I had a patient recently that we see about three or four times a month for migraines. She's a drug seeker and everyone knows it. She's been fired from several doctors in town, even Dr. Feelgood - and if you get fired from him you know it's bad.
I was feeling irritated already because her husband had been out to the desk several times in the 14 minutes she had been in the room wanting to know when she was going to get pain meds. I mean, c'mon you have had 37 ER visits this year alone, you know the drill - you have to be seen by the Dr. first. After the doctor saw her he ordered a shot of Dilaudid and Vistaril. I went in to give it and she informed me she didn't want a shot, she had told the Dr. that it only works if she get's it IV. Instead of wasting time going round and round with her I left and told the Dr. to go hash it out with her, if he is going to order narcotics for a patient who has had multiple documentations of drug-seeking behavior then I refuse to do his dirty work for him. To his credit he told her one pain shot, no IV and then out the door and that was all he was giving her and if she didn't want that he would discharge her home right now. She decided to get the pain shot so I went in to give it to her and when I got in the room she was telling her husband to go to administration and complain so she could get a free visit "like last time."
I SWEAR I THOUGHT MY HEAD WAS GOING TO EXPLODE.
WTF!!!!!!!!!!!! We have a known drug seeker who has been fired from multiple practices for violating her pain contracts who has been documented to be a frequent visitor to all the ER's in town who went crying to administration for not being given her narcotic fix and instead of the spineless assholes telling her to never darken the doors of our hospital again they GAVE HER A FREE VISIT!!!!!!!!
Wednesday, November 12, 2008
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I'd like to know what the fuck these admins are so afraid of? Every slack-jawed moron comes to my hopsital acting like they're at the Ritz. We feed them , clothe them, give them a bed to sleep in and gas vouchers. None of them pay for a God damned thing and we STILL walk on eggshells around them. One day I'm just going to blow, I swear to God! I just don't understand!!! They need us more than we need them! W!T!F!
Infuriating isn't it
Infuriating isn't it
I just want to say that after reading your blog and the blogs of many other Emergency Room workers, I've come to have an intense new respect of your job and resources. Know this is at least one person who won't be going to an ER for a stuffy nose or a stubbed toe. I'll wait til my toe turns black and falls off first :P
<3
Welcome to our hospital, here to kiss your ass, not save it!
That woman and her husband should have been paraded around the hospital (with a generous shot of narcan)locked in stocks while on-lookers and ER staff throw rotten tomatoes at them! A free visit - what a freaking scam!
And to think, there was a time when I wanted your job. :)
I've been working as an Interim Patient Care Manager along with working in the ED since last spring and believe me when I say that all the administration of the hospital gives a shit about is patient satisfaction.
It makes me physically ill when I have to take a charge off of some asshole's bill because they didn't like the drugs they got.
IV Narcan for the drug seekers!
And humongous Foley catheters for the administrators!
my nurse mamnager gave our favorite drug seeker a handknit afghan....where's the emesis basin
oooooohhh, that just BURNS me up!
I think I would have blown a top. Free narcs all around, just come and jam up the ER. We'll give you a fix and write off your bill.
Administrators have no spine whatsoever.
/jo
I like to tell our administrators this line:
I can either take care of the sick people or pamper the neurotic ones. I can't do both.
Some people would prefer sick people dying in the hallways while the docs and nurses wipe the asses of people with nothing wrong with them.
My husband would kick me to the curb if I ever tried to pull that crap. He certainly wouldn't be complicit.
I work in what I thought was a great facility with a good rep. I had noticed we were seeing more and more drug seekers, but thought it was the growth in the community and our area etc, etc....
Just found out our docs had a meeting about denying the seekers BECAUSE on the street our facility is KNOWN FOR GIVING DRUGS OUT WHENEVER! Wow, how discouraging to work in a hospital with that reputation.
I work in an Australian ED - and we have 'free' visits for all Australians (Medicare covered)
so we have 'dr shoppers'
used to have a 'imposer folder' 20 years ago, with names, aliases, descriptions, usual requests, and usual locations - the do-gooders got rid of this - an apparent invasion of privacy - so now we can't id the out of area ones.
I am sick of the rubbish we get through ED. never ends.
You must work in my ER. What's worse than the administrators is the ER doc who keeps feeding these junkies! What ever happened to Tylenol and Ibuprofen? Why is Dilaudid the new ASA? I thought Dilaudid should be reserved for the guy with his open femur fx or the guy who comes in with a hand avulsion,skin and flesh hanging. It's absolutely ridiculous! Our ER docs need to grow some balls and learn how to say NO!
