An ER doc tells off drug seekers

An anonymous rant found on craigslist:

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

(via Type-B Premed)

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  • Anonymous

    How about just ingoring the stupid pain scale and practice clinical medicine letting the spreadsheet boys attend to their pointless numbers.

  • AAAAUGH AUUUGH = 8

    Patients don’t always get the same pain scale presented to them…
    Sometimes, it’s a ten-scale with the high end the “worst pain you can imagine”; sometimes the high end is ridiculously, uselessly presented as a subjective scale of the worst pain the patient has ever experienced.

    Can you tell a difference between the two options?

    I refuse and will always refuse to assign a number to my pain. I intend, to the extent my pain and physical condition allows, to use actual words to describe my pain.

    As in, I am in agony, I’ve never felt anything worse – or, I have a nagging, bothersome, left hypochondrial pain.

    I get grief for it. “We must have a number for our records. Just pick one”.

    Stupid pain scale.

  • Anonymous

    I had a gallbladder attack last night and considered running into traffic to end it all. It was by far the worst pain I’ve ever experienced, and I’m supposed to rate that a 7? Give me a break!

  • Maurice Bernstein, M.D.

    To Anonymous of 6:29pm: If the pain you experienced last night was the worse pain that you have ever experienced and the worst pain that you ever could imagine, that’s a 10 by all criteria. I agree regarding the uselessness of trying to quantitate pain into narrow categories. I would think that the categories should be no pain, slight pain, tolerable pain and intolerable pain. The entire value of this exercise is to identify a patient in pain and convert intolerable pain into something more tolerable or, if possible, give the patient complete respite from any pain.
    ..Maurice.

  • Anonymous

    (Hint)

    It is all subjective. Using a “semiquantitative” scale to mask the underlying subjective nature of the assessment does not magically make it objective.

    ~Criminallopath~

  • Anonymous

    To all posters before this: please READ THE CRAIGSLIST ARTICLE! [including the poster here who identifies self as MD]
    -the article is addressing the drug seekers – whom we know, and by definition are in no real pain [they may have psychological "pain" granted]
    -ethics and defensive medicine are the only 2 factors giving these drug seekers the ED physician’s attention; and the writer is trying to help everyone, including the MD’s/DO’s or those who can write class II’s and III’s sought after by these drug seekers
    -believe it or not, even if the doctors know the manipulation, humanism prevails…fatigue sets in and everyone just wants to be out of the ED…SO I AGREE WHOLEHEARTEDLY: IF YOU ARE A DRUG SEEKER PUTTING ON AN ACT, BE LOGICAL AND GREAT WITH IT, SO YOUR LIFE AND THAT OF THE DOCTOR WILL BE EASIER; YOU ARE ALSO HELPING THE OTHERS IN REAL NEED BY FOLLOWING THESE RULES, AS THE DOCS WILL BE ABLE TO DEVOTE MORE TIME AND ENERGY TO THE REAL PERSONS IN NEED, everyone will be Happy, Happy,Happy…
    -when you put up a real logical scenario too, the doc at least don’t feel drained emotionally from the continuing insult to his/her intelligence; and u get your sought after rx easier to boot!!!
    -that craigslist article should be published in every ED or national newspaper
    -perhaps Rush Limbaugh should talk about it in his marvelous show too!

    -another rule that may help is: do not share or sell your loot or make money off of it, and get caught by law enforcement; this puts your prescriber in trouble and would be more reluctant to help you next time around; let your addiction stop at you! not your bf/gf or the community…

  • Anonymous

    I agree that it is all subjective and that no ER Doc. should assume someone is lying just because HE may not think a 10 is what someone’s else’s 10 may be.

