- Disappearing John has a post today about an article he read on patient satisfaction scores entitled "The Customer isn't always right." Here is a snippet:
"He talks about the biggie first, the fact that the only people who get sent surveys are those who do not become inpatients (those people get a different hospital-wide survey), so the only people getting surveyed are the less-sick patients, who tend to wait longer, and are often upset about not getting admitted, not getting antibiotics for their viral illness, or being told they shouldn't have come to the emergency room.
He makes another great point about the waste of resources. Hospitals are running on slim budgets already, and are paying a large amount of money for the survey companies. Add to that, most hospitals have now hired outside consultants to provide "scripting" and hints to improve the scores (I know ours has). How much would our satisfaction go up if that money was spent instead on more staff?"
Two excellent points. I would like to see us stop referring to the patients as customers. They are not customers, they are PATIENTS. By forcing the doctors to give them want to keep them happy you are completely negating all the years of medical school and specialized training that doctors have to learn how to diagnose and appropriately treat people who are ill and injured. If all we want is for them to be happy we don't need doctors or nurses, we can just sit a housekeeper at the front desk with a stack of pre-signed prescriptions for Vicodin and antibiotics and work excuses and have them hand them out to whoever asks that way we will be taking care of the long wait also.
And yes, how much exactly is the hospital spending on those bullshit scores anyway? Couldn't that money be better spent on more staff or supplies.?
If we have to do a patient satisfaction score, let's ensure that they are only given to the people who really needed to be in the ER to begin with. And that leaves out the vast majority of the prompt care patients. Don't give them to the 'back pain' and 'migraine' crowd, give them to the pneumonia, kidney stone etc and make sure to give on to everyone that was admitted. And then ask them questions that actually mean something, ER's sometimes can't control the wait time, it is not a doctors office, too bad - deal with it and quit whining. Here is my dream survey:
1. was the ER clean or should they hire enough housekeepers to actually have time to clean the place and pay them a decent wage so they will have incentive to do a good job and not quit when something else comes along?
2. Did your nurse have enough time to spend with you or were they trying to run an ER safely when they were short 3 staff members.
3, Did your nurse have enough time to spend with you or was she spending all her time in front of the computer because charting now takes three times as long?
4. If you were admitted did you get up to your room in a timely manner?
5. If you were admitted was the room ready or did your ER nurse have to move furniture and find an IV pole before putting you in the room.
6. If you were admitted did your floor nurse meet you at the room and greet you?
7. In the ER did the staff take time to explain what the plan was and give you updates? (this is a biggie to me, no matter how busy we are it only takes a few seconds to tell people what is going on.)
Thanks John!
57 comments:
You said, "let's ensure that they are only given to the people who really needed to be in the ER to begin with. And that leaves out the vast majority of the prompt care patients. Don't give them to the 'back pain' and 'migraine' crowd..."
With all the respect you and other ER nurses are due, please learn more about Migraine disease. If you do, you'll change your mind about the "Migraine crowd." Migraine is a genetic neurological disease that can cause strokes and literally kill in extreme cases. People with Migraine don't go to the ER unless they've exhausted all other options. I realize some "bad apples" present in the ER claiming Migraine because they want opioids, but a real Migraineur only wants the pain to stop. Doctors tell Migraine patients to go to the ER if their prescribed Migraine medications fail. We have no other choice.
ER nurses are vitally important. We need you and count on you. Please understand that we are not faking. If we're in the ER, we need to be there, need your help.
Thank you,
Teri Robert
Migraineur
author, patient advocate
Hi! from somewhere I found your blogger and I just love it. I´m also ER nurse, but far-far away from you- in Estonia. But I have to addmit, the problems are the same. If you sometimes just want to write, then please be my quest and do it. it would be so nice to talk with somebody who is doining the same thing. with all the best from estonia!
Most of the migraine-stroke and migraine-death hysteria comes straight from the headache forums. Only migraine with aura is associated with increased incidence of stroke (about 2X) in age matched controls. Most "migraines" we see in the ER are not associated with aura, and are frequently atypical and doubtfully true migraines at all. Non-aura migraines have no increased morbidity or mortality.
But most migraines occur in younger women anyway whose risk of stroke is so small as to be essentially insignificant, so a doubling of that risk isn't really all that worrisome. Sorry.
And just because the incidence of stroke is increased in classic migraines, that stroke doesn't necessarily occur at the time of the headache. A youngish woman with a headache, transient neuro symptoms, and a negative CT scan is likely to be discharged with recommendation from the Neurologist to take some Excedrin migraine and follow up in the office.
Headache without neuro symptoms? Sorry, we have to see the sick patients first. Please wait in your room.
Teri - Estonia that is so cool - wish your blog was in english
Annilee, Estonia! I had to look up on the map to find out where that was, too cool, welcome to my blog. It is funny to hear that even so far away you have some of the same problems we do here.
Scalpel said, "Only migraine with aura is associated with increased incidence of stroke (about 2X) in age matched controls. Most "migraines" we see in the ER are not associated with aura, and are frequently atypical and doubtfully true migraines at all. Non-aura migraines have no increased morbidity or mortality."
Again, respecting everyone's knowledge, stroke does happen at times with forms of Migraine other than MWA. It can occur during status Migrainousus also. Nor does the age hold true.
Aside from the risk of stroke, do people in real pain not deserve relief even if it is Migraine pain? When someone's regular abortive meds don't work, and it's after hours or on a weekend -- and their doctor has said to go to the ER in such circumstances -- what do you propose they do?
I have read the studies referred to in the Medscape article. I've written articles on those studies myself, spoken with some of the researchers. Twice every year, I take a week to go to the American Headache Society conferences to learn about Migraine disease and headaches.
Please, don't just put all Migraineurs in a group of people who shouldn't be taking up space in your ERs. There are times when we really need your help.
Thanks,
Teri
Teri, we can usually tell by looking at the visit history. Migraine sufferers that have tried everything are on abortive treatments and have rare ER visits. The 'migraines' I am talking about we see several times a month and they are allergic to all of the regular migraine treatment medications. We don't automatically assume that everyone with a migraine is drug seeking, we're not stupid. And we rarely withhold pain meds from anyone, even someone we strongly suspect is drug seeking because we don't want to run the risk of not treating someone who really needs it.
And, BTW, there is a difference in medical speak between migraine and 'migraine.'
Thanks, ERNursey. I'm sorry I didn't recognize the difference the quote marks made. I realize how hard people who are drug seeking make your job!
