Glenn Beck

Glenn Beck’s hospital horror story is getting some attention. Apparently, he had a surgical procedure with marked post-op pain. As physicians tried to control his pain with increasing doses of narcotics, he suffered adverse reactions as a result.

A couple of thoughts:

Fentanyl is not just an “end-of-life drug”. It is simply another form of narcotic, and its use in the post-op setting is not unreasonable.

However, morphine, fentanyl, Toradol, Percocet every two hours and a morphine pump does seem like an extravagant amount of narcotics.

“I went back to the hospital and before we left the house, the doctors said, you call me and we will call in advance to make sure they’re all ready for you.”

The biggest myth out there. No physician can call ahead and “get the ER ready for you”. Patients will be individually triaged based on their medical acuity.

“I read the directions on the box that they stop your breathing. They can kill you. They’re as serious as you can possibly get. I’m still in agonizing pain. I’m still taking percocet on top of it.”

Yes, narcotic pain medications have serious side effects. But Mr. Beck was still in agonizing pain. This simply highlights the delicate balance that physicians face when managing pain and narcotic side effects. You can’t have it both ways.

My wife is holding me up and she says, my husband’s doctor called, they’re expecting him, he needs to have a catheter put in and he needs pain medication right away; he needs to be admitted.

The decision to be admitted is made by the ER physician or the patient’s personal physician. Patients cannot “demand” to be admitted.

Absent from Mr. Beck’s story is what the status of the ER was at the time. Was there someone coding? Were there multiple traumas? How many patients were present with more medically acute problems?

It is easy to point fingers, but without this accompanying context, it is important to realize that we’re only reading one side of the story.

(via a reader tip)

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  • Anonymous

    I sympathize with Mr. Glenn Beck.
    I see him as an entertainer rather than a political commentator. He has always shown and expressed his lack of compassion for a certain group of people, and suddenly he is an expert on compassion.

  • SarahW

    Perhaps this will draw attention to methods of managing traumatic and post op pain with nerve blocks instead of Narcotics.

    Link to Wired Magazine article about pain management in Iraq

  • Evil HR Lady

    As a non-medical person, this is my take. If my doctor says, “I will call ahead and they will be prepared for you,” I expect that to be true.

    The doctor should have said, “I will call ahead and they will get to you as soon as possible, but you can’t control what’s happening in an ER.”

    He also described people standing around and talking about the weekend. Now, we don’t know what else was going on and who these people really were and there may be a zillion reasons why they couldn’t treat him right then, but if a patient is in pain and sees people talking about the weekend the assumption is “you are ignoring me.”

    It’s not professional behavior. Again, their lack of immediate responsive may be completely justified. But, the outward behavior was not.

  • Anonymous

    Couldn’t happen to a nicer guy…

  • Anonymous

    “I went back to the hospital and before we left the house, the doctors said, you call me and we will call in advance to make sure they’re all ready for you.”

    The biggest myth out there. No physician can call ahead and “get the ER ready for you”. Patients will be individually triaged based on their medical acuity.
    —————————–
    i disagree with the comment. there is no promise that the patient would be seen immediately, merely that the er physician would be made aware of the history so that they could provide the best possible care. thus they are ready for the patient.

  • Anonymous

    “Apparently, he had a surgical procedure with marked post-op pain.”

    You know, kevinmd, you go to such pains to pedantically pick about the medical mischaractizations in the article, and yet you completely misdescribe what happen to Beck.

    He did not have marked post-op pain, he woke up during his surgery and had severe complications.

    This is part of a pattern, kevinmd. You misdescribe, misattribute, and omit those things that show the medical field for what it is–a bunch of greedy, unscientific quacks.

  • Anonymous

    You choose between pain 5/10 and death… Take your pick…

  • Anonymous

    Actually, I have seen lots of patients demand to be admited, or the families demand. The ED Doc will admit with something like rule out pnuemonia or failed to respond to outpatient treatment.

  • Kevin

    Bowing to “pressure to admit” is no different from a physician ordering antibiotics or a CT scan because the patient asks.

    Path of least resistance.

    Doesn’t make it right.

    Kevin

  • Patrick

    If he was going to be admitted, he should have gone in through the front door, not the ER. Mr. Beck’s doctors, “the best of the best”, either don’t understand (doubtful) or lied to him (probable) to get him off their butts.