    I have also had GB attacks, bad ones, that have left me on the floor throwing my guts up. It was not MY number 10 on a pain scale. But, the reason it wasn’t is because I have also had the pains of post op and recovery major cancer surgery. Also, the pains of Total joint replacements, so to me a GB attack pain is not a number 10. My number 10 is when I am in so much pain that Im unable to comunicate effectively with the physician. That has actually happened with my cancer treatment, and the ER doc said to me…”This conversation is useless, you’re in too much pain”

    So just because you have seen horrendous pains in your ER doesn’t mean that person who tells you their pain is a 10 is lying to you. It very well could be their number 10.

    I also agree that almost always the question is put to us in terms of a 10 being the worst pains “you” have ever felt. That is not an accurate way to go about it.

  • Chris, RN

    I never use a pain scale except for eye pain. People aren’t going to lie about their eyes. I use an ADL scale. If they’re eating, able to bathe, go to work, and function at work, there’s no way their pain is 10/10 regardless of what they claim. 10/10 means they cannot find a position of comfort and are unable to think of anything else but pain.

  • Anonymous

    Please, medical people, include “no pain” in the asking. After surgery for a broken hip, my first adult hospitalization, a nice nurse repeatedly asked me to rate my pain, 1 to 10. I was so brain fogged from the anesthesia and probably pain killers that I could only think to try to give her a number, any number, varying so as to not bore her. But I never once felt a twinge of pain, not from the moment the paramedics arrived to pick me up off the floor (Obviously they gave me morphine though I never complained of pain. I tried once to move after falling and that DID hurt!). I guess it’s just as well I was giving the nurse “numbers” (5 or 2 or 7, etc) since she had to record something. But better to be asked “no pain?”

  • Anonymous

    1:30,

    If you have no pain, why not just simply say zero??

    Throwing out numbers for amusement or to please might get you overdosed into respiratory failure by a nurse trying to be helpful and trying to fulfill her bean counter imposed nursing requirements regarding pain assessment.

  • Anonymous

    TO me~ that IS COLD…”your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot.” [END]

    I am someone who is always in pain and is now physically addicted to both Oxycontin (8 years) and Xanax (21 years.) IN addition I have numerous chronic health problems ~ such as pulmonary fibrosis (thought to be MAC related although I am HIV -), Hep C , prior TIA, prior hypertension, depression, etc.

    I also KNOW I am dying. I am now 106 lbs and 5’9. (I weighed 243 lbs for about 8 yrs or so prior to Jan. 06.) I am in my early 50′s.

    I have horrid insurance (Med. & Medicaid) and no car, nor do I know anyone with a car.

    I have only been outside 5 times since Jan 06 as well…one of those trips to my PCP who in hindsight “dumped me” by telling me he was afraid I was dying and told me to go find a big hospital in the city who took NIH funding. He then added that his pratice and all of his referall specialists loathed and did not take my “new” secondary insurance due to the Medicare Advantage fiasco that occured abruptly for dual-eligibles in my state in Jan. O6.

    I told him our car was dying as well and he reminded me there was no public or medical transportation anyway. [I had moved in Sept. 05 from a quiet middle-class county to the nearby "budget busted" big city.] He was correct as I called every specialist and none took my secondary and confirmed by phone that the trans. was in-city only.

    In July of 06 ,I know..(the worst time possible) I did go to “supposedly” one of the TOP 10 hospitals in my state that got a LOT of NIH funding as my PCP suggested. I was admitted but they were at 110% capacity. I was only kept 2.5 days (1.5 of it in the ER) and the care was ~to be kind ~ “frenetic.” I rarely saw a nurse and if I did..I was spoken at, not to. I was healthier then and 167 lbs. (Although I had lost over 70 lbs. in 7 months.) My addiction(s) were not as bad as they are now. Then I was only taking 5 Xanax daily. They discovered the pulmonary nodules.

    I actually ended up begging the brand new attending (who always appeared very frustrated and overworked)to be allowed to stay but was abruptly discharged at 4 PM on a Friday anyway..never seeing their “promised” social worker or recieving any coherent follow-up care. I had wrote up a list of questions but the “team” was always in a hurry and rushing in and out. I never could get any of them to answer or even look at my papers.

