Pt demanded a stronger pain med

Specialties Emergency

Published

: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 rolly-poley little wife advised me that the APAP#3 wasn't going to be good enough. She stated that he was a 250lb. man that needed much stronger pain medication. I replied that it was a sprain and that we don't normally prescibe a narcotic for a sprain. His wife was adamant that I go ask the doctor for something stronger. She was that type of person that doesn't know half of what she's talking about and you can't get a word in. She developed a quick case of diarrhea of the mouth. So, I walked out and advised the doctor of the situation. He responded exactly as I expected. Yep, you guessed it, they're not getting anything stronger. I went back into the room with the bad news. She became angry and proceeded to orally defecate :barf01: some argument that since they were paying cash for this visit that they should be able to get whatever they requested. The pt advised that he didn't have a regular doctor and that this would be his doctor visit and so he needed medication. To tell you the truth, they both went off on a tangent and I sort of quick listening. They yapped the entire time while leaving, but did leave. I know I shouldn't have (you know the old saying about argueing with a fool), but I argued with the two of them about how it was just a sprain and that I had never had anything for the many sprains that I had had, yadda yadda yadda. I just don't get it with this entitlement attitude of these folks. I've been putting up with this for a few years, but it still pisses me off. 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."

So, now to a question. How would some of you respond to this situation? What would you have said to a pt demanding a narcotic for a minor injury?...Beside, "Suck it up, wuss!" Oh, how I wish I could say that.

Thanks in advance for your replies.

Specializes in Emergency Nursing, Critical Care (Heart).
I had a similar situation last weekend, but with a psych pt ("refusing" to be made involuntary....ummmm hello?) I think you handled it fine. My way of handling things like that is kind of a step by step...

1) Go to the doc, get expected answer (hell no) return to the room.

2) Of course, pt continues arguing. I don't argue with patients anymore (gives me bad karma :)) I just smile and say "I'm sorry, but the doctor has made his decision. These are your discharge instructions. XYZ would be signs of a problem, and we would like you to follow up at that point." When they continue arguing...

3) I would ask the doc to come in, explain again that there will be no other pain med script (although I did work with a moonlighter once who would offer 5 percocet or 20 APAP - it was interesting to see what these ppl would choose). I stay in the room so I can chart what is still continuing.

4) Doc leaves, pt is told again that there will be no other script, and that we are asking them to leave now as their emergent condition has been treated. They are either to leave by themselves, or security can help them.

I really try to not argue with these people - you aren't going to be able to convince them you're right. I probably - however - wouldn't have been "big" enough to ignore the "we paid cash" argument. I think I would have had to say something to that...something like "we treat everyone the same here, regardless of whether they pay cash, have private insurance, or have Medicaid/care. The fact that you are paying cash for this visit does not mean we are working for you or that you get to dictate your care." Oooh how I despise entitlement.

Thank you for your reply. Believe me, I wanted to say something to her when she brought up the cash, but I couldn't get a word in. She was runnin off at the mouth. You know, I hate having to go back to the docs. I really try to handle these situations myself, but just felt for documentation reasons I should at least consult him. Then just as you, I documented all that they said. I wonder, too, if the meds were even for him. People think that every shift is our first and that we have never heard some of their excuses. Arrgh. Take Care.

Specializes in cardiac med-surg.
:rotfl: You made me giggle, so true!!

verra verra phunny:lol2:

Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

I think the entire USA needs a lesson on proper behavior.

Specializes in ICU, ER.

I 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?"

My 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.

Specializes in Hospice, Med/Surg, ICU, ER.
i would hazzard a guess that it wasnt even for HIM.......

Exactamundo! This is the case w/ several of my pts at the Urgent Care.

Specializes in ED-CEN/PACU/Flight.

That 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...

i would hazzard a guess that it wasnt even for HIM.......

BINGO

Specializes in ER, ICU, Infusion, peds, informatics.
i 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.

Specializes in Emergency.

Personally 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.

Rj

Specializes in ER, NICU, NSY and some other stuff.

I 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.

: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."

I'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)

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