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This Is All YOUR Fault

JackpotWhen a patient comes to the emergency department at 3:30 in the morning with an injury that was sustained while moving furniture just prior to arrival, it raises my eyebrows a little.

When the first two sentences out of the patient’s mouth to the triage nurse are “I need something for pain – it’s 10 out of 10” and “Also, I’m allergic to Toradol, tramadol, codeine, morphine, and I can’t take NSAIDs because I have an ulcer” then it raises my eyebrows even more.

The injury wasn’t a 10 out of 10 injury. The patient was reportedly moving a couch while wearing flip flops. She caught her foot and hit the outer part of her great toe on the edge of the couch. In the process, she ripped the callus off the side of her great toe, leaving a raw area about an inch in diameter and a scrape to her instep. This injury caused her to have 10 of 10 pain.

As the nurse started to clean her wound, the patient howled. Literally.
“Aren’t you going to give me anything for this pain?”
“How about we start with some Tylenol.”
“Tylenol?!?!”
“You’re allergic to all of these other medications and your wound certainly doesn’t look bad enough for something like Norco. So I think we’ll start with some Tylenol.”
She looked at her boyfriend who had accompanied her to the emergency department.
“You know, it’s FAKERS like you who make it so that people in legitimate pain like me don’t get proper pain medicine.”
He had a shocked look on his face. I didn’t know the boyfriend, but I kind of agreed with the patient’s sentiments. Drug seeking patients do tend to ruin things for patients who really are in pain. This woman appeared to be overacting from the pain she was having from her injury, but who knows? It wasn’t too busy in the ED at the time, so I went and looked the patient up on the state controlled substances database.
Surprisingly, the patient only had 88 prescriptions for controlled substances from 18 different prescribers in the past 12 months. Only four prescriptions for Norco in the past 10 days.

I went back in the room and handed her the printout from the state database.

She scowled at her boyfriend. “This is all YOUR fault.”
Then she got up and stomped out of the emergency department before the nurse had a chance to bandage her wound or to provide her with Tylenol for her 10 out of 10 pain.

Funny how information can have such a dramatic effect on relieving pain.

 

6 comments

  1. I’m a hardcore small-government guy, about 99% of the time.

    But I love, Love, LOVE the state narcotics prescription database. Knowledge is power.

    In the last 317 instances, the power to unmask the douchebag fakers trotting to the ED to get their narcotic fix. Natzsofast, Slick.

    I used to work with one doc who, above all others, would treat the Printout Moment Of Truth with all the melodrama of a B-movie detective unmasking the guilty criminal, and all the glee of Inspector Javert’s in-character “J’Accuse!”, complete with pointed finger.

    All the guilty parties departed in haste, and more than a couple cried when caught outright.

    Were it not for the 800# HIPPA-potamus in the room, they would have all been YouTube moments worthy of permanent internet video fame, and the thousands of view hits they’d garner.

    Oh, and after 25 such moments, I hear you get free steak knives.

    Keep up the good work.

  2. Is that database available to you e.r. Doctors 24/7. Maybe this could be used more often to help both e.r. Doctors who don’t wish to make patients suffer no more than they already are, and legit chronic pain patients who pay the price for those seekers, who make this difficult for you to make an honest judgement call praying you get it right. I know I’d want you to look me up, if I came in to your e.r. For much needed help. And never would I want you to get into legal nonsense just trying to help me.

    • Okay I understand..

    • Are you the same “Carole” who has so far submitted no fewer than 138 comments on Dr Whitecoat’s previous post about drug-seekers?
      o_O

      • Why? Do you have plans for her, gonna put her in her place, tell her off, insult her, hurt her feelings, bully her, threaten her, dare her to come to your e.r. Put her down, tell her you don’t care what happened to her mother and how it nearly destroyed her. Trust me the only thing you could do is kick her while she’s down- perhaps say mean and cruel things about her mom- that might work. Other than that she’s decided from this point on no medical blogs that are nasty towards people and or patients is going to change her opinion that there are more great and awesome doctors and nurses out there than there are not. She still has distain for those who harmed and didn’t help her mother, and those lovely people behind a poor job of hiding it— she’s not fond of those mean replies and comments given by those who’s profession she admires and respects. Am I her? You decide!

  3. It sounds like you could go a long ways towards combating problems if it was required to look a patient up before writing a controlled substance script.

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