Teri
first, i want to say thanks to the er nurses that believe a person with a migraine. the one time i went in (before it was all properly diagnosed and i was given a prescription for imatrex) i knew enough about migraines to know that i was having one that made me want to put an ice pick though my head. (i was 19, now 21)
I went into the er around 10:30/11:00 p.m. and was in a room for the night by 12:30. everyone i saw was great and were very helpful. if they weren't i don't know what i would have done.
secondly, any er nurse or whoever that doesn't get it, please keep in mind how far a little help goes in a situation like that. when i went in, i wasn't able to do much other than answer questions and stay sitting. if nobody believed me, i honestly can't say what i would have done...i wasn't in any state to think on my own.
i wasn't drug seeking, it didn't cross my mind. i just wanted to not be in pain, i just wanted to sleep. i didn't know the dangers of a migraine, i just knew that teh people at the hospital could help me.
so thank you again to those that help, and please educate yourself to those who doubt that a migraine is something real and important.
elayna
I don't want to cause arguing or controversy on an otherwise interesting blog, but wow, Scalpel, I'd hate to be a migraine patient in your ER. I have only been to the ER once for a migraine that was a 9/10 scale. Those doctors took me seriously and gave me medication that otherwise saved my life--had I been in that hell very much longer, suicide would have been an option I'd not have thought twice about. Since when are migraines not a "true" sickness? Vomiting with headaches isn't normal, and some people vomit themselves into dehydration with a migraine, which presents its own set of unique problems for the human body.
I present with aura with roughly 50% of my chronic attacks, have been through spells of persistent aura, and also have the "dreaded" PFO. I currently take a preventative and abort with triptans, but it doesn't always work. God forbid I should ever have to go to the ER again because of doctors like you, who make me feel ashamed for having something I can't control and would rather die than cope with a bad attack when my insurance won't pay for more triptans after I run out. I would hope that you would take anyone seriously who came to your ER complaining of migraine pain whether they are experiencing aura or not. I realize there are drug seekers and the like, but it's sad that it's in your hands to help someone who may be suffering more than you can know and you're going to second guess them. Whether stroke is going to happen or not is negligible for many migraine patients, but why on earth would you let that negligible chance slip through your fingers and possibly make it into reality? As a doctor, you have to be under enormous pressure to make the right decisions, ones that don't bring back the drug seekers and ones that save lives. But for God's sake, don't lose your compassion towards people who are in that much pain just because you think a stroke risk is negligible. You don't and can't know when stroke is going to strike someone like me, if, indeed, it does. But it's good to know your risk factors and be prepared in case. Migraine debilitates people and it takes years away from them. You could be someone who helps us by changing your attitude--the majority of us aren't uneducated patients looking for the next fix. We just want our hell to end.
Take care.
"Migraine debilitates people and it takes years away from them."
Debilitates them? Maybe. So does a fractured hip. You want me to see the young person with her 1000th headache before granny? Sorry.
Takes years away from them? Bullshit. Migraine patients have normal mortality rates. Migraine does not shorten the lifespan. In fact, the opposite is true.
Here's the deal: I can't give migraine patients narcotics until I have time to actually see and evaluate them, because otherwise they'll leave after their shot when they are feeling better. I'm not going to play that game. I have to see the sicker patients first. Every patient with chest pain comes before a migraine patient. Every kid with a broken arm. Every dizzy old person. Anyone with any condition that might actually cause them harm. Migraines hurt, but they are not dangerous. So migraine patients have to wait.
When all the sick patients have been evaluated, only then can the migraineur get their candy (for the 10th time this summer).
Get it? Probably not, but I don't care. I only care about saving lives, not making everyone (and their annoying mother) happy. When you need your life saved, you'll be glad you came in to see me.
I have been a migraineur all my life, but about 10 months ago my migraines turned daily. Any preventative we try seems to fail right now. I don't seem to have much luck with abortives either, even though I've tried triptans in all flavors in pills, nasal sprays, and injectibles (I've also used ergotamines, Fioricet, Midrin, etc). It's immensely frustrating, but I continue to work diligently with my migraine specialist to find a solution to keep me out of pain and the ER.
I certainly didn't choose this life. I didn't choose to be in pain 24/7 for days or weeks on end when in status migrainous because my home abortives simply won't work. My only choice sometimes is to go in to the ER because I can't insert my own IV to receive the DHE treatments I DESPERATELY NEED. I can't describe the overwhelming desperation and helplessness that overcomes you when you are in that much pain for so long and you just need someone, anyone one to be compassionate and help you. My pain is very, very real. Just as real as a broken ankle or a kidney stone. I am just as much right to pain management as these other patients.
It is incredibly frustrating to see myself discounted as someone who is "deserving" of ER care. As if dealing with the turmoil of chronic illness and pain isn't hard enough, to have those who are supposed to understand and take care of you delegitimize your experience is heart wrenching. It makes you doubt yourself and your sanity. Pain and migraine are invisible illnesses. Because some can't see my pain or the cause of my pain, it's always in contention. But I assure you, it is very, very real.
I don't mean to be pointing an accusing finger and saying, "you evil people!" I only want to explain from my point of view what negative attitudes towards migraines can do to the patient. It's devastating. Truly devastating. I avoid the ER at all costs because being treated like a drug abuser and faker is so humiliating (and this has happened to me). Furthermore, the lack of knowledge about migraines at ER's can be so disheartening sometimes. I'm just now reading Scalpel's last message. Narcotics are not "candy" for us, it's MEDICAL CARE, nor are they the only way to treat a migraine (DHE, Depacon, Tordaol, Magnesium...all non-narcotic).
I've also had some stellar experiences in the ER and Urgent Care (which I use very infrequently by the way). Nurses and doctors can truly maake a huge difference in how positively I'm able to cope with what's going on. I always remember those little kindnesses.
Scalpel--
Migraine most certainly can take years away from you. I've practically lost the entire last year of my life to migraine. It may not kill me any sooner, but the time lost lying in cold, quiet, dark rooms day after day, month after month, year after year, certainly adds up. Do you know how many social gatherings I've missed? Family events? Vacations? Evenings with my husband? My life is dictated by migraine.
It's so bad that I'm comtemplating dropping out of graduate school because I've become so disabled by chronic daily migraines. I'm losing everything that makes me who I am. Can you imagine having to give up your medical practice to this disease? Do you know how frustrating that must be? And then to be fighting an uphill battle half the time with the very people (doctors) who are supposed to be helping you fight it is just mind-boggling.
