I read the part about fibromyalgia, then I was irritated: I hope this did not
come from a real ER doc, we are not supposed to feel this way about
peoples pain. OH, and also, some bad language in places, sorry, copied
this from craigslist.org I will have to admit, as a nurse and I know nurses
on the forum will relate to some of this.
Advice from an ER doctor to drug seekers
Date: 2007-03-27, 10:56AM PDT
OK, I am not going to lecture you about the dangers of narcotic pain
medicines. We both know how addictive they are: you because you know
how it feels when you don't have your vicodin, me because I've seen many
many many people just like you. However, there are a few things I can tell
you that would make us both much happier. By following a few simple
rules our little clinical transaction can go more smoothly and we'll both be
happier because you get out of the ER quicker.
The first rule is be nice to the nurses. They are underpaid, overworked,
and have a lot more influence over your stay in the ER than you think.
When you are tempted to treat them like sh*t because they are not the
ones who write the rx, remember: I might write for you to get a shot of
2mg of dilaudid, but your behavior toward the nurses determines what
percent of that dilaudid is squirted onto the floor before you get your
shot.
The second rule is pick a simple, non-dangerous, (non-verifiable) painful
condition which doesn't require me to do a four thousand dollar work-up
in order to get you out of the ER. If you tell me that you headache started
suddenly and is the 'worst headache of your life' you will either end up
with a spinal tap or signing out against medical advice without an rx for
pain medicine. The parts of the story that you think make you sound
pitiful and worthy of extra narcotics make me worry that you have a
bleeding aneurysm. And while I am 99% sure its not, I'm not willing to lay
my license and my families future on the line for your ass. I also don't
want to miss the poor bastard who really has a bleed, so everyone with
that history gets a needle in the back. Just stick to a history of your
'typical pain that is totally the same as I usually get' and we will both be
much happier.
The third rule (related to #2) is never rate your pain a 10/10. 10/10
means the worst pain you could possibly imagine. I've seen people in a
10/10 pain and you sitting there playing tetris on your cell phone are not
in 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50%
body surface deep partial thickness burn, or the pain of a real cerebral
aneurysm. Even when I passed a kidney stone, the worst pain I had was
probably a 7. And that was when I was projectile vomiting and crying for
my mother. So stick with a nice 7 or even an 8. That means to me you are
hurting by you might not be lying. (See below.)
The fourth rule is never ever ever lie to me about who you are or your
history. If you come to the ER and give us a fake name so we can't get
your old records I will assume you are a worse douchetard than you really
are. More importantly though it will really really piss me the f**k off.
Pissing off the guy who writes the rx you want does not work to your
advantage.
The fifth rule is don't assume I am an idiot. I went to medical school. That
is certainly no guarantee that I am a rocket scientist I know (hell, I went to
school with a few people who were a couple of french fries short of a
happy meal.) However, I also got an ER residency spot which means I was
in the top quarter or so of my class. This means it is a fair guess I am a
reasonably smart guy. So if I read your triage note and 1) you list allergies
to every non-narcotic pain medicine ever made, 2) you have a history of
migraines, fibromyalgia, and lumbar disk disease, and 3) your doctor is
on vacation, only has clinic on alternate Tuesdays, or is dead, I am smart
enough to read that as: you are scamming for some vicodin. That in and
of itself won't necessarily mean you don't get any pain medicine. Hell, the
f**ktards who list and allergy to tylenol but who can take vicodin (which
contains tylenol) are at least good for a few laughs at the nurses station.
However, if you give that history everyone in the ER from me to the guy
who mops the floor will know you are a lying douchetard who is
scamming for vicodin. (See rule # 4 about lying.)
The sixth and final rule is wait your f**king turn. If the nurse triages you
to the waiting room but brings patients who arrived after you back to be
treated first, that is because this is an EMERGENCY room and they are
sicker than you are. You getting a fix of vicodin is not more important
than the 6 year old with a severe asthma attack. Telling the nurse at
triage that now your migraine is giving you chest pain since you have
been sitting a half hour in the waiting area to try to force her into taking
you back sooner is a recipe for making all of us hate you. Even if you end
up coming back immediately, I will make it my mission that night to
torment you. You will not get the pain medicine you want under any
circumstances. And I firmly believe that if you manipulate your way to the
back and make a 19 year old young woman with an ectopic pregnancy
that might kill her in a few hours wait even a moment longer to be seen, I
should be able to piss in a glass and make you drink it before you leave
the ER.