    My PCP’s office staff messed up the OP referrals 3 times and then refused to try again. TO be fair.the OP ref.’s were done by a brand new resident and were not done correctly.

    She set me up with clinic appointments with “more brand new residents” (instead of putting down an actual hospital doctor) so the coding was somehow meaningless or non-existant. Neither the hospital nor my old PCP would call each other and I got lost in the middle.

    After 10 months or so of trying to get some type of home care, psych care, transportation or to find a new PCP who would accept both my insurances (which I never could), I gave up. Even attempting to just get basic correct information from this “new wretchedly thrown together” MedAdv. Plan was so ludicrous..I stopped calling out of frustration. They “outsource” their MH/D&A to a state 15 hours away who have no knowledge of this area. Temps constantly would answer the phones at the new MedAv and make things up. Supervisors were always too busy to come to the phone,etc. As for my secondary insurance..the welfare office knew nothing as far as docs who accepted it. The state said to call my local welfare office…they knew everything. The welfare office said to call the state back. I could go on and on. It was and still is disheartening and unorganized!

    Now 9 months later,I can barely stand more than 2 minutes at a time , nor can I perform any ADL’s. Sadly, I also have no family or friends except my grown son who is also an addict. Chronic constipation is so bad, I literally have to bite on a washcloth to prevent screaming from URQ back pain attempting to defecate, so I rarely eat and a decubitus ulcer is surely next as I am skin and bones. All my hair has fallen out and I have no one to bathe me. (My son does not know how to care take at all.) Always alone and never able to sleep or lie in any position for too long w/o pressure from being so frail -my Xanax use has spun wildly out of control. For 20 years I had always taken it as directed.

    I am dehydrated and void about 2 ounces a day if I am lucky. I never did have good veins from previous hospitalizations..so I have daily nightmares of having to go to an ER that is probably already short staffed and having to beg to be throughly washed first. ( I know I would most likely need a central line and ding ding.instant infection.)

    I KNOW I WOULD BE ANY ER DOC’s WORST NIGHTMARE.

    I read these blogs and all the doctors and nurses write about these days is money. [Or your dislike of Medicare/Medicaid/problematic patients.] I read too much..to the point that I suffer daily rather than even attempt to go to an ER again.

    The thought that I would not be believed or either just detoxed way too quickly or just right off of 20 Xanax 0.5 a day [and around 80 mg. of Oxycontin] is worse than dying this way. Or how do you do a colonoscopy or bronchoscopy on someone so addicted? Why is everything pushed toward outpatient when I have no one to help me at home? Would I be rushed out the door of any hospital or dumped to some horrendous nursing home in a ghetto (my insurance IS that bad) with roaches and most certainly undertrained, understaffed and most likely uncaring staff?

    I called the three lone drug detox’s in my area that even take my insurance and as expected, they are located in the worst neighborhoods imaginable. You get 3 to a maximum 7 days if you are lucky. Their protocols are “horrendous” according to guidelines supported by the better tx centers, 300 page addiction treatment protocol commission reports I have read or the recent HBO’s “Addiction Series” board’s guides and choices information [geared obviously for people who can afford to choose.]

    I am way too sick now to even walk..let alone attend groups or be in a facility with no truama hospital staff. My seizure risk would be so high even 30-90 days out if I did not go totally insane from “reverse anxiety” first from the Xanax WD alone. Also, having read extensively on addiction I know that a 3 or 7 day program in my condition would or could not work…esp. with no family, friends or transportation for aftercare. I can not even walk more than 10 feet now without getting severely lightheaded.

    I believe my abilty to even be this cognizant after 16 months of almost total isolation [except the 4 hours or so daily I see my son] speaks to the things I have not yet lost..my high level of intrinsic intelligence, acute awareness of the current state of mind of physicians and the grave disparities in medical care that sadly exist today and my own knowledge of my personally difficult medical and psychological condition(s).

    I KNOW that you all appear to categorize everyone who uses drugs or deteriorates like I have as “non-entities” or not worth treating.