  • Anonymous

    Dx: Urinary Retention
    Post-op Pain
    Narcissistic Personality Disorder

  • scalpel

    When you really have to pee, a minute seems like an hour.

  • Anonymous

    everybody should go to fda.gov (http://www.fda.gov/consumer/updates/fentanylpatch122107.html) and search fentanyl. should NEVER have been given patches. straight from fda’s second warning on these patches:DURAGESIC(fentanyl) is only for patients with chronic (around the clock) pain that is moderate to severe and EXPECTED TO LAST FOR WEEKS OR LONGER.You should ONLY use fentanyl if you have been taking at least 60milligrams (mg) of oral morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily, or an equally strong dose of another opioid for A WEEK OR LONGER before starting fentanyl. doctors can ignore 2 fda warnings? time to start sendind docs to defensive doctoring classes.

  • Goatwhacker

    My first reaction is how over dramatic Beck is being here, but I guess I’ll give him the benefit of the doubt. I’ve never seen anybody as worried about respiratory depression as this guy, where the heck is that coming from? All it would have taken is a couple of minutes to explain pain control and Beck could have used his PCA pump and got some rest.

    The “wonderful” surgeon dumped big time on the ER here. I’m not sure the non-medical readers are getting this aspect.

  • Christian Sinclair, MD

    Thanks for highlighting this story and all the other stories you bring. Just a tip, opioids is probably a much better/preferred term as opposed to narcotics. Narcotics just emphasizes the stigma of opioids since it is primarily used as a law enforcement term. A lot of medical providers still use the term narcotics, but for those who work closely with these medications, it is perceived as inaccurate and outdated.

    Another great point this story brings up is that just because medicines like fentanyl and morphine are used at the end of life, does not make them inappropriate for other medical situations. Although using fentanyl patches in the opioid naive should be done with caution.

  • The Happy Hospitalist

    This narrative sounds like a conversation I may have with one of my out of control alcoholic, entitled antisocial chronic pain seeking unemployeed, disabled freeloaders who refuses to LEAVE the hospital.

    Is it politically incorrect to say that?

    Honestly, I feel bad for the people he came in contact with, based purely on the words he has written.

    And nothing else.

  • Anonymous

    I am an ER doc and completely sympathize with mr Beck. Everybody seems to be missiing the main thing the guy is cribbing about-lack of empathy! I have seen that in my ER before and it makes me crazy when the nurses are chit chatting and some family member has an agonizing look on their face is standing at the nursing station trying to get an answer.
    Of course his doctor dumped on the ER. That happens everyday. But the ERs job is to releive pain-who gives a rats ass whether his doctor callled ahead. The guys is here, he is agonizing pain-take care of him!

  • Anonymous

    Anybody know what the surgery was? Sure seems to me like a chronic back pain surgical intervention. A few things amaze me… he instantly woke up and described pain to the anesthetist, asked for something and cannot remember it. Here in the ER we call that the 10+ reflex … 10+/10 pain and disoriented to TPP but still asking! The reply to the government mandated question “wake up and tell me on a scale of 1 to…” “20″ syndrome.

    Second .. the patient wakes up instantly and needs “three hours to stabilize me on pain” — whatever that was. Did this not set the alarm bells off … they actually let him go home. What the hell were the anesthetists and surgeons thinking!? If this guy wanted to go home so bad, they Docs needed an AMA.

    Third … Did anybody do a drug/alcohol/substance abuse screen before surgery? This patient either has no opioid pain receptors in his brain, or a liver that can metabolize narcotics (the proper term!). This patient, I’ll wager, was not a pharmacologic virgin.

    Fourth… yes heavy narcotic use can lead to urinary retention. And that is why they leave the catheter in for a few days, because with the potent narcotics they were using the patient will stay in urinary retention.

    Fifth… I hope this patient doesn’t get cancer or some other painful disease, because the cupboard is bare for controlling his pain with narcotics. The Sched 1 drugs may work, but you will not find any ER Docs that can prescribe heroin.

    Finally, this represents the surgical trifecta. The surgeons get a procedure (on a questionably suitable candidate), raise the expectations of the patient that the red carpet will be rolled out for him by the ER (so the anger is directed at the ER and not the surgeon), and end up ultimately dumping him on some poor hospitalist and seeing him in consult. A potentially chronic surgical complication offloaded on the ER/Hospitalist, with and patient worships the surgeon.

    Nice.

    iDoc

  • Anonymous

    This patient, I’ll wager, was not a pharmacologic virgin.

