaudid. That was in April 2001, and I still get it. The dentist said, "No wonder you take so much medication. You definitely need it." In reply, I said, "This is the one my PCP thinks I'm exagerating with just because nothing shows up on a test!" It's called post embolotic syndrome. It occurs when help in resolving the PE isn't enacted fast enough. In layman's language, I think it's called, "Phantom pain." Pardon me for saying it, but when I hear him talking about imaginary pain (the kind that's all in your head? Yeah, RIGHT!) I feel like calling him a lunatic.
Are you totally, beyond any reasonable doubt, for sure for sure, that you aren't wrongly labelling a legit pt in real pain? Ever? What may be suppossed dead giveaways may not be. I'm so not looking forward to making that call when I start working in the ER!
oh I have had the wonderful pleasure of being told "you can't be feeling that much pain" in regards to a bulging lumbar disc L4 L5, L5 S1....that is until the surgery (after 1 year of "conservative treatment" that was necessary in order for insurance to approve surgery) and the neuro found a completely ruptured disc that had jammed between the two nerve roots....then it was "oh, no wonder you had such pain"...
Are you totally beyond any reasonable doubt, for sure for sure, that you aren't wrongly labelling a legit pt in real pain? Ever? What may be suppossed dead giveaways may not be. I'm so not looking forward to making that call when I start working in the ER! [/quote']
It's not JUST that they know every narcotic by it's generic name...
It's not JUST that they're allergic to every non-narcotic analgesic invented...
It's not JUST that they are in the ED 3, or 4, or 5, or 6 times a week...
every week...
It's not JUST that they see 5 PCP and 4 pain management MDs and 3 Neurologists and 6 rheumatologists and 7 orthopods...with narcotic prescriptions from them all...with refills...
It's not JUST that they are the only ones who say: "You know, those shots only work for me when you push them really fast"...
IT IS ALL OF THE ABOVE!!!
I'm sure they do have pain...can you just imagine that they are not only going through withdrawl...but their original pain comes back tenfold...
It's just that we are NOT helping anyone if we don't identify that they are seeking and treat THAT problem.
Are you totally beyond any reasonable doubt, for sure for sure, that you aren't wrongly labelling a legit pt in real pain? Ever? What may be suppossed dead giveaways may not be. I'm so not looking forward to making that call when I start working in the ER! [/quote']
When you start counting your experience in decades, then answer that question yourself.
in response to Z'splaya....timuptom is soooooo on the money....after so many years you gain the experience of not only vitals at triage, but being able to "read" people very well....not only through verbalization, but body language, the looks in their eyes, little nuances, that only come with doing it many, many, many times...At all times a seasoned nurse will also be looking for symptoms of any real underlying illnesses, as even repeaters, seekers, frequent flyers, do come in at times with other problems..again if they return to the same ED, you get to know your patients well, and can tell when they really have something going on.
"I'm allergic to ibuprofen, ultram, toredol, tylenol, and aspirin, and my pain is an 11 on a 10 scale. Demerol is the ONLY thing that ever works." We've all heard it.
Are you totally beyond any reasonable doubt, for sure for sure, that you aren't wrongly labelling a legit pt in real pain? Ever? What may be suppossed dead giveaways may not be. I'm so not looking forward to making that call when I start working in the ER! [/quote']
I Agree The Pain Scale Is Silly Especially With Cardiac Pts. Most That I Have Seen Talk Pressure Not Pain. Also I Have Seen Many Frequent Flyers But What Makes Me Mad Is The Docs Who Have Given 1 Script After Another Of Vicondin Then Suddenly Try To Cut The Pt Off With Nothing.... We Have Created This Monster And Then Say Too Bad No More Narcs For You. But No Help In Stopping Either.
When you start counting your experience in decades, then answer that question yourself.
and dont roll your eyes at me
I'm not rolling my eyes at you. I'm rolling my eyes at the fact that I'll have to make that call some day and I'm sure that I'll be wrong sometimes. Don't take offense to it, I meant no harm or disrespect! For someone to say there is no way in the world they could be wrong is a pretty strong statement, even after 30 years or so. No one is perfect. Yes I'm sure when my experience gets up into the decades I'll be jaded and think nothing can get by me and I will probably have to pinch myself to remember I'm still human and I do make wrong calls. It is possible. Thats all I'm saying. :)
And I'm not refering to the ones that go in 6 or 7 times a week allergic to every drug except drug of choice. Isn't it possible that because of these people, legit pts that present with some of these "symptoms" of drugseeking behavior, like allergies to whatever(not everything) are treated poorly due to 10 previous seekers in the same night? My doctor even admits thats the case.
I used to work with a gal who had chronic headaches that were extremely debilitating. She was constantly in being seen in the same ER of the hospital that we work in. She started being labeled as a drug seeker since MSO4 was the only thing that relieved her pain, and she knew and told them that it was the only thing that worked. After 3 months of pain, she went to another hospital for a second opinion. They found a large anerysm in her brain which was causing the headaches. After surgery, she had some cognitive impairment that prevented her from working.
Perhaps if someone had taken the time to take a history or listen to her, she perhaps could have had a longer career in the nursing field.
Imagine if we had the ability to be empathic for just one day, particulary on the "drug seekers"?
FranEMTnurse, CNA, LPN, EMT-I
3,619 Posts
I had a horrible experience this afternoon. I was being fitted with a new set of dentures when my most dreaded pain hit.
It frightened the nurse and the dentist. The dentist asked me if he ever witnessed it, and I said, "Yes, and he thought I was having a heart attack. I was in so much pain then he asked me if I wanted a shot of Morphine. At that point, I didn't care what was given to me as long as the pain could be relieved. He started out the door, then he returned saying, "Wait a minute. You're allergic to Morphine. Then he asked me if I wanted some Dilaudid. That was in April 2001, and I still get it. 
The dentist said, "No wonder you take so much medication. You definitely need it." In reply, I said, "This is the one my PCP thinks I'm exagerating with just because nothing shows up on a test!" It's called post embolotic syndrome. It occurs when help in resolving the PE isn't enacted fast enough. In layman's language, I think it's called, "Phantom pain." 
Pardon me for saying it, but when I hear him talking about imaginary pain (the kind that's all in your head? Yeah, RIGHT!) I feel like calling him a lunatic. 