Why are doctors so easily manipulated by drug addicts?

[TigerGalLE, BSN, RN]

I've started working prn at a new hospital in a different county from my previous job. At my full time job (a med surg floor) we see our share of drug seekers. We may have one drug seeker as a patient every few shifts. They almost always have another underlying medical problem. But at my new job the amount of drug seekers is absolutely ridiculous. I will have 1-2 drug seeking patients every shift. And yes they usually have underlying medical problems. But seriously 8mg of morphine and 25mg of phenergan IV every 3 hours for a patient with DM? Where is your pain? Your abdomen? Well you're eating soup and drinking coffee so it must not be too bad. I guess because this hospital is the only hospital in that particular area we see more drug seekers than my other job. At my full time job the hospital is 1 of 2 major hospitals in that particular county.

I have never given narcotics like I am having to give at my new job. I have patients who are getting Morphine 4mg IV every 2 hours for SBO and this has been going on for over a week!! And you wonder why your bowels haven't started moving????? I had a patient 2 nights ago call for her morphine and phenergan and when I got down to her room she was snoring!! Then when she woke up 2 hours later she was furious that I didn't give her the medicine while she was sleeping?

These people aren't fooling me? How do they fool their doctors so easily? Or do their doctors just not care? The same people come into the hospital over and over every few weeks with the same issues and spend their entire admission higher than a kite. I know addiction is a disease but when doctors are enabling the disease they surely won't get better!!!

And the truely scary part is this hospital is full of new grads... These new grads don't even blink an eye about giving large amounts of narcs over and over every 2 hours.... This is a serious accident waiting to happen......

[classicdame, MSN, EdD]

it is easier than treating the underlying mental condition

Not that that makes it right, but it is easier

[delphiniumRN]

the best approach to this type of patient is a pain consult, either by a psychiatrist that specializes in pain or a pain doc. The pain must be managed per JHACO to a resonable level for that patient, however they are multiple modalities other than piling opiods upon opiods.

Be very careful about your assesment prior to administration ie resp rate, and bp. pain level before and after. You never know when a patient will have an apnea episode d/t excess opiods on board. Good luck...

[iluvdetroit]

Doctors want their patients to look at them as a "good guy" a lot of the time. Also, I have noticed this pattern many times with the drug seeking patients that I took care of: middle-aged or older male doctor, fairly attractive younger female patient. Not that I think the docs have affairs with their patients, maybe just that they want to be liked by them. Doctors are professionals but they are also human. That's all I can figure.

BTW, if you had to pick a main demographic for your drug seeking patients, what would it be? For me, it seems like most of the time they were fairly attractive, 30-something, white, middle class or higher, females. Just curious what all of your impressions are? And btw, I am a white middle class female, so I'm not picking on anyone, just stating my findings.

[TigerGalLE, BSN, RN]

But you know with people like this... Their pain is always 10/10 even after you medicate them with enough morphine to kill someone. And I know according to JHACO a person's pain is what they say it is....

I usually document exactly what I see. Patient sitting up in bed watching TV, talking on the telephone, and eating graham crackers, peanut butter, and drinking soda. Complaining of abdominal pain "25 out of 10" and "nausea." Medicated with blah blah and blah....

Or CNA reported that patient was c/o "having a panic attack" and requesting nerve medicine. On assessment patient sitting up in bed watching TV. RR 16 BP 112/52, HR 71. Patient appears to be in no acute distress and is chatting with visitors at bedside. Patient requesting IV ativan for her current panic attack. Blah blah blah

UGH!

How are we not putting our licenses at risk here?

Detroit:

The drug seekers I've worked with are usually middle aged and white. Street drug users do not usually fit this description but can be just as difficult to deal with.

[Keepstanding, ASN, RN]

prime example: michael jackson's doctor. just trying to please the patient

praiser :heartbeat

[classicdame, MSN, EdD]

there is definitely pain present - just not physical pain

[delphiniumRN]

prime example: michael jackson's doctor. just trying to please the patient

praiser :heartbeat

that is a prime example of poor polypharmacy and greed/ bad judgement that led to death. i believe it was a nurse who tried to blow the whistle on the diprivan

[Tweety, BSN, RN]

I'm sure there'll be the "how dare you judge" posts.

Untreated pain is a lawsuit waiting to happen, not to mention a Joint Commission standard. If a patient says he's in pain, then the doc is obligated to treat it. Doctors are not stupid, most of them know they are being manipulated, but rather than being called every hour for pain medication, and with the threat of being sued they treat the pain as reported by the patient.

Then of course there are those patients whom later have the nerve to sue their doctors for turning them into drug addicts.

[TigerGalLE, BSN, RN]

I'm sure there'll be the "how dare you judge" posts.

Oh I'm sure there will be too. And trust me, I am not a nurse that is against pain management. It is just frustrating when you are having to beg a 70 yr old man with terminal cancer to take something for his pain b/c he is afraid he'll get addicted.. Then you have the next generation of patients who are sucking it up so fast that you have to get the pyxis restocked before you can give the little old man something.

[NewNurseyGirl2009]

Doc's can actually get sued for not treating pain. And remember "pain" is wha tthe patient says it is. Not that it's right but one of our doc's said they are backed into a corner when this happens.

[Jaila]

I worked in a fam practice years ago...the pts on chronic pain meds, lost their scripts, drug seekers,etc all had to make office visit for med refills. Needless to say if he declined (and he knew they were seekers), then they found a new doc and there went business out the door. Many doctors are business oriented.