WE NEED YOU. We need you on our side. We're not making this stuff up. It's real. An ER doctor like you can make a tremendous difference in a migraineur's care, for better or worse. I understand that I need to wait my turn when I get to the ER, but when it is my turn, I expect to be treated with curtesy and respect and to be given my full dues as a legitimate patient.
It seems to me some people just shouldn't work in the er or possibly with patients at all.I've gone to the er,throwing up,passing out,having convulsions.Only to have a dr come up and shake me,yelling in my face to stop it.
Ok,here's the deal,just tell that to a stroke victim.I've had people go in front of me,who drive themselves there,leave with prescription in hand,while I sat there for 5 more hours.Wow,that guy must've been in real need.
Pardon any spelling errors or others as I'm in the middle of going on day 2 of a very high migraine attack.I am never without pain.I have tried many meds,been to physical therapist,accupuncuture,neurologistwho also had a headache clinic.
And yes,Migraine does rob you of your life,Scapel...I am 49yrs old.I've had major problems with migraine and migraine attacks since 1996.The past few years the worst,this past 2yrs mostly homebound.I have 4 grandchildren.My 5 year old grandson said the other day "grandma used to drive."
ERnursery,migraineurs that have tried everything and are on abortives have rare ER visits:No...not so.I am one of those.I can have times where I go several times in a month,and at least once a month for months afterward.Then not go for 3 to 4 months.
I've had to have my husband stop the car,because the pain is so bad I don't know what to do.I've ended up rolling on the sidewalk.I've thrown up and screamed at the same time because I'm sure my head is going to burst with the pain.
I've been called up to the desk and asked a question and can't understand what's been said to me.My daughter had to answer.Then a few minutes later,called into be seen,got up and fainted.
I was active before migraine took over my life.I went to church,I went to the fitness center every day.I was active in building a business with my husband.
I don't go to the er unless I just can't take anymore.I wait too long,because of attitudes such as you have.
When you are in so much pain you're out of your mind with it that you almost put your head through a glass door just to make it stop,you tell me it's not real.I've had 3 children,2 kidney stones,a broken ankle,a root canal,had 4 teeth pulled at the same time,I would go through any of those again than to go through my migraine attacks that take me to the er.
When I'm given a shot and tell them my pain level has not gone down and they tell me they can't wait for it to work,they need the bed,something is wrong.Make me wait for hours,putting others ahead of me,then send me home in the same pain I came n
My sister is a nurse.She had migraine attacks for a few years when she worked in the operating room.She would lose her vision.
I can tell you,she knows my pain is real.She gets irate at the way I'm treated at the er most of the time.
Imagine,going over to a door,now put your head against the wall.Slam the door against your head as hard as you can about 5-6 times as hard as you can.Now,think it would hurt.
If you can,imagine your head hurts so bad you think you're going to die,the pain gets worse and goes on so long,you want to die.Now,you're in a brightly lit waiting room,2 tvs blaring,your name is called,but you can't walk,you're in a wheelchair because you can't walk.You tell the nice nurse in triage migrine.She sighs and rolls her eyes.Hours later you get in a room.
The dr is actually nice,he talks low,and turns the lights off.He leaves and another nice nurse comes in and flips on the lights and in a very loud voice announces "Oh,a headache!"as she thoughtfully flips all the lights back on.Instead of putting an iv in your arm,she does it on your wrist.
Now,you don't want to bother the nice nurse as she does her work,even though your wrist is small and as she beats the crap out of it so bad,you're sure she's going to break it,you don't budge.
By the time she gets it in,she wisely says "Oh,hardly worth the trouble,hm?"
The disrespect we get is enough to keep us away long enough,when we finally have to give in and go,please take care of us when we get there.
Another suggestion,if not,maybe you should find a field where you don't deal with paitients,but take care of customers.
Anonymous, if your doctor is allowing you to have to come to the ER that often he is not doing his job. There are plenty of narcotics, anti-nausea meds to take at home. May I suggest a pain specialist?
It's apparent people don't read the comments thoroughly. Anon's comment shoud be re-read. First of all, narcotics are addictive and cause rebound, which simply lead to more migraines in the end. It's not responsible for any doctor to prescribe them as a long term solution to a condition that is progressive for some of us. I have only had a bottle of narcotics ONCE, and I asked the doctor for a small prescription (he gave me 5 pills and I did not take more than 2 if I remember, for that 9/10 attack). My sister is addicted to pain meds because of an industrial accident that mangled her hand a long time ago. I never want to be in that boat. Not when there are plenty of other meds with a better migraine treatment profile than opiates or narcotics.
A lot of us DO see specialists and a lot of our specialists help us when they can, i.e., when they're OPEN during the WEEK. We are urged by our doctors to go to the ER after hours, or urgent care. Some people who are on the path to finding the right treatment combo have no choice sometimes...It takes a while to find that right preventative combo. I got lucky and it took me a year to find mine, but for some people, it takes far longer.
Scalpel, by all means wait on someone who has a life-threatening condition before me. I totally understand the need of some people that may outrank my needs as someone with invisible pain that certainly won't kill me. I don't want someone else with life-threatening injuries to suffer or die because I needed pain meds. But what about people who suffer migraines that resemble strokes? How are you going to treat the hemiplegics, or the ones who have seizures?
And yes, we certainly do lose time and life to migraine. I am very restricted in my activities as a result of this disorder, and I'm so grateful I have an understanding husband and family and I do put forth the effort to do things with them when I feel like I can. So many of us already feel guilty about what we can't control. If you were holed up in the house the majority of the week because the sunlight or the heat are a trigger, you'd feel as if the world were passing you by, too. Many in my family have changed their tune from "it's only a headache, stop being a hypochondriac" to "how are you today, I can't even imagine" once they became educated on the subject.
But, it's really apparent that you don't understand our lives at all. Migraine may kill very few people on the whole, but it's still a killer nonetheless. People have lost their lives to negligent ER care and I don't think there's any excuse for that. I'm sorry that you can't take this opportunity to learn about those of us who struggle, and that you have to turn it into a defensive tirade on why we aren't worthy of treatment. I wouldn't waste the effort, except the issue is important to me. I know doctors are human and can't always respond to every little complaint, but for God's sake, you can take them seriously, really, it won't hurt you.
To scalpel,
My fiancé did everything her doctors told her, including making an appointment with a migraine specialist. There was wait of several months for that appointment they were so booked.
