There’s another war being fought between the chronic pain patients and the physicians who fail to treat them over at Scalpel’s blog.
Healthcare providers who treat patients with pain repeatedly complain about all the drug-seeking pain patients who clog up the emergency departments and suck up health care dollars trying to score a few Vicodins or Percocet tabs (“Vikies” or “Perkies” as Nurse K calls them). Chronic pain patients then respond by calling the health care providers heartless and cruel, and then by imploring any available deity to inflict massive amounts of pain on the healthcare providers, their families, their pets, and their unborn children so that the healthcare providers “know what it feels like.”
This is getting to be like an abortion or gun control debate. Enough already.
Chronic pain should not be treated as an emergency.
If you abuse drugs and get busted by your current physician who will no longer prescribe you narcotics, don’t come to the emergency department looking for your next fix.
If you forget to refill your pain medication prescription, don’t come to the emergency department on a Friday night and expect that the overworked ED physician is just going to blindly write another narcotic prescription to get you out of his or her hair. Ain’t going to happen. You can see that your pills are getting low. You have a phone. Call your doctor and get a refill. Lack of planning on your part does not constitute an emergency on the emergency physician’s part. Plan ahead next time.
There are always exceptions to every rule, though. If you have chronic pain and haven’t been to the ED in a long time, I’m going to look upon the situation a little differently than if your mail starts getting forwarded to our hospital because you are here so much. I know that pain sucks, and I’m going to try to help you. But I’m not going to become an enabler that allows you to be reckless with your chronic medical condition.
If I don’t know you, I will personally call your physician and ask about your medication use. If you are from out of town, I will personally call the hospital ED in your home town. I’ll also call your pharmacy to get your medication history. If I can’t verify your history, you may get an overnight supply of medications, but it will only happen once. Your chart will get tagged so that if you come in with the same modus operandi in the future, everyone will know about it. If you have lied to me, you’re done. Not only do you get Tylenol for your current visit, you get put on “the List” so that all the docs in our ED know that you have previously lied in an attempt to get pain medications. Does all this take longer? Of course. But it serves a purpose by discouraging people from registering for “headaches” when they are really just looking for a quick fix. Because I regularly make these calls, I have a small contingent of patients who will not register in the ED if they find out that I am working. To me, that says a lot about their motives.
Those few docs who do write pain prescriptions to get patients out of the ED eventually end up shooting themselves in the foot. First, they get a reputation. Then the chronic pain visits start to increase. So they end up making more work for themselves. Eventually the patient with a chronic pain medication refill may actually be sick. By assuming that the patient is just there for more medications and giving the patient pain meds without much afterthought, you can miss a deadly disease.
Legitimate chronic pain patients and migraine patients should be upset that they are sometimes looked upon as “drug seekers” when they come to an emergency department. But here’s where a lot of you are off the mark: You’re blaming the wrong people.
Let me give you an unrelated example to illustrate my point (i.e. don’t send me hate mail and talk mean to me because your agenda may be furthered by stating that I am comparing chronic pain patients to vicious animals).
A friend of mine has a nice lovable pit bull. He’ll come up and lick you, he’s great with the kids, and he’d never hurt a thing. But anyone who doesn’t know the dog is scared to death of him. Some people won’t even come over to my friend’s house because they are so afraid of the family pit bull.
Now who is to blame for the bad feelings that people have about this wonderful dog? Is it the people who are scared because they don’t know the dog? Or is it the many other pit bulls who have maimed and killed people and who, in the process, have given pit bulls in general a bad reputation?
Just a couple of days ago a young patient came in to the ED with a bunch of symptoms. Everything was wrong with her. She complained of nausea and vomiting, headaches, chest pain, abdominal pain. Her vital signs were abnormal. She just happened to have moved to town a couple of weeks before her visit and couldn’t remember her physician’s name or the name of the hospital where she used to go. She was on narcotics for four years because of a complication from gastric bypass surgery and “constant” abdominal pain.
I treated her symptoms. She got phenergan for her vomiting and a couple of liters of IV fluid. She got Toradol for her pain. An amazing thing happened – she felt and looked better in a couple of hours. But still had this nagging abdominal pain.
Then came the “Oh, by the way.” Seems that she thought she was in “withdrawals” after being off of her methadone and Percocet for the previous week. I told her I would not refill her narcotics prescriptions but would give her some medication to help with her withdrawal symptoms until she could follow up with the on-call physician. Her response? “F$*% this. I’m going to my sister-in-law’s house to get some heroin, then.”
Over time, when you see patients like this over and over again, you’d be silly if you didn’t begin to wonder whether people with chronic pain are just out to get some physician-approved “heroin”.
I think any ED physician or ED nurse who has been in the business for a few years gets to be pretty good at picking out the real pain patients from the “fake” ones. Based upon the survey I did (admittedly nonscientific), it seems that even people without medical training can pick out patients who are exhibiting drug-seeking behavior. You may get upset about some of the things that Scalpel has to say, but I think I know Scalpel well enough to say that if you’re legitimately in pain, he’ll take good care of you. If you’re looking for a fix, chances are that he’ll bust you.
Whether you agree with Scalpel or not, all of you upset chronic pain patients need to start pointing your pitchforks, waving your torches, and casting your evil spells on the mean pit bulls, not at the docs who are hesitant to treat the nice ones.