    In reality I was and in many ways still am a warm and caring person. I am also very sensitive…which makes the thought of being “hated upon sight” or “judged harshly” even worse than suffering daily this way. I DO suffer.

    SS for writing so much.. I just wanted to REMIND everyone here that not all people are drug seekers ( I have a safe full)..some of us are also very ill and have an ounce of pride left. That pride I retain inside somewhere (coupled with shame and guilt) keep some of us upon reading all of these blogs and articles from even attempting to seek care.

    I don’t know why I am still alive but I certainly hope it ends soon. I see no way with the way medicine is structured now how I could have ANY realistic chance [or even be alotted the necessary timeframe it would take] at this severe point in my med history to recover.

  • Anonymous

    People wouldn’t have to lie at the ER if unsympathetic, judgmental Docs like this did their damn jobs! What this post did was confirm that docs profile patients, and often unjustly! People in real pain often exhibit signs of drugseeking because they are in fact SEEKING DRUGS for their pain. First, if they are lieing there is a chance that their could be a good reason. Example. Legitamate pain Patient has oxicontin script stolen by the guy fixing his AC guy and it is a weekend. Goes to ER 1 and tells the truth. Docs can’t get a hold of his doc and give him some Vicodin because his levels are too high and they can’t confirm. Patient not only has existing pain but starts WDs finally in agony goes to ER 2 where he has to lie about his name and conditions because telling the truth got him now where the first time and he doesn’t want them to find out he was at another ER. Or, maybe it is just some vicodin addicted college kid who has never gotten help for his “disese”. Yes, drug addiction is a disease, in which this ER Doc just had an opportunity to actually help and treat this person but instead chose to belittle, tease, judge and criticize this person instead. In any case, no one has the right to judge until you have walked a mile in that persons “drug seeking” shoes!

  • Anonymous

    so then what’s ‘typical pain that is totally the same as I usually get’?

    my head/back hurts?

  • Anonymous

    I work at a community health clinic. OMG the redneck hillbillies here are worse than the junkies with abcesses in Detroit hoods (where I worked as a “scut monkey” in my salad days).

    one guy admittedly messed his neck up in a helmetless motorcycle wreck-lucky he didnt leave his brain behind. Tough construction guy with tatooes. I explained beginning of visit we have to be careful we have many idiots coming in “so I’m an idiot b/c I have tatoos?” I even told him I check criminal records (and find people who have been busted for getting narcs under false pretenses).

    He flipped and demanded his money back and went to my Boss.

    I hate being a doc sometimes

  • Anonymous

    Your stereotyping of patients in pain is why real patients in pain can’t get back to see the doctor.Doctors and Nurses think all are drug seekers because theyv’e manifested that way in there minds.

  • Anonymous

    “Your stereotyping of patients in pain is why real patients in pain can’t get back to see the doctor.Doctors and Nurses think all are drug seekers because theyv’e manifested that way in there minds.”

    Where do you get that? We love to help people in real pain. It makes us feel like rockstars. We hate, however, to be lied to, manipulated, threatened, berated and belittled because some jerk thinks that the squeaky wheel always gets the grease. We aren’t stupid and we know when we are being manipulated so spare us the lecture about stereotyping.

    The real reason people in pain can’t get back to see the doctor is because people take up our time knowing that medicolegally we have to work up certain complaints with the “million dollar workup” that takes hours. And the whole time all they really wanted was drugs. So they manipulated the system, willingly suffered some pokes, prods and irradiation just to get high. Meanwhile Jenny brokenleg has to wait for the room while the BS pancreatitis is ruled out and the dilaudid sponge is discharged.

    And don’t think its only the doctors. Family members are constantly coming to us saying- “My husband-son-etc has a problem with drugs. Please don’t give him narcotics. He has been to 4 hospitals today for the same pain and has gotten prescriptions at each one” So then we have to go confront the sqeaky wheel.