One night, she had the worst migraine ever. With it, she had some other symptoms she'd never had before -- projectile vomiting and numbness of her hand. I called her neurologist's office. His service contacted him and told me to take her to the ER immediately. He had said that she'd need IV medicine for the vomiting and the pain in an "IV drip" to also rehydrate her and that his office wasn't set up to do that.
I took her to the ER. The doctor banned me from going in with her even though we were engaged and I wss her medical power of attorney. There, the exam rooms have doors directly into the waiting room, so I sat in the chair closest to the door to wait. I had no sooner sat down than the door opened and the doctor escorted my love out the door into the waiting room. He told her he didn't treat drug seekers and that we could leave or he'd have security call the police. He refused to have someone call her neurologist's office.
That night, I fell asleep while she was sitting in a hot bath, something she frequently tried for relief. This night was different as I discovered the next morning. Because she had been in so much pain and had been treated so disgracefully by that doctor, she took her own life.
I will never forgive that doctor. He is paying dearly for his callousness and arrogance. His medical license was suspended, and he had to sell his house to pay her parents what they won in court. They kept not a penny of it, but started a scholarship fund in her name. The doctor will spend the rest of his life paying them the rest of what he owes them, but they will never be the same.
Some would say that migraine killed my fiancé. Her family and I, the medical board, and a jury say the doctor killed her.
Beware Karma, scalpel, beware.
James
I treat every patient with respect and compassion. In order of acuity. Once it is your turn, you are the most important patient in the ER, because I've already seen everyone else who was sicker.
Until then, wait in your room with the lights out, and I'll get to you when I can. At the end of the shift, you'll still be alive, and so will my other patients, God willing.
Don't send Mom up to the nurse's station every 10 minutes to ask "how much longer?"
Don't be abusive to anyone in the ER. Don't make any sort of threat whatsoever. Don't get the other low acuity patients in the waiting room all stirred up. Wait your turn. You will eventually get relief, whatever it takes.
You have my guarantee. I've never discharged a migraine patient who was still in pain.
You are not less important than any of the other patients in the ER. But believe it or not, you might be less "sick," meaning less likely to die or suffer complications. No, pain is not a serious complication. Just because you feel like you are dying doesn't mean that you are.
So chill out, and try to understand OUR point of view.
James....got a name for that doctor? Or a link? Such an event must have made the news. I'd be interested in reading about it.
Scalpel--
Your above messages show anything but compassion and respect. You have have constructed a protypical migraine sufferer who is demanding, rude, disrespectful, wants to jump their turn in line, and over-exaggerates their pain. I'm sorry if you have gotten a few bad apple but the vast majority of migraine sufferers are GOOD PEOPLE with LEGITIMATE medical needs who are NOT trying to scam the system. As a doctor, if you're portraying this type of attitude, even subconsciously, you're doing far more harm than good.
I'm not trying to be rude or disrespectful. I realize you have an incredibly difficult job, and believe me, I'm deeply indebted to several ER docs, but I really think you need to re-examine your beliefs and do a little more education about migraine disease.
I try to educate misinformed migraineurs every chance I get. But often they don't like to hear the truth.
Each migraine patient has only their own personal experiences and the anecdotal stories shared on their favorite migraine forums to form their opinions, while physicians like myself have the experience of treating hundreds of different migraineurs and the medical background to more accurately put certain issues in context.
How the heck would you know what the vast majority of migraine sufferers are really like? GMAFB.
I am a highly educated migraine sufferer. I read those medical journals you so neatly link to every chance I get. I order books written by world reknowned migraine specialists. I get involved in my own treatment as much as possible by asking questions of my own migraine specialist, who by the way, spends a great deal of time teaching other doctors at CME conferences.
Miseducated I am not.
I could be one of your patients, but you're unwilling to hear me. Instead you swear at me and try to mock me. You showed no compassion at all for James. In fact, you questioned his authenticity. Unfortunately, I think you are too blinded by your own prejudice at this point to really hear what I'm saying, which is unfortunate. Your patients will suffer for it. I know that I have already suffered because of doctors who hold attitudes like yours.
Please don't cause anyone else to suffer, that's all I'm asking.
Please, Scalpel, what is the truth?
Your post previous to the last sounds a lot better than your previous two, trust me, I highly respect many doctors, and certainly give ER docs the benefit of the doubt considering what they go through on a daily basis. The job has to be very stressful and it demands a lot of you.
The problem is, when we come into the ER, you've likely already judged us without getting a background first, or even seeing us first. I may be assuming, but just hear me out. From the words you've said here, it sounds like that's what you're thinking. You and I both have very minimal time to get to know one another in that setting and take appropriate action. No one's blaming you for being cautious, but we are blaming you for jumping the gun just a bit. You seem to act as if you are treating problems and not people, so we're taking you to task for it. You treat ER patients for a few hours, seeing them at most for maybe 15 minutes (IF even that and then it's a rotation of nurses), which is what you have to base YOUR experiences on. My migraine specialist spends at least 30 minutes with me every time I go into his office, and he answers my questions and talks to me, works with me, and expects me to also work with him in order to control my problem. You don't have that liberty, to know each face intimately, so you CANNOT box every migraine complaint into a little checkbox of expectations. You may see many migraine complaints, but you don't SEE the people and you don't work alongside them to help them day to day. You may have experience, but you're not a migraine specialist, either, so you don't have their background and experience in treating us either. So forgive me for believing that your context is a little skewed based on said factors. What you do is jump to conclusions, not put things into context. ER migraine is all you know, not the day to day and ins and outs of the disorder or the people it affects.
I'm sorry you have to deal with people who abuse the term "migraine". There are always bad apples in whatever category you please.
When we live the day to day of migraine you ask us how the heck we'd know what the majority of migraine sufferers are really like, then you're the one who needs to give me a break. Nice use of language from a professional, by the way. I hope you're not going to bring this down any further with that kind of talk.
Take care.
Each migraine sufferer only knows what their own migraines are like, and what has worked for them in the past. Their perspective is often very narrow, like that of someone who lives in a small town and thinks that the best Mexican food is found at Taco Bell. Reading a cookbook is no substitute for cooking.
I'm not sure what you folks want from us in the ER. You've seemed to accept the fact that you aren't going to be seen before sicker patients. Does anyone here disagree with that concept? I've assured you that I'm going to relieve your pain when it's your turn to be seen. I've never treated any patient with disrespect. What more could you ask for?