As an ED physician, I am grateful to be in a state that has narcotics records online. I can put in the pt's name and other identifying information and get a list of the controlled substances they've filled for the past year. (usually delayed by a few weeks)
It is extremely helpful. I can take the multipage list to the patient and explain that I cannot give them narcotics because they've already gotten a total of 200 oxycontin from 6 different docs this month. It also helps when the pt has a short or empty list...I'm comfortable that they aren't doctor shopping for narcs and can give them whatever is appropriate.
Narcotics records on-line!!!!! Oh be still my quivering little heart!!!!
*swoons*
We only have HIPPA and EMTALA to blame. Without these, an ER could keep a list of blacklisted drug seekers and frequent fliers (HIPPA violation) and boot 'em out when they show up (EMTALA). IMO we need to rewrite some exceptions to these laws and put it on a ballot in 4 years!
See, as a patient this last weekend, I wish I could have found a Dr. Feelgood type! I was driving my car and felt a pop in the lower right part of my abdomen, followed by PAIN. I went to the local ER, was checked in right away, and was CT'ed within an hour. The CT showed an inflamed appendix that needed to be removed ASAP, but there were no ORs open just yet. After the diagnosis I asked for a pain med (not by name) and was denied. The reason? 15 years ago (the last time I was in an ER) I was there for alcoholism, and had to be detoxed. I've been sober since that very day 15 years ago. However, Dr. Cruelty there in the ER said "I'm not in the business of giving narcotics to drunks." I laid on the bed for three hours, until I met the surgeon. I got my surgery 15 minutes after meeting the surgeon and was admitted to the floor about an hour and a half later (I think.) The surgeon was very good to me. After the surgery he offered me pain meds right away. I was straight with him about my alcoholism and he told me "thanks for your honesty but while you're here we're not going to worry about that." He gave me whatever meds I required for the next two days, and gave me a script for Percocet. I again expressed some concern to him...he told me he'd already talked to my husband and that my husband had agreed to keep the pain meds hidden from me and to dose me at appropriate intervals.
I was impressed with my surgeon, but I'm considering suing the ER doctor...and I'm not usually a litigation-minded person. That ER doctor singlehandedly changed my mind about capping awards in malpractice lawsuits.
Sincerely,
Slutty Roadwhore, still 15 years sober, just a little sore
Dear Slutty (sorry I just had to do that.) Even if you have a current documented substance abuse history, denying pain meds for that alone is unethical. If your story is accurate I would at least complain to the ER director and hospital administration. Sorry for your experience, what a jack ass that doctor is.
I thought someone would get a kick out of the name!
I'm definitely going to complain to the hospital's administration; I've already left a message for their patient advocate. I mean, I can understand not wanting to give narcotics to someone in active addiction, especially if there's a question as to whether or not the patient's faking or malingering. I know that doctors, when it comes to pain medicine, are sometimes damned if they do and damned of they don't. But my CT clearly showed that something was wrong...so wrong that the surgeon wanted to cut it out of me! And you'd think that the fact that I told the doctor straight away that I'm an alcoholic would be worth something. Guess I was wrong.
But yeah, I'm getting the ball rolling with hospital administration. I somehow doubt I'll sue...I'm not really that type of gal.
Dahling don't you know? The customer is always right. Excuse me while I go puke now. De ;)
Our ED docs would have given the meds to the lady with the hx of etoh abuse considering her situation! That is terrible. However, i don't think my manager would authorize a free visit for the original post's complaintant. I know that we have our fair share of drug seekers that we see several times a week. Many of which have a pain contract, that regularly gets violated by one of the docs..very frustrating for the nurse!
It's me again!
I'm feeling great now! I only had to take the pain meds for like three days, and then we chucked the rest because Tylenol minus Oxy was working well. At my follow-up appointment with the surgeon, the surgeon told me to take Ibuprofen so I had to remind him that NSAIDs make me stop breathing; we had a good laugh over that...no big deal!
The patient advocate told me that there was going to be some action taken with Dr. Cruelty in the ER, but he can't tell me what's going to be done. The advocate also apologized profusely for me treatment from the ER doctor. He also said he'd pass on to the surgeon the kudos I have while discussing my stay.
And in a week I'll be 16 years sober, God willing!
Dear Slutty,
Congrats to you on your sobriety and your feeling better...I wish I had more patients like you who were down to earth and sincere...take care
denise d er rn
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