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 ER.

[color=#483d8b]it starts when you put them in a room and tell them to undress and put the gown on, opening in the back, please. i usually get "i have to take my clothes off?" well, yes, if the area you are complaining about is covered with clothing, then you have to take them off to be examined. and it all just goes down-hill from there. they don't want to be stuck for iv/labs, they don't want to drink the contrast for the ct scan, they don't want the pelvic exam or the cath u/a. they want you to tell them what is wrong, but the don't want to go trough the testing. and, they don't want to wait for the test results. (and they usually start complaining that the wait has been so long, that we need to feed them. so we then have to explain why it is that they can't eat with a c/o abd pain, n/v)

oh how true!!! i recently had a female with a "migraine". the doctor gave her fluids, toradol and reglan. her husband was furious! he demanded something stronger for her. told us that if he had insurance she would get something better. guess what she got what she wanted - dilaudid (press-gainey anyone?). less than five minutes after her dilaudid she was asking for her discharge instructions.

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Specializes in ICU, ER, HH, NICU, now FNP.

funny thing is....

A drug seeker won't get a call from from Press-Gainey anyway - wanna know why? They probably won't put their real phone number on their admission paperwork - and if they do, they won't answer a call from a number they don't recognize!

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Specializes in ER, ICU, Infusion, peds, informatics.
funny thing is....

a drug seeker won't get a call from from press-gainey anyway - wanna know why? they probably won't put their real phone number on their admission paperwork - and if they do, they won't answer a call from a number they don't recognize!

unfortunalty, our hospital system uses written surveys, in a postage-paid envelope.

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Specializes in Emergency.
unfortunalty, our hospital system uses written surveys, in a postage-paid envelope.

yes but when the pt is homeless or just gives you the address of the local vacant lot they dont get mail either.

yes abd pain is a major work up. at least now a days we are a little more patient friendly. i can remember when belly pains didnt get pain meds until the surgeon/ob doctor saw them as you didnt want to mask that pain.

rj

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Specializes in ICU, ER, HH, NICU, now FNP.
Yes but when the pt is homeless or just gives you the address of the local vacant lot they dont get mail either.

Exactly! These people don't WANT to be found - you're fortunate (or not) if they even give you their real names. Drug addicts tend to be a paranoid lot.

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Specializes in ER, ICU, Infusion, peds, informatics.
yes but when the pt is homeless or just gives you the address of the local vacant lot they dont get mail either.

yes abd pain is a major work up. at least now a days we are a little more patient friendly. i can remember when belly pains didnt get pain meds until the surgeon/ob doctor saw them as you didnt want to mask that pain.

rj

ours are handed to the patient by registration when getting their insurance info. then they can either give them to registration when they checkout, or they can mail them in once the get home.

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: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.

How would I respond? I think I would NOT have assumed that the pt didn't need a stronger med. He was, after all, pretty heavy and he had, after all, injured his weight-bearing body segment.

I would have NOT gotten angry, looked down my nose at him and his wife, and been impatient and judgmental, I would NOT have taken what you seem to have taken, which is a one-size-fits-all, holier-than-thou attitude. I would have figured the guy knows his own body, I would have assumed the best about him, that he was being sincere, and I would have figured that he was ENTITLED to proper pain relief. Don't be mad. You asked.

Oh, something else - I would have the doctor go deliver his message to them himself. Why should I do the dirty work? He gets paid the big bucks so he can just go in and face the heat himself. While he's at it, he could explain himself to the patient. After all, the word "doctor" means "to teach".

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BINGO

And you know this how?

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Specializes in M/S/Ortho/Bari/ED.

Wow, this is kink of a sticky area. I'm a second career/new nurse (passed NCLEX yesterday! :monkeydance: and we were always taught in school about pain being the 5th vital sign and it is what the patient says it is and blah blah blah... But some people are just so obviously playing the system.

I wonder though, if that makes us less empathetic when we come across patients that are justified in needing a higher level of relief and are not getting it? Not everyone deals with pain as well as others. When I had my pancreatitis and a lap chole with ERCP done I definitely saw the brief flicker of judgement pass over my nurses faces when I asked them for my PRN meds. The guilt vibe I was getting from them was so stressfull I wondered if I should just lay there in pain so they would not classify me as a weenie!

With Migraines, the way I can tell what's up is how the patient reacts to being administered a Triptan. Because if you are a true Migraine sufferer, no narc will kill any migraine the way a triptan will and they are always so relieved to feel better.

I just try not to judge. Good advice on how to deal with the frequent flyers though!

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Specializes in ICU, ER, HH, NICU, now FNP.

But triptans truly do not work for every patient. And not all triptans work for every patient. Brand X may work for one patient and Brand Y may work for another but niether of them may be effective for the third patient.

You can't count on triptans to relieve all migraines. And then there are rebound cycle migraines...

Some migraines truly do need narcotic pain medication.

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Specializes in ER.
Why are all abdominal pain considered BS?

She said abd pain where all the tests were negative.

TrudyRN; Judgemental statements don't appear to be confined to the OP in this thread.

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Specializes in Med/Surge, ER.

I would have handled it just as you did, and I'd probably tell them that if the APAP #3 didn't control the pain, they could use OTC Motrin in between doses.....LOL.....drug seekers always love that answer.

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