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Which Patient is Telling the Truth?

Which Patient is Telling the Truth?

(source: www.nlm.nih.gov)

ERNursey

February 27, 2008

Patient number 1 is a 40ish man with no medical history that comes in from his job at a construction site where he suffered a sudden onset of right flank pain. Driven in by a co-worker he is barely able to walk in, hunched over, pale, sweaty, diaphoretic, writhing on the gurney, tachycardic and hypertensive. Shortly after getting to triage he starts vomiting. During triage he seems apologetic when he rates his pain a “7 or 8.”

Patient number 2 is a twenty something who is brought in from the parking lot in a wheelchair by a friend, they are laughing and talking on their cell-phones when you bring him in for triage. Chief complaint is a twisted ankle. Despite apparently being able to walk to the car at home he is now unable to walk and has to be brought into triage in a wheelchair. In triage his skin is pink, warm and dry and vitals are normal. He rates his pain a “12.”

Patient number 1 is given Toradol and Compazine IV and has complete relief of his pain. He is diagnosed with a small, non-obstructing kidney stone. Discharged home with prescriptions for Motrin, Vicodin and Flomax as well as a urine strainer.

Patient number 2 is diagnosed with muscle strain. He is offered an stirrup splint and a prescription for Motrin. He is unhappy and demands a pain shot, crutches, work note and a prescription for Vicodin. He is told no at which point he jumps off the gurney and stomps out of the ER in a huff, screaming “I’m never coming back to this motherfucking place.” Another miracle cure, courtesy of emergency medicine.

This is the kind of thing that clogs up ER’s all over our country. America is filled with people that contribute nothing to society but come equipped with a massive sense of entitlement, they want what they want, when they want it, when they want it. Told no, they became belligerent and assualtive, spewing threats toward they staff. Fearing patient complaints or confrontation, more than one practitioner has taken the path of least resistance. Hospital administration, driven by their wish for high patient satisfaction scores, fails to allow MD’s to practice medicine and join JCAHO in forcing us to be legalized drug pushers rather than medical practitioners.

Someday, when there is an epidemic or surge of casualties from a natural disaster or terrorist attack the ER won’t be able to care for those victims because we will be full of patients with ‘chronic pain’ who are seeking drugs.


Have you had any interesting ER experiences? Share them in the related discussion thread.



      

      

      
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    ronniee

    over 2 years ago

    12 comments

    Nice Post.

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    daddyofsadn

    almost 7 years ago

    68 comments

    it iis a real shame that this is happening all over our country its a shame when those that really need our help have to wait because some idiot looking for a nightly fix is clogging up the er instead of the hospitals being so worried about their rating they need to kick the frequent flyers asses to the curb and free up the er for those that really need help

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    Account Removed

    almost 7 years ago

    It is because of patients like patient #2 that our medical costs are so high. It is a shame that ED now is more like UC (urgent care)!!

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    theala

    almost 7 years ago

    418 comments

    Gretchen, EDs have been primary clinics for decades. They are the only point of access to those with no insurance because they can't be turned away. I don't have a problem with that when they're truly sick. I do have a problem with what we used to call the "pain train": regulars or "frequent fliers" whose only goal is to obtain narcotics. These people need to be treated for their drug addiciton and not allowed to use the ED as their enabler. Now of course, the kid with the ankle I would have treated as real pain, as the example ED clearly did, until he started behaving inappropriately. Alas, I am too familiar with Patient 2.

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    DaMomb

    almost 7 years ago

    1242 comments

    This is happening all over though, not just the EDs etc. Primary care in many places has become the newest walk in department. People demand the "Burger King" type health care approach...I am truely disturbed too that the highest incidence of the patients DEMANDING care, drugs, etc. are those who are on government subsidized healthcare plans...I'm really getting cynical, and having a hard time finding the empathy for a 20 something patient who has "chronic" back pain and is "need" of Vicodin that I PAY FOR IN THE FIRST PLACE!

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    Gretchen

    about 7 years ago

    16 comments

    It's a shame that our ER's are becoming primary care clinics! But then again that pays our salaries. Double edged sword if you ask me.

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    lanorigb

    over 7 years ago

    16 comments

    Hehe...I remember helping my preceptor with a young 20ish female pt who came in for RUE pain...we did a FULL workup for her thinking she might have a DVT and after finding nothing (and wasting hours of the ERs resources) she remembered lifting heavy weights the night before...DUH!

  • Archive_nurse_max50

    NevadaRN

    over 7 years ago

    118 comments

    I'm an urgent care nurse - so I know exactly how she feels. Some people really clog up the patient flow with non-problems. Sometimes I want to say Wallgreen's is across the street!!

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