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Treating Pain: The “Candyman” Conundrum

Treating Pain: The “Candyman” Conundrum

Scrubs Magazine | Brady Pregerson, MD & Rebekah Child, RN

ER doc Brady Pregerson and Nurse Rebekah perform a raid and bust on that sketchy personality, the “Candyman.” Why does he exist? And what is he thinking?

In Part I of our Pain Management series, we looked at the challenge of gauging your patient’s pain. In this article, we examine the many consequences of taking a too-easy approach to a complex issue.

Dr. Brady: Treating pain and other symptoms such as nausea and anxiety is a core competency in many medical specialties. Sometimes it’s all we can do.

As doctors, nurses and PAs, we should take pride in easing the suffering of our patients. It’s morally superior to over-treat 100 drug-seekers than it is to withhold analgesia to a single patient who is truly suffering.

Some physicians have the philosophy that if they just assume all of their patients are telling the truth and treat them accordingly, everything will work out for the best. This is an attractive way to approach pain management and surely simplifies the job. It completely avoids the added task of being the narcotics police in addition to being the doctor, and your patients will love you. Also, you can often discharge patients more quickly this way, because instead of giving them a long explanation after telling them “No,” you can instead just say “Yes.” Perhaps this is the best approach.

Of course, there are downsides to being the “Candyman.” Will your nurses respect you for it? Will your DEA number be used to buy prescription drugs that are later sold to junior high school students for profit? Will your behavior encourage repeat visits from drug-seekers who back up the waiting room and put sick patients at higher risk of a bad outcome due to delays in care? After all, it has been frequently said, “If you feed the bears, the bears come back.”

Nurse Rebekah’s Viewpoint — Continue reading on the next page→


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    kd_aman

    about 5 years ago

    72 comments

    I agree with what the Dr. said about believing everyone is telling the truth - because you really can't judge patient's pain. Pain is what the patient says it is, according to what I learned in nursing school. I have run into times in clinical where it has looked like we had drug seekers, and they had a history of using, but they also had legitimate, obvious reasons to need pain meds. Just because they are addicted does not mean they don't need pain relief now too. There are alternative pain meds to just narcotics, we can use those for the drug seekers. I have seen that done. Sometimes they refuse and only want something specific. But sometimes they have built up so much of a tolerance that even though that's the only drug they will take, it does them no good pain-wise. I digress. I have learned in my experiences so far, that this is a tough subject because situations can be so different with people. A fellow student even ran into an ex-nurse who became addicted to pain meds because she had been diagnosed with a type of cancer a year ago and put on hospice....but then ended up living too long and got taken off hospice...Well, in hospice they aren't usually shy with the narcs. She became addicted and is also in terrible pain. What do you do in that situation? It was very sad to hear. I could go on about this subject for awhile though. It is a tough call. You don't want to contribute to people's problems but you don't want to make them suffer either.

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