Patient question... drug screens.

[RosaParksIsMyHero]

I'm going through my CNA classes, but this is a question about a different issue.

I had a severe bout of nausea and vomiting. My belly hurt some and the vomiting had come on very suddenly. It started on a Friday night (went out and ate sushi), and I'd been puking or retching all night and all the next day. (Couldn't hold down water, but it was easier to throw up the water than to dry heave.)

My man was worried and told me to call the doctor's office as he left for work (he works nights) My doctor doesn't even have a number to call to have him paged -- I called, and it said if there was an emergency to go to the ER. So I call the Nurse's Line my insurance had and asked what I should do -- I just wanted to stop puking. She said for me to go to the ER, so I went. Since my guy was now at work, I drove in myself.

I explained to the intake guy that I wouldn't ordinarily go to an ER for vomiting but that my doctor's office was closed and I didn't know any other urgent care places. I was recovering from a cold so I was coughing a lot He asked symptoms, I explained, asked pain level, I said 3. He said he'd get me triaged.

The nurses were really surpised that I'd driven myself in. I explained my man was at work. She said "There's not much we can give you for vomiting except Zofran if you have to drive" and I said "That's fine, I'd love something that wouldn't make me loopy." They did the exam, drew blood, got a urine collection, and then they gave the Zofran and the bag of fluid. I felt better, but then started dry-heaving again, so they gave another dose. The second dose was what did it, and I was happy.

However, at discharge, the doctor treated me very coldly, and acted odd. I said "That stuff is a miracle, thank you!" She said back "Well, you aren't getting any pain medicine so don't bother to ask, here's a script for Phenergan suppositories, the nurse will explain how to use them" and walked off. This woman had been extremely nice before the test results came back. I never even mentioned the abdominal pain to her, when she poked and prodded she asked if it hurt, and I said "a bit".

Diagnosis on my discharge was "food poisoning"

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Which leads me to ask.... I had smoked marijuana at a party two weeks back. I'm not a regular smoker -- I would never spend my money on it. I don't think it should be illegal, but if it were made legal I probably still wouldn't buy it. Other than that... I sprained my wrist a year ago and took pain pills then, but not since then. I don't do any harder drugs than marijuana, and again... it's not important enough to matter.

The only explanation I can think of for her cold behavior and the pain medicine reference was that she thought I was a junkie or a drug seeker.

So.... do you always screen for drugs in ER patients? If a screen that showed positive for marijuana make you treat your patient differently?

[big-chicken]

I would have demanded an explanation from the doctor immediately. If I wasn't happy with the reponse, I'd be talking to a patient advocate or administrator.

There's no excuse for treating patients this way, even if they are junkys.

big-chicken.

[Dolce, RN]

I think she treated you unprofessionally.

[Altra, BSN, RN]

Just so that I understand correctly ...

1. You got the symptom relief in the ER that you were seeking.

2. Your point of contention is that you perceive that the physician treated you "coldly" before discharge.

3. You are making the assumption that the "cold" persona of the physician is related to a urine drug screen result positive for cannabinoids.

My honest opinion ...

1. No, urine drug screens are not automatically ordered on all ER patients. However, a urinalysis on all patients presenting w/abdominal pain or any GI-related complaint ... and a urine pregnancy test on all females of child-bearing age ... are standard protocol. There is no way for us to know if a urine drug screen was also ordered.

2. You're taking what was likely a 45-second encounter with someone who has never seen you before and will likely never see you again and personalizing it greatly. The physician could have discharged 17 people in a row before you, all of whom griped for pain meds. Don't assume this is about you.

Glad you are now feeling better.

[Altra, BSN, RN]

I would have demanded an explanation from the doctor immediately. If I wasn't happy with the reponse, I'd be talking to a patient advocate or administrator.

There's no excuse for treating patients this way, even if they are junkys.

big-chicken.

What exactly would you like the patient advocate to do?

[widi96]

If you wanted, you could go to MR and request a copy of your chart. If they did a UDS, it would be in there. Not that it is out of line for them to have done one, but if it isn't even in there, then there is no way they could've known.

[iwanna]

If you are not a regular smoker, Thc should be out of your system by two weeks. Actually, even within a week, if you seldom smoke weed. However, it can take up to six weeks for a heavy pot smoker. So, I doubt that if they did a drug screen that you would show positive for THC.

I agree with OP that they may have had some drug seekers going through withdrawal. However, the nurse was out of line with her comments. But, the bottom line is that your medical issue was resolved. I would not take it personally.

Most ER staff have low tolerance with addicts. Some are great. However, many of them look down on addicts. Yes, they should not help them by giving them a fix with pain meds. Although, they can give them something for their withdrawal, if they are willing to have drug consult for rehab. e.g.catapress, phenergan. My daughter is an opiate addict and called her PCP for help. He told her to go to ER and they will get her hooked up with rehab. They were very rude and asked why she would come to the ER for that reason. It was because that is what the dr. told her to do. She was not seeking drugs, but wanted something to help with her withdrawal. She was willing to go to rehab, right then. Unfortunately, it was on a Friday after hrs. and they did not have a detox bed for her. We did get her into rehab a few days later. However, after she was dc/d from ER, we reached dr. on call. She called in the catapress and the phenergan. And, got in rehab three days later. Okay, I got way off topic. But, I just wanted to let you know how most ER looks at addicts. So, this is why yu may have been treated in the way that you were. Not that you have substance abuse issue, but they may have had their share of addicts for the day.