So if you keep these few simple rules in mind, our interaction will go
much more smoothly. I don't really give a sh*t if I give 20 vicodins to a
drug-seeker. Before I was burnt out in the ER I was a hippy and I would
honestly rather give that to ten of you guys than make one person in real
pain (unrelated to withdrawal) suffer. However, if you insist on waving a
flourescent orange flag that says 'I am a drug seeker' and pissing me and
the nurses off with your behavior, I am less likely to give you that rx. You
don't want that. I don't want that. So lets keep this simple, easy, and we'll
all be much happier.
Sincerely,
Your friendly neighborhood ER doctor
it's NOT ok to contact this poster with services or other commercial
interests
PostingID: 301345524
I'm not sure if he meant fibromyalgia is a phantom malady, I think he's
just exasperated that pain medication junkies pull it out of the hat
often.
Yeah, he is but I had posted a thread a while back about how fibromyalgia is
perceived in the medical community and I just hate to see an ER doc, if he
really is one, saying these kinds of things. It really puts the person with
fibro in the same class as the drug seeking junkies and I don't agree with
that.
From my experience last year, they think FM is BS. When my appendix burst last year, the nurse practitioner missed it...I believe because I was so accustomed to pain that I didn't realize how bad it was and neither did she. Three days later when I saw my GP, he told me to go immediately to the ER. When I finally got in to see the ER doc/surgeon, he wanted to know what I was on, so I gave him my list. He asked what the Avalide was for (Duh!) and I told him hypertension. Because I didn't say "high blood pressure", he started grilling me, looked at the rest of my list, especially the fibro, and decided I was drug-seeking or making it up...despite my white blood cell count being astronomical and my GP already determining the appendix. Hours later it was sorted out, but right in front of me and my parents, the damn dr said to his interns...here is a typical case where you think she's making it up and sometimes it actually turns out to be a problem.
PS - I was in the hospital for 10 days just to control the infection, and when they came back to take out the appendix, there was very little they could find other than necrotic tissue. And thus began the RA.
Wow, you are very lucky to be sitting here with us. I'm glad you pulledI gotta agree with gimpy on this one. I am betting since FM is such a mystery illness to most docs and the chief complaint is pain most ER docs would be suspicious of the person coming in for pain meds and saying they have FM.
I tell ya what tho, my ER doc thought I was freaking drug seeking!!!! The (censored). I also dont think he believed my pain level was at a 9 at the time I went in. My BP said so..the look on my face said so...and umm the swelling should have said so. My bad foot was purple it was so swollen. I had pitting edema (when you touch the swollen part of your body and it "pits") on my feet and hands. My knee...what knee? Needless to say Danny made it VERY clear that is not what we were there for since I have my very own pain meds that normally work just fine. My pcp also made it VERY clear that is not what I was there for and if I was in that much pain I was to be taken care of PROMPTLY. And I was.
I feel we let ourselves go into uncontrollable pain at times because we fear we will be labled as drug seekers. It took a ton of convincing to get me into that ER that day because I did fear I would be labled and not helped.
The dude who wrote that article...whew...he has some anger going on! Anger Management anyone??
I know that ER docs are way over worked and under a ton of pressure from all angles.
But wish he could come down with an un-verifiable disease that is chronic and see what he thinks of living, working, and perhaps parenting with such misery. About the 4th month I'd like him to be treated by himself in the ER. Then he can magically recover. I wonder how much these smart asses would change if they got a good 'taste'.
http://www.ama-assn.org/amednews/2006/11/27/hlsb1127.htm
I had read that the AMA had finally come out with an edict from high that even if the patient cannot be diagnosed with fibro or chronic fatigue, to at least GIVE THEM SOMETHING to help with the pain and symptoms. Hello, someone copped a clue at the AMA?
There's more fun in this site:
http://www.ama-assn.org/amednews/2007/05/07/hlsd0507.htm
I had to go find this link:
hlsb1127.htm">http://www.ama-assn.org/amednews/2006/11/27/
hlsb1127.htm
I had read that the AMA had finally come out with an edict from high
that even if the patient cannot be diagnosed with fibro or chronic fatigue,
to at least GIVE THEM SOMETHING to help with the pain and symptoms.
Hello, someone copped a clue at the AMA?
There's more fun in this site:
hlsd0507.htm">http://www.ama-assn.org/amednews/2007/05/07/
hlsd0507.htm
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