And yes, I have doubts about James' story. It sounds like a migraine forum urban legend to me. But if it is true, I would love to read more about it. I would think he would be eager to share it with us.
About James's fiancé:
This Suicide Was Senseless and Preventable.
That doesn't validate his story. Penned in 2005, there is no mention of the (evidently) multi-million dollar lawsuit. A malpractice megaverdict against a physician for wrongful death because his patient reportedly killed herself because she was unsatisfied with her treatment would be news indeed. And two years would be a record pace for such a trial to proceed and for such a verdict to be reached. Without appeals, apparently.
Remarkable, if true. Certainly newsworthy, and as far as I know, unprecedented. So where's the beef? Anonymous internet stories are BS until proven otherwise, sorry. Especially those that appear to have an agenda.
I remember that story. Not anything about a court case or verdict, but the original story. It was written by Terri Robert who's a leading writer and patient advocate who was honored by the national headache foundation. Not long after that happened, a group of people got together and raised thousands of dollars in the young woman's name and donated it to magnum, the national migraine association.
You might as well save your time and fingers, peeps. Scalpel is so cock sure of himself that you're not going to get through to him. So just move on and pray for any migrainer unfortunate enough to land in his er.
This is a perfect example of how certain patients and their families exaggerate their stories to try to manipulate us.
Perhaps there is a kernel of truth wrapped in a disgraceful lie, or perhaps the whole story is fake. There is no diagnostic test for a migraine, and no written record of the scary consequences of this evil physician's mistreatment of the anonymous patient in "james'" tale of karmic vindication.
In both circumstances, the claims are without proof. We are supposed to believe a sob story and be afraid of the consequences if we don't acquiesce. How dare we doubt either example, lest our compassion be questioned?
I am a migraine sufferer. I am not a 'migraine' sufferer, I am a MIGRAINE SUFFERER.
I have been struggling for 10 years with the help of neurologists and headache specialists to find some relief from this debilitating condition. I take 8 medications every day to try to prevent them. I take 3 medicines, when needed, in an effort to abort them. I inject myself with needles here at home because I cannot keep food or medications down when I am sick with migraine. I go to my doctor's office and recieve about a dozen injections of numbing medicine and steroid in my head in the hope that I will have a few good days with my family. Still, I have migraine about 5 days a week.
Each month, I go to the local hospital for 2 days for an infusion of DHE in the hope of having a few good days. After my hospital stay, I "lose" the next two days because the medicines are so sedating to me. I WORK to try to control migraine disease. 10 years of work, pain, and struggle. Still, despite my efforts, I have yet to find relief.
I have two little children who I love more than life itself. I have a husband who loves me and says I am the light of his life (even though our life right now is one neither of us would have chosen).
I miss out on so many things because of migraine. I can't take my kids out in the sun, because I will be sick. I often miss family outings because I am vomiting to the point of dehydration.
You may say that my doctor must not be treating my condition properly. What am I to do when I am seeing the best headache specialist within 200 miles?? I read and learn all I can about my disease. I am an active patient, working with my doctor in an effort to manage this disease.
But the problem is that migraine disease is not one of those health issues that automatically responds to one particular medication. Any neurologist who knows anything about migraine will tell you it is a process of trial and error. Medications are added, upped, decreased, changed. Supplements (CoQ10, Butterbur) are added, results are observed. There are hundreds and hundreds of combinations out there! I see my headache specialist monthly, and each time we tweak my medicines. How much of this med can I take without extreme side effects? how much of that? Will it help at all? All of these adjustments are done carefully, gradually--and it takes time to see if results will come about. Time, and pain. In my case, results have been very limited.
My headache specialist is now recommending that I think about a surgical implant to help with pain management. I am seriously considering it (even though the results from this procedure have been mixed). My family and I would try almost anything at this point to find some relief from my pain.
I am one of the patients who does come to the ER for relief. I come about once every 6 weeks or so. I come when the nerve block injections in my head have failed, when the inpatient IV medicines have failed. I come when I feel like I am going to vomit out my insides if I have to have this pain one moment longer!
No, I am not allergic to every migraine medicine out there--only compazine. But sometimes I do require IV nausea and pain medicines in the ER to give me back some sanity. I LOATHE pain medications. I cry, hold my breath, and vomit when I get them in my IV. The narcotics give me MORE time away from my family, MORE days lost in hazy, drug induced sleep. But they take away the pain, if only for a short while.
I have been riding this train for 10 YEARS!! When I come to the ER for help, I certainly hope to find a nurse and doctor who are willing to treat me with care, concern, and an appreciation of my level of pain.
Scalpel and ERNursey, I hope you and other health care professionals will remember that there are people like me in this world and that we, too, come to your ER. I am aware that some people abuse the system. Please understand that I am not one of them! I fully understand if you must help a critically ill patient before coming to me. I will wait patiently while you see the one with pneumonia, or kidney stones, etc.
But when you come to my room to see me, please remember that I am not a 'migraine.' I am a person with a family who loves me and I have migraine disease. I have come to you because I have exhausted my options at home and my headache specialist has advised me to come in for help. I have come to you because I need it to stop, if only for a while. Please, do not treat me with the negativity I have seen here in these posts. Please, remember that I ONLY come when I am absolutely, completely, desperate and I need the help that only you can provide!
scalpel
James' fiance didn't kill herself because she was unsatisfied in her treatment; she killed herself because she was in tremendous pain and was devestatingly humiliated by the ER physician.
What do we want, you ask? We want people in the ER to believe us. We know we may have to wait, but we don't want to wait on principle just because we have migraines. If we are vomitting uncontrollably, take us to a room. If we are exhibiting stroke-like symptoms, even if we are a young woman, take us to a room. Yes, I am a young woman who presented with migraine and stroke-like symptoms. I was very scared. If you had been my doctor, I would've been terrified.
I really doubt you treat migraieuers with any respect, your contempt oozes out of your posts like a muddy sludge.
I've had chronic migraine for over seven years, I've been to the ER twice.
If you would just educate yourself on migraine, you would know who was real and who wasn't.
I want to add, scalpel, that when I've gone to the ER or urgent care, I 1.) never requested any narcotics, or any meds period, and the ER personnel chose to give me one shot of ativan and 2.) at urgent care, I've only requested toradol.
Do you want a cookie?
I'm urgent care doctor who has migraines--been through it all--chronic daily, migraine with aura, migraine without aura, puking, you name it. I've never taken a narcotic for a headache--they really don't work.