    Good call–he’s not. He was once a drug addict.

    Someone asked what the surgery was for; it was for hemorrhoids.

    Yes, hemorrhoids. And he thinks he “almost died.”

    I wanted to scream when I saw his ridiculous hysteria. And WTH, he was back at work in days–how bad could it really have been? I think the staff he said was BSing deserves his complaint–unless he hallucinated the whole thing–and he was obviously given an absurd amount of painkillers. (Of course, maybe they just wanted him to STFU.)

    My sympathies to this obnoxious jerk’s wife. Can you imagine living with someone like this? Ugh!

    Honestly, I think this whole drama is just being milked for ratings. It’s notable that he keeps mentioning how his YouTube video was “most watched” and stuff like that. I mean, does anyone even watch Glenn Beck on CNN-HN? I don’t, but I (stupidly) did on Monday when he returned. Yeah, his little stunt worked.

    God help him, his wife, and the medical profession should GB ever get a serious illness or injury. Sheesh.

  • dreaming78

    I suffer from chronic back pain, and my pain level is lessened but not completely resolved by the fentanyl patch (basically, I live at a four instead of the 6-8 I’d be at without them). I’m not anywhere near death (I hope!). Morphine does nothing for me, as a combination of long-term opiod use and inherited drug tolerance means that I am one of those people that, when in pain spike, only Dilaudid has any kind of effect on me. I’m far more familiar with these drugs than I want to be.

    The boxes for the patches very clearly state that they’re not for post-operative or acute usage. I’m baffled as to why they’d be prescribed. As for the side effect of breathing problems, I was under the impression that was the case for most heavy-duty painkillers.

    And this guy DID leave the hospital AMA, paperwork or not. I’m sorry, but if I woke up during surgery, and then was at a high pain level afterward, I would not leave until my pain was under control. I don’t quite understand how leaving the hospital after surgery, when it was suggested that he stay, is any fault of the hospital or the staff caring for him.

    I’m sorry he had a bad experience, but it really does seem like he had more than a small part in creating his own misery. If he was too weak or in too much pain to advocate for himself, then it was his wife’s job to advocate for him. Also, I very much doubt that that the orderly/nurse/whoever that met them in the waiting room REFUSED to help him. That would be grounds for disciplinary action at every hospital I’ve ever been too. Take some responsibility, Mr. Beck. If you’d just stayed the hospital for observation and pain management, oh. Wait. You wouldn’t have a way to be an attention whore. Think I hit it, there?

  • Zagreus Ammon

    It is just too funny, to think about such a horse’s ass having a problem with his own. I always thought his personality was a little constipated. Of course his pain meds were ineffective. That implies a lot to any physician who has dealt with people of his ilk. After all, who is the idiot who believes surgery is painless? Pain is to be controlled, not eliminated.

    Sorry but I’m going to say it:

    crybaby

  • Anonymous

    As a patient, it is really hard to judge whether what is happening to you in the ER is what should be happening. A while ago, my daugther started to limp and her doc said she probably had a viral infection of the hip and should go home and rest but if she started running a fever or stopped walking entirely I should go to the emergency room immediately becausee it may have become a bacterial infection of the hip. That weekend both of these things happened and I took her to the ER. The intake person listened impassively to my story and sent me to a long line for the triage nurse. Sometime later the nurse called us and took her temp and blood pressure; then we waited and waited and waiited. About 3 hours later, I could tell that my daughter’s fever was getting worse and still we hadn’t been called. I thought, “well, there must be more urgent cases ahead of me” but finally I asked a rather harried looking staff member to please check for me and he did. Right after that a nurse burst through the ER door and said, “Is this the chld with the bacterial infection of the hip? We’ve been looking all over for you!” I can’t imagine where they were looking as we were exactly where we had been told to wait -in the ER waiting room. Anyhow, later I wondered if I should have made a fuss or something earlier. It seemed to me that perhaps some sort of “communication error” had occured. I don’t know how “urgent” our case was compared to the other people there-I have no way of judging that. It might have been helpful if the staff gave people some guidance about what they should expect when they are triaged-something like please come back and let us know if you aren’t called in 20 minutes or something like that. In the absence of some system like that, I think that staff should be understanding of patients who question wait time, etc.., just like the staff member was who went back iinto the ER to check on the situation for me. As it turned out, my daughter did not have a bacterial infection, she had a tumor that had caused a pathological fracture of her femur.

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