List Archives

Sun Apr 29 13:07:28 BST 2007

 Respectfully to all-- THIS is what we often want to say to patients, but
> cannot, because we are and will *hopefully continue to be*, their
> advocates.
>
> That being said-- the 10/10 while chatting, or munching the McD's they
> brought *with* them, galls me. I personally have experienced 10/10 once in
> my life and it was NOT even childbirth or completing marathons!!
>
> On, on.
>
> Charlene Morris, PA-C
>
>
>
> >
> > Advice from an ER doctor to drug seekers
> > Date: 2007-03-27, 9:56AM 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 shit 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 fuck 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 fucktards 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 fucking 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 shit 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
> >
> > ~~~~~~~~~~~~~~~
> >
> >
> >
> > Barbara C. Phillips, NP
> >
> > http://www.NPBusiness.ORG <http://www.npbusiness.org/> <
> > http://www.npbusiness.org/>
> >
> >
> >
> > *********************************************************
> > TO UNSUBSCRIBE OR CHANGE YOUR OPTIONS GO TO:
> > ACC-Circle mailing list
> > http://mailman.listserve.com/listmanager/listinfo/acc-circle
> > NOTE: To post a reply to the entire list, use your email program's
> > *Reply To
> > All* button; To reply to the sender only, use your email program's
> > *Reply*
> > button.
> > NEED TO UNSUBSCRIBE?? *Please unsubscribe me* messages posted to the
> > list
> > are IGNORED. Go the the list web page to set your options.
> > PROBLEMS? Email the list administrator at acc-circle-owner at listserve.com
> >
> > Wear your professions patch proudly. If enough of us do, we will have a
> > great PR campaign. WE NOW ALSO HAVE PINS.@$5.00 EACH
> > http://amcollege.org/Patches.html
> >
> >
> >
> > *********************************************************
> > TO UNSUBSCRIBE OR CHANGE YOUR OPTIONS GO TO:
> > ACC-Circle mailing list
> > http://mailman.listserve.com/listmanager/listinfo/acc-circle
> > NOTE: To post a reply to the entire list, use your email program's
> > *Reply To All* button; To reply to the sender only, use your email program's
> > *Reply* button.
> > NEED TO UNSUBSCRIBE?? *Please unsubscribe me* messages posted to the
> > list are IGNORED. Go the the list web page to set your options.
> > PROBLEMS? Email the list administrator at acc-circle-owner at listserve.com
> >
> > Wear your professions patch proudly. If enough of us do, we will have a
> > great PR campaign. WE NOW ALSO HAVE PINS.@$5.00 EACH
> > http://amcollege.org/Patches.html
> >
> >
>

List Archives

For your convenience, find the Trauma List Archive Below

Advice from an ER doctor to drug seekers