You all need to understand that we are not upset by those of you with bad headaches who are happy to come in and get fluids, Toradol, DHE, Imitrex shots, Decadron, anti-nausea medicine IV, or any other non-narcotic treatments. Heck, I'll even add a little narcotic to those things because it is occasionally helpful, at least in the very short term. Our frustration are the people who come in and demand Demerol (or the narcotic du jour). They just want their shot and want to leave. They won't try the non-narcotic things that actually work well. They won't even consider prophylactic (preventative) medications. They won't go to neurologists and primary care doctors to get preventative treatments and make plans for how to treat their headaches acutely at home themselves. They just want Demerol. I've had plenty of people with actual migraines who've gotten Demerol in the ER in the past who hug me when I give them Toradol or Imitrex because it works much better. People with actual headaches will generally take whatever we recommend to help their headaches, not just demand Demerol. They aren't rude and nasty. They follow our recommendations for followup. They fill and take their prescriptions for prophylactic drugs. They haven't gone to every ER and urgent care in town with the same demands. They don't have 50 different narcotic prescriptions from 50 different doctors on file at local pharmacies, having paid cash for all of them.
If you don't do these things, don't worry about it. If you do all of these things, we're going to be suspicious, period.
Good luck trying to reason with someone like Scalpel. He is quite content to publicly wallow in his own ignorance and arrogance, as are far too many ER docs. He obviously gets a thrill out of being able to behave outrageously to people with pain, his protestations of "compassion" notwithstanding. If you read his blog he often talks about migraine sufferers and their "annoying mothers," just as he does here, obviously projecting his experiences with one person onto the whole.
Though I don't suffer from migraines myself, I know plenty of people who do, and they describe the pain as excruciating. That's good enough for me. World famous pain researcher Dr Ronald Melzack once noted that people use similar words to describe similar pain syndromes or painful experiences. People don't use words like "excruciating" for paper cuts and scraped knees. They do use them for migraines,childbirth and other things which most people recognize as extremely painful.
The remarks Scalpel left on my blog in reference to a post I wrote about how people are treated by ER docs like him says it all:
"Nah, my tooth got fixed, but good luck with that "mystery pain" of yours. NSAIDS "don't work" eh, and you need REALLY BIG doses of narcotics, but oddly you are allergic to all of them except Dilaudid. Bummer.
Funny how those P450 deficiencies missed that one, huh? Keep dreaming that some day your true deficiency might be revealed to be something other than drug addiction and generalized pussiness.
Fucking losers. Get off your ass, go back to work and quit your whining."
To James:
I am deeply sorry to hear about your loss. I have also lost friends who ended their lives when they couldn't get treatment for their pain, but were instead humiliated and abused by the "doctors" they were unfortunate enough to seek out for help. I have heard accounts of many more in my years in online and real life support groups.
I don't think there's anybody who lives with severe chronic pain who hasn't contemplated suicide, and it pains me that someone you loved was driven to such a final act by pain, when that pain could have been treated. I have heard too many stories like this.
Truth hertz, doesn't it? And context is important, for those who are interested. You could use the visitors, eh Payne? Err, Redhawk?
Or should I call you Mr. Conlon?
The first failure in this large discussion is that there is a definitional gap.
First - every emergency healthcare provider uses the term "sick" or "not sick". The term does not connote anything regarding the person beyond whether they are in imminent threat of dying ("sick") as evidenced by their vital signs and other signs and symptoms or whether they can wait to be seen or treated ("not sick). This definitional difference also applies to MIGRAINE vs. 'migraine'.
Second, providers utilize blogs, journals, bar stories as a means of discharging steam. If they had no outlet in which to vent their frustrations - i.e. complain about drug seekers that 99% of the time receive pain medications in the ER based on a compassionate desire to not miss a legitimate pain complaint who we see day in and day out - then you should be concerned that the ERnursey and Scalpel are insensitive. In fact, I believe that through the use of their blogs, they are perhaps the most level headed providers in their facilities.
Third, the emergency system is broken. One poster makes the comment of how his/her migraine specialist spends 30 min with them and knows them. First, they are paid and reimbursed by insurance companies to do so. Second, they work 9-5, schedule appointments and are specialized. An emergency professional, on the other hand, frankly must focus on providing treatments for those imminent to die. Moreover, they are reimbursed (paid for their services) and judged by their hospital bureacracy not on the care they provide patients but on the number of patients they see in a given time period. Add onto that the always incoming ambulance or helicopter with another "sick" patient and "not sick" patients will be continously placed at the lower end of the triage scale. Most EDs are swamped at any given time with multiple "sick" patients while flooded with many complaints that are most appropriately addressed by a primary care physician or by proper care by the patient themselves. I'm sure all of us in emergency medicine cannot count the number of patients we have seen with legitimate complaints based purely on lack of followup or disregard of physician orders (such as the epileptic patient who fails to take their seizure medication and has a seizure).
Sadly, pain is a difficult symptom to treat and it differs as every individual is unique. Pain is definitely not appropriately long term managed with a series of ER visits. And to accuse Scalpel or ERNursey or myself of lack of education on migraines supposes that when we spend the precious continuing education time we are granted by our employers, we should read about an illness, though admittedly debilitating, that will not kill the patient (i.e. migraines) over reviewing new treatments that increase the survival rate of a patient who went into cardiac arrest. To ask us to learn it all to the level of a migraine specialist is unfair and highly based on individual desires.
The system is broken. Ideally, your pain specialist (or their colleague) would answer your call late at night and speak to you about additional options. But alas they take the night off and refer you to the Emergency Department. They are not the only specialists or physicians to do so and I cannot fault them in our litigious society.
Well, if I can go in to the ER audibly wheezing and be treated like crap, anyone can for anything. So really, for me, the bigger issue is, why are patients with valid concerns, who don't scream and yell or act inappropriately or ask for drugs, treated so poorly? And I'm not talking about long wait times, I'm talking about bad attitudes.
On another note, I find all this info on migraines incredibly fascinating. I think I work with a 'migraine' sufferer and I totally see why those with 'migraines' give everyone who really has them a bad rep. Until now, I thought you were supposed to take tons of narcotics in combination all the time.This was represented to me as normal. I read here that's not the case and I think perhaps my 'migraine' sufferer has a completely different problem; addiction.
M
My migraine doctor WILL NOT prescribe narcotics for migraine. He sees it as inappropriate care because it does not solve the problem. And I agree with him. I would much rather have my DHE to ABORT the migraine than a bottle full of Vicodin so I can wake up a week later with it still going on. Why are some ER's still offering pain meds as the first line of treatment when abortives are supposed to be the standard of care? I don't know.
