Pt demanded a stronger pain med

Specialties Emergency

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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.

Specializes in TCU,ICU,OHRR,PACU,5Solid Organ Transplan.

Nope!!

Specializes in ER, ICU, Infusion, peds, informatics.
i'm rather disgusted by this post myself. i too have had my ankle "sprained."..it was very, very painful. nsaids have never worked for me, not even for muscle aches or headaches.

that sprained ankle went on to get surgery within 6 months, and that was followed by hip surgery a year later. i'm really thankful the nurses at the urgent care center i went to believed me when i told them that nsaids didn't work and could they recommend something else. they recommended vicodin, which took my pain from a 7-8 to a 2-3, very manageable.

what did i do differently than your patient? i didn't get upset, but then again, i didn't have to....the nurses were caring, attentive, and they listened to what i had to say.

my body chemistry is very particular as to what pain relieving meds work. vicodin works, but it keeps me awake all night long so i prefer it only for daytime pain. demoral is o.k. for nightime......my point being, who are you to decide what is going to work for an individual. being that less that 1% of people who use pain meds for pain relief become addicted, who does it harm to give someone in pain the benefit of the doubt?

i would be pissed off if someone told me i wasn't in pain when i really was and i would act accordingly. is it so surprising that wifey got angry? she was trying to protect her loved one from pain and suffering.

this reminds me of a time i was in the hospital for a ruptured ovarian cyst, i kept asking the doc for pain meds......it hurt so bad. he kept saying no (he thought i was overeacting to a uti). i was crying and almost hyterical w/ pain. when the ultrasound came back.....boy he hustled in there with that morphine like his orifice was on fire. my husband was so angry he was almost crying as well. he never apologized for the nearly 3 hours i went w/o pain meds. if he had i would have chalked it up to circumstance, but b/c he didn't apologize we made a formal complaint againt the doc (not the nurses, who were trying to get me meds, the doc just wouldn't listen).

anyhoo, long story, but i think i've made my point.

the major point that i get from your post is that different people have different levels of pain tolerance, and that people metabolize drugs differently; what works for one may not work for another.

i don't think very many people would disagree with those points. some might, but not many.

but at the same time, i don't think the original post was about those issues.

as i read it, the op was taking issue with the following:

1. the pt's wife, not the patient, was not satisfied with the original script (tyl #3).

2. the patient hadn't even tried the tyl #3 to see if it would work.

3. she thought that the fact they were paying cash entitled them to a stronger pain medication.

yes, some of the ensuing discussion did talk about not needing narcs for most sprains or other "minor" ailments. i was one of the posters that made that assertion, and i stand by it. for most, nsaids work quite well for sprains. there are exceptions, we all know that. that is why it is so essential to have an established relationsihp with a pcp that knows their patients' histories.

i'm not sure if it was mentioned in this thread or another, but providers have to be careful when prescribing controlled substances. those kind of things are monitored, and they can get in a whole lot of trouble with the fda for indescriminate prescribing of narcotics and other scheduled drugs.

edited to add:

adding on to my list above:

4. there was no indication -- other than pat size -- as to why tylenol #3 wouldn't suffice. didn't mention low pain tolerance, history of nsaids not working, or a valid reason for requiring something stronger.

Specializes in PCU, Home Health.
This went no where. After about 10 minutes of listening to him call me everything but a woman, I say,"Listen to me. You are not getting narcotics. You will not ask me for them again. I have educated you regarding narcotics with possible neurological etiology. I have Tylenol for your HA. Would you like it now?"

He turned me into my director, VP and CEO. They made me apologize but they agreed with my assessment. He left AMA! I am here to serve the public, yes. I am not here to be a punching, spitting, foul mouthed, stupid, killer nurse. The patients and a lot of times their families, are verbally aggressive and borderline physical aggressive.

WHAT did you apologize for? Were you not being truthful? What did they make you say? That is crazy- I have a difficult time with people who demand or act like they are at a hotel- and have requested training- all of that 'can I get you anything else because i have time' is complete crap! I dont have time! I am busting my tail trying to please you while I need to be getting a B/P on my patient with a cardizem drip and my other patient is on the Bedside toilet. Those 12 family members you have in here with you commenting under their breath about me can be your waitress!

(Thinking good thoughts... bunnies in a meadow.....)

Specializes in Onc/Hem, School/Community.
You did fine.

If there was a remote possibility shame would work, having a shocked expression on your face and saying something like, "Oh, no, our doctors are watched very closely on their pain medication prescribing; Dr. Stethoscope could lose his license!" However, since lots of people these days wouldn't know shame if it had 18 wheels, was bright red and ran over them in the parking lot, that probably wouldn't work.

Just repeat, with a smile on your face, "I'm sorry, Dr. Stethoscope isn't going to give you anything else today." And repeat, as often as necessary, until they give up and go away. Don't discuss or argue further, just keep repeating the same thing.

People do get tired of beating their heads against a brick wall and stop.

I agree and do what you do. I like to call it "the broken record approach"! :lol2:

Specializes in Onc/Hem, School/Community.
Why are all abdominal pain considered BS? I had a LOT of abdominal pain near my ovaries-radiating to the middle of my abdomen. I put up with the excrutiating pain because I was afraid to go to the ER because of this board and comments like this. I was afraid of how I would be received. One day the pain became so intense...went away for a second...and came back full blast. I made an urgent care appointment because it was after hours. I waited over 2 hours until my appointment doubled over in pain. My mom drove me to the appointment. I had an elevated BP and pulse, but no temp. The nurse kind of rolled her eyes. Dr. came in palpated, blah, blah. Didn't request a urine until the end of the appointment~AFTER he said maybe it's PID we should do a pap. :uhoh3: No, sir, I don't I think so! Urine dipsticked for pregnancy as a formality because I'm tied up. Faintly positive...maybe not... let's get an ultrasound. The story ends with my left fallopian tube removed>>>>>>Wow. Dumb ass abdominal complaint people.:trout:

I know this is a little off topic, but I know what you mean. I went four years with crippling abdominal pain and was treated like a "drug seeker" by the doctors I went to see, the ERs my husband took me to, and my insurance company. We lived in a very small state, so my hubby drove me to the next state over and took me to an ER there. The doctor there took me seriously, admitted me, put me on a PCA, and scheduled a laparoscopy first thing in the morning. I had massive abdominal adhesions r/t two C-sections. The adhesions had developed their own blood supply. The doctor recorded the surgery to show his colleagues and told me he did not know how I had continued to walk for so long. I asked him why the other docs had never picked up on it. He said, "Oh, adhesions don't show up on ultrasounds, so sometimes, I just have to listen to the patient." :rolleyes:

Specializes in Palliative Care, NICU/NNP.

" I replied that it was a sprain and that we don't normally prescibe a narcotic for a sprain."

Do you mean a narcotic besides Codeine??

As a nurse that has been to the ER and said that an ASA won't take care of my stabbing pain in my ear (my eardrum ruptured on the way home) and having the doc tell me no one needs more than an aspirin. I know how those people felt. I knew what I needed and it wasn't ASA. If someone handed that line now I would have spoken up.

Tylenol #3 is a narcotic. Maybe that drug hasn't worked for him in the past. Who are we to pontificate what works for a sprain when we aren't in his body. I think we need to quick looking at everyone that comes in as a drug seeker. Personally I don't like codeine and would have asked for something different and I am not a drug user.

Make life simple

As they come in the door

Give them a menu

Be sure to tell them about

The Daily special

Never argue with them

say here it is

or the doctor said yes or no

and walk away

so true...

I used to beat my head against the wall...

no more...

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