But, all is good with you now. So, please forget about it.

[big-chicken]

I would expect the patient advocate to address the unprofessional attitude of the physician and would also expect the PA to provide satisfactory answers to any and all questions I asked.

My understanding is that a hospital cannot perform a drug screening on anyone without the persons permission, unless there is a court order.

They can run labs on blood/urine but cannot screen for drugs without permission.

Also, pot smokers are not known to go to hospitals and seek narcs. Marijuana is not a narcotic. Perhaps they found something else in the labs. In any event, you have a right to see your file and access ALL info pertaining to your' health. I would have addressed this with Doctor attitude immediately after the comment.

big-chicken

[Altra, BSN, RN]

I would expect the patient advocate to address the unprofessional attitude of the physician and would also expect the PA to provide satisfactory answers to any and all questions I asked.

There is the mountain ... and there is the molehill. You have to decide which is which.

My understanding is that a hospital cannot perform a drug screening on anyone without the persons permission, unless there is a court order.

They can run labs on blood/urine but cannot screen for drugs without permission.

False, at least in my state. But if it would make you feel better, I'll attempt to get consent from my next unresponsive, apneic patient with track marks in his/her arm before I get a urine drug screen.

You may be confusing lab results which are admissible evidence in court vs. labs ordered to arrive at a medical diagnosis.

BTW -- OP has provided no evidence that a urine drug screen was performed as part of his/her ER evaluation.

[mianders, RN]

I'm going through my CNA classes, but this is a question about a different issue.

I had a severe bout of nausea and vomiting. My belly hurt some and the vomiting had come on very suddenly. It started on a Friday night (went out and ate sushi), and I'd been puking or retching all night and all the next day. (Couldn't hold down water, but it was easier to throw up the water than to dry heave.)

My man was worried and told me to call the doctor's office as he left for work (he works nights) My doctor doesn't even have a number to call to have him paged -- I called, and it said if there was an emergency to go to the ER. So I call the Nurse's Line my insurance had and asked what I should do -- I just wanted to stop puking. She said for me to go to the ER, so I went. Since my guy was now at work, I drove in myself.

I explained to the intake guy that I wouldn't ordinarily go to an ER for vomiting but that my doctor's office was closed and I didn't know any other urgent care places. I was recovering from a cold so I was coughing a lot He asked symptoms, I explained, asked pain level, I said 3. He said he'd get me triaged.

The nurses were really surpised that I'd driven myself in. I explained my man was at work. She said "There's not much we can give you for vomiting except Zofran if you have to drive" and I said "That's fine, I'd love something that wouldn't make me loopy." They did the exam, drew blood, got a urine collection, and then they gave the Zofran and the bag of fluid. I felt better, but then started dry-heaving again, so they gave another dose. The second dose was what did it, and I was happy.

However, at discharge, the doctor treated me very coldly, and acted odd. I said "That stuff is a miracle, thank you!" She said back "Well, you aren't getting any pain medicine so don't bother to ask, here's a script for Phenergan suppositories, the nurse will explain how to use them" and walked off. This woman had been extremely nice before the test results came back. I never even mentioned the abdominal pain to her, when she poked and prodded she asked if it hurt, and I said "a bit".

Diagnosis on my discharge was "food poisoning"

-----------

Which leads me to ask.... I had smoked marijuana at a party two weeks back. I'm not a regular smoker -- I would never spend my money on it. I don't think it should be illegal, but if it were made legal I probably still wouldn't buy it. Other than that... I sprained my wrist a year ago and took pain pills then, but not since then. I don't do any harder drugs than marijuana, and again... it's not important enough to matter.

The only explanation I can think of for her cold behavior and the pain medicine reference was that she thought I was a junkie or a drug seeker.

So.... do you always screen for drugs in ER patients? If a screen that showed positive for marijuana make you treat your patient differently?

Medical drug screens are not usually done unless the patients condition warrants it (AMS,ect), and no consent is needed because you consent to tx when you sign in. However for anyone except you to obtain these records they would need a court order. I do seriously doubt that you smoking a little marijuana a couple weeks earlier would show up in a drug screen anyway. Some doctors just have a bad bedside manner. Our ER doctors are contracted through an ER physicians group and if there is enough complaints against a particular doctor they will address it.

[big-chicken]

As I stated I would ask the Dr to explain the sarcastic comment immedately, before they walk away. If I had to chase the doctor down the hall to get the answer then so be it. Failing that a trip to the admin area to address this with a patient advocate is not out of the question.

If there is something in a patient's labs that counter-indicate them recieving pain meds, shouldn't the patient be told what/why?

Until such time that paitients take doctors to task for this behavior, it will continue and chances are they will be sarcastic with staff and everyone else they encounter. In many cases staff may not want to address the problem as it can affect their employment. Patients can make complaints without worrying about repercussions. Altra, Are you saying that patients should tolerate this from care givers? Patients would be doing the nursing staff a favor by addressing this issue.

I expect in most cases the doctor would provide an explanation, and in many cases they would apologize. If the doctor won't explain their comment should the patient just shrug it off ?

drive-south

[canoehead, BSN, RN]

In my ER you wouldn't have been drug screened, and if you were no one would care about the marjuana if that was all they saw. ESPECIALLY since you had symptom relief with Zofran, and were ready for discharge.

I think the doc confused you with someone else, or was in a huge rush to get people dispo'ed R/T something else going on in the ER. His/her momentary crankiness shouldn't be allowed so much dwell time in your brain. Not worth it-forget about it.