Instead of blaming the physician for not getting your narcotics for migraine (assuming the drug is indicated in the first place)....
Shouldn't the anger be placed on the many people who come to ER's to scam drugs?
I've had patients lie about everything under the sun to get drugs. They lie about who their regular doctor is. So we don't prescribe narcotics when covering other docs, nights and weekends. We can't believe what we hear. So that "stuck in an airport" story is likely false, and soooner or later, someone with cancer pain, stuck in an airport somewhere really will feel like a criminal when we won't phone a narcotic prescription to Peoria.
People won't lie about migraine? I've had them lie about having AIDS.
I've had "migraneurs" go to ER's all over a 200-mile radius, on a, every two or three day basis, to get narcotics. Some were well-educated professionals. I use the scare quotes as I doubt it was migraine to say the least.
I had one patient come in with a convincing pain story. She got narcotics. A week later, I admit her from our ER, comatose. She took the medicines to what I can only describe as a "Tupperware party" where they share the drugs scammed to see what effect they can get from polypharmacy. Needless to say, I admitted her, revived her, then showed her the door.
I've worked with the police and prosecuted when they have scammed medicines from me and were caught selling the drug.
The ER's know them. But, fearing litigation, they get the benefit of the doubt, unnecessary workups, and end up with two-foot-thick medical charts.....all ER visits....and hundreds of thousands of dollars cost. Seen it with my own eyes.
Then there's the state legal action against docs who think, in good faith, that such pain should be treated with opiates.
The problem comes from true drug-seeking patients (addiction or profit), over-reaching prosecutors, and the trial bar. But you blame the doctors when they run skittish? How about blaming the people who make them skittish?
It's not about getting narcotics, it's about getting treated with respect and dignity like real patients. The migraine sufferers here are not asking for special treatment, just fair treatment. It's not our fault that there are drug-seekers in the world crying wolf. We are just as much victims to them as understaffed and underfunded ER's.
I understand what you are saying about the "drug seeking" patients. But then you should know enough as a medical professional that the true Migraine patients will not just come in asking for narcotics. I never want to treat my Migraine attacks with narcotics. I try everything before I would even think to try that. I would not want to mask my pain - I would want to abort it.
By all means, please treat the critical patients before us - but don't treat us like we don't have pain - like we want drugs - we just want to be able to make the pain stop! Don't you think it hurts sitting in that waiting room with the bright lights, screaming children?
And I'm not sure what the deal is with the "sending mommy up to ask how long it's gonna be" - the people posting here are adults - treat them like it.
Please - if you are so into "educating the misinformed" why would you not use your real name? I'm very curious as to which facility you work out of, since I will be soon relocating to Texas. I pray I never have to use your faciliy...If anyone like you worked at the Hospital and outpatient facilies I work for - you wouldn't last a day, that is, if you are really a doctor, which I'm skeptical.
Yes I'm a real doctor. No, I won't tell you my real name or where I practice. I don't give medical advice over the internet, so my education to you here is limited to how to act when you present to the ER and to explain why you aren't first in line. If any of you are ever my patients I will gladly share my knowledge and experience of the emergency treatment of migraines (or whatever else is bothering you that day).
Read paramedic's post above to get a better understanding about our misunderstanding here. You guys come to the internet to seek medical advice and information about your condition. Medical blogs are NOT the right place for you to do that. Stick with your forums and the WebMD type sites for that stuff.
These sorts of medical blogs are written by us for us to blow off steam after long grueling hectic shifts in which we have spent hours being the sort of kind, compassionate professionals that you all dream of, treating people who often aren't really very appreciative. You have no idea what sort of person you are talking to on the internet, so don't make assumptions about things you have no basis of knowing.
And yes, many "migraine" patients who are adults still bring their mothers in to troubleshoot for them, making a scene in the nurse's station and hallways when they've been in the room for 20 minutes and haven't seen a doctor yet, and then to demand the same 4 mg of Dilaudid that she gets "every time," refusing to consider alternative therapies.
Patients and families like that suck the life out of us and make us (me) a bit grumpy at times, and so do people questioning my character and compassion. So sue me...maybe I'll turn over my house to YOUR mother like the doctor in "james'" wet dream fantasy.
Actually, I'll go ahead and say this too....I've read some of Teri's forum posts since we first met yesterday, and I think she is knowledgeable and gives pretty good advice generally.
But I suspect she created the fictitious persona of james and the story that went with it.
Prove me wrong.
I have had migraines for about 15 years now. For many years now they have been out of control at times, meaning I have had them 4 or five times a week. I take a daily preventative and I have abortive medication at home to take when I feel a migraine coming on. Since the first of the year my migraine pattern has been lasting longer and longer, meaning that some last over 72 hours. My nerologist has ordered home health twice now to come out and set up IV infusion, this worked once and failed the second time. I have passed out twice this year with my migraines.
To the health professional who said that migraines do not interfer with our lives and we should not take up space in the ER. My migraines have robbed me of so many things I don't have enough space on this web page to list it. The short list.... short term memory loss, speech problems, pain, of course, I miss family functions due to migraines, depression due to chronic pain, thats the short list. If you don't have a disorder and migraine is just that, a nerological disorder, not just a headache, then you have no idea just how much it can effect someone's life. I have had to go to the ER twice this year both times I was in Status Migranious. I did not ask for any drug, I was examined asked questions and treated. The nurses and doctors were wonderful. The second time I was there the doctor asked me what my pain level was and told me if it got any worse at all I was to come back to the ER. They could not have been nicer. All of them from registration, triage, Er nurses, the whole team.
If you can only be nasty and bitter about my post please feel free to pass it by....
thanks for listening.
Lori
We didn't ask for your medical advise.....I wouldn't take it from you anyway. You talk in circles and obviously have no bedside manor.
And again - if you go and read the above it was stating how I understand what you are saying about the "drug seeking" patients. We are not them. Thats all we were trying to get through that huge head of yours - we see that won't work. At least your "friend" ERNursey had enough compassion to explain what she was talking about without getting all fired up and offending people.
Maybe you need the cookie.
"We didn't ask for your medical advise (sic)....I wouldn't take it from you anyway. You talk in circles and obviously have no bedside manor (sic)."
Maybe you have...who knows? And it's not like you get to choose your doctor when you come to the ER.