    There wouldn”t be as much of an issue if you would advocate for us to be absolved of the responsibility for what those who seek rx controlled substances for secondary gain. Then we would be free to treat anyone’s pain without fear of DEA investigation and loss of our license. And for what?

    It all boils down to an US vs THEM situation which has been created by the DEA. I (and many others) am not willing to prescribe scheduled substances to a known abuser (or even admitted abuser like one of the previous posters) and risk losing what I have worked so hard for so many years to attain. So it really does become me against them. Many many docs get letters from the DEA inquiring as to why he or she has prescribed so much vicoden this year…big brother is watching. In this hostile environment, you are right to think that known or suspected drug seekers will get hassled in the ER. I want to make it as unpleasant as possible for them to come to where I work for secondary gain. Now, if you want to take away my personal liability, that is a different story. But as it is, it is me and my family against their desire to get high and my family wins.

  • http://KEVINMD.COM ER NURSE

    HAVE YOU EVER WORKED IN AN ER ? I THINK NOT. A PAIN SCALE IS NECESSARY TO GET A BASELINE ON A PATIENTS STATUS. IT CAN GO UP OR DOWN,YOU NEED TO KNOW IF MEDS ARE HELPING OR NOT. BELIEVE ME THERE ARE PLENTY OF DRUG SEEKERS OUT THERE AND THEY WILL LIE AND DO MOST ANYTHING TO GET THIER DRUGS.ITS SAD BUT DR,S HAVE TO BE VIGILANT AND THEY ALSO HAVE TO KNOW WHATS WRONG BEFORE THEY CAN JUST DOLE OUT PAIN MEDS.IT COULD DO MORE HARM THAN GOOD IN SOME INSTANCES.ER,S ARE ONE OF THE TOUGHEST PLACES YOU CAN EVER WORK, ITS ALSO ONE OF THE MOST REWARDING.

  • Joe

    Dear “Doctor”:
    I too am a Doctor of Medicine. I serve the subpopulation of patients that have chronic or acute severe pain conditions. Your rant is typical of burned out cynical physicians who have no business taking care of patients anymore. Like a seasoned police officer who sees every citizen like a potential or probably criminal after years of service, you see every patient in pain as drug seeking instead of a possible real patient suffering from pain. I have seen countless cynics like yourself who think that they know what “pain” is, that is until they suffer from a painful condition that may be life lasting such as chronic severe back pain. It’s funny how when the pain hits home they become much more open about understanding chronic pain syndromes and much less concerned about “patients” trying to hit them up for drugs. Countless numbers of people are turned away from Emergency Rooms who have true pain issues because of cynical doctors like you, who blindly disavow their moral duty to alleviate human suffering. Time to retire old timer.
    Sincerely,
    Dr. “Joe”

  • Colton Case

    You can rest assured that the same “Keepers of the Key to the medicine chest” do not go through these same hassles. They do not take Tylenol for their extreme pain.
    Is it just a power play, to make a person”aka Drug Seekers” jump through hoops for the drug?

  • Colton Case

    Isnt it better to medically prescribe the drugs than to have the patient have to buy medication from the streets? At an unreasonable price of $1.00- $5.00 a pill? If a person is in pain, they are going to seek relief ,be it in another persons prescription or alcohol.

  • Colton Case

    Let’s be honest about why the drugs needed to end pain are so hard to get. The drugs that make the physical pain go away, are being replaced by Psyche Meds. something that really sums it all up. It is a way to control people by mind control. If you control the mind the body will follow along. If you dont believe this ask any body that has been incarcerated, ( and I dont mean incarcerated for drug related crimes). After being booked into the jail, the next stop is the infirmary and Psyche Meds are given. So by the time the inmate reachs the housing dorm , they can barely do the Thorazine shuffle. Thus you have docile zombies all in front of a TV provided in a day room. End results when the inmate is released from jail, it is a condition of their probation or parole that they continue to take these state prescribed Psyche Meds.
    Otherwise they violate their parole or probation.

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