Saying I have no "bedside manor" because I seem to be a dick on the internet is like saying I'm a bad driver because I suck at Gran Turismo 4 on Playstation.
Or like me saying that you must be an idiot because you can't spell.
I try very hard to stay up-to-date on Migraine research by reading journals and books, attending American Headache Society conferences, and talking with Migraine specialists. Giving "medical advice" is not what I do as a patient educator and advocate. I try instead to give people information that they can take to their doctors or that will help them cope with their Migraines.
I didn't create the "ficitious persona of James and the story that went with it." I could have chosen accounts that were reported in the national and international news that were equally as tragic. I chose James and Janice because I'd helped Janice find a Migraine specialist with whom she'd scheduled an appointment.
It would help neither Migraineurs nor my career to create such a case. My editor at HarperCollins would hardly have tolerated a fictitious case in the book I wrote, and I would never engage in anything so unethical.
I haven't talked with James in some time and know nothing about a financial settlement or any action against the doctor. One would think that if that occurred, the hospital would have been named in the case as well as the doctor. I don't even know if James commented here himself or if perhaps someone else "borrowed" his story from my article.
I'm not here to "prove" anything.
I read through this blog with increasing disbelief. Then I got angry. But that's rather useless.
After all, scapel could indeed be as fictitious a persona as he accuses the infinitely more reasonable and polite - and publicly verifiable - Ms Robert of inventing. Why should I get upset by someone who's likely to be hiding behind their own fantasy, an internet troll?
Given that scalpel has initiated the ad hominem attacks against migraineurs, I can only say that where I come from we have a name for people who mouth off in this arrogant, dismissive way. We call them tossers.
And, as a migraineur, sonny, who's lost several years of life to the misdiagnosis of migraine stroke (thanks to your brethrens' similar arrogance and ignorance), I can tell you for certain that I don't have to take anymore tosser behaviour from any medic I encounter nowadays. I DO have a choice. I don't have to accommodate your arrogant, ill-informed opinions.
When my GP tells me freely that I know more about migraine disease than she ever will, and when my neurologist defers to my superior knowledge, I can tell you that you need to go back to school based on your showing on this forum.
Having lost so much of my life due to tosser medic behaviour... well, it was just your sort of medic Ihad in mind when I wrote recently 'Doctors? I wouldn't waste a drop of perfectly good urine on one if it was lying aflame in the proverbial street.'
I guess my disdain for and dismissal of you matches your own towards us migraineurs. What IS your problem? Why the immature, belligerent attitude? I confess, I'm intrigued. Did you fail biology at school and couldn't get into med school or something...? Is the Burger King job getting you down...?
That story is implausible for several reasons. First, since he was the last person to see her alive, the only other person in the house when the death occurred, and the significant other of the decedent, "james" would have been a prime suspect in the death of "janice."
A police investigation would have been indicated, and an autopsy by the medical examiner required to prove the death was in fact suicide. That takes time, and is probably the reason, if the story is true, that "james" prefers to remain anonymous.
Secondly, at least from the thirdhand facts we have, just because she may have killed herself does not make the physician seem to be reasonably liable for her death.
Did she express suidical ideation to the doctor and did he ignore or discount it? Such a statement was not mentioned, but that's the only way it would seem likely that the doctor would even have any possibility of liability. He treated her for a migraine. She didn't die of a migraine. She didn't like the way she was treated. She killed herself.
He might have been disciplined by the state medical board, but it would be a stretch to have him lose his license altogether. And a court case trying to prove medical negligence would take a lot longer than two years. Attorneys don't even file malpractice claims until the two year statute of limitations is almost over. And a case like this would last several years, and would have made the national news.
There is nothing to be found on the internet about it, trust me, I looked. And you can ask Mr. Sean Conlon about my mad google skillz.
"tosser?"
"behaviour"
You must be a Brit. Go brush your teeth, pillock, if it's not too late.
Well, scalpel, you just lost me on this discussion. Your reply of, "You must be a Brit. Go brush your teeth, pillock, if it's not too late," was an unnecessary personal slur toward someone you don't even know.
This may be just an interesting diversion to you, but a discussion on how Migraineurs are perceived is serious business to the rest of us. Regardless of the topic of conversation, such comments are unnecessary and just out of the realm of civility.
Replying to you any further is obviously a waste of time. Good luck. Karma's a bitch.
There can not be a more arrogant Doc. any where in any ER... Scalpel breeds discontent between patients and employees of the medical profession online, and I imagine he certainly also does it in real life. It is a shame that he can not engage in conversation, without losing focus, and resorting to personal insults.
Why don't you retire because you are a disgrace to the profession of medicine. You also have an extremely negative effect on the nurses who associate with you.
Ah yes, British dentistry...yet another branch of Arrogant and Incompetent Medics Anonymous!
Are you going to blame the poor hapless patient for that too...? I mean, as well as messing up your nice neat fantasy ER room and, tch, actually wanting [how dare they] decent treatment!
Pillock? Yes, well, it seems that you've adequately shown us your great love and compassion for humanity there, as throughout your musings here.
What is your karma debt for making up a fictional account of a suicidal migraineur and passing it off as real in order to sell books, Teri? Should we ask your publisher?
scalpel,
According to the World Health Organization, Migraine alone is 19th among all causes of years lived with disability. As of 2005, Migraines cost American employers about $13 BILLION a year because of missed workdays and impaired work function. Annual direct medical costs for migraine care were about $1 billion, of which physician office visits accounted for about 60% and emergency department visits contributed less than 1% of the direct costs.
(sources: World Health Organization and Hu et al. "Burden of migraine in the US: disability and economic costs." Archives of Internal Medicine)
Also, current studies show that women who have migraine with aura are 6.9 times more likely to suffer stroke than women who do not have migraine disease. (Source: Stroke)
"Just the facts."
Migraineurs,
There are ERs out there that are staffed with compassionate doctors and nurses.These places have great triage systems. Yes, they take emergencies first. They will try their best to get migraineurs into a quiet, dark place as quickly as possible.
One such system is the Roper-St. Francis System in the South Carolina Lowcountry. Their ERs are staffed with some of the best people you could hope to meet.
Got any studies to show that treating migraines prevents strokes? If someone is having a stroke, they are given immediate attention. If someone is just having another migraine, then they have to wait until we've treated all the strokes, heart attacks, stabbings, car accidents, and dialysis patients before we can treat the headache patients.
Just the facts.
You migraineurs are so high strung, shrill, and panicky it's no wonder you have so many headaches.
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