Wednesday, June 3, 2009

Repeat Business

I think I've said it before.


My ER is quite a magnet for repeat business for dental pain, migraineurs and various other narcotic seekers. It's quite a business.

Some of our docs and a couple of the nurses work at other ER's and see the same people from time to time. It's funny how they kind of just walk out when a nurse who took the same complaint (word for word) looks at the chart and says "Hmmm. I know you were give a 'script for Pen VK and Vicodin last Friday evening at Mt. Seaside. Are you not taking them?"


One girl claimed her backpack was stolen. Which contained her prescription for Percocet. One guy said he lost his prescription (at least his fifth for 20 Vicodin in the last 2 months). Another claimed her 3 year old threw her Percocet in the toilet. And the old standby "I knocked them into the sink".

How refreshing would it be to have someone come in and say, "Look, I'm addicted to painkillers" instead of devising these ridiculous fairy tales. A young guy I remembered from 2 or 3 months ago came in and told the exact same story about how he saw the dentist, he has an abcess and was told to come to the ER for antibiotics (and pain pills) and blah blah it will cost him $700 to pull his tooth and he doesn't have the money. Same story exactly, I looked it up because I remembered he had an unusual name. Funny that this time he had a different last name. He was invited never to return.


We have an unusual group of co-dependent migraineurs. A couple of them take turns driving each other (we don't let 'em drive after they get their fix for obvious reasons). One doc gave a migraineur VALIUM for cripes sake along with 100 mg out of the usual 150 mg of Demerol they normally receive. Now they all want it.


Speaking of driving under the influence of mind altering drugs, one of the chronic migraineurs got her meds, got on the phone for her ride, and said she would wait outside on the bench as he would be right along. OK. We were busy, but I was suspicious. I know what she drives, too, and I checked the parking lot. Nope, no van. No patient on the bench either.


I popped into my bosses office which has an expansive view of the back parking lot where we employees park. Oh, look.....there is my patient 15 feet below me starting her van and driving away.


Oh, doctor, guess who just lied and drove home?
Wanna talk liability?


That's it, he says. She's not getting another narcotic from me, and let the record show that she was observed driving after she said she had a ride.


Three days later she came back, parked her van in the back and got............NOTHING.


This is not to be mean or vindictive. Do you want to put your loved ones, both on and off the road at risk with this nutbag driving with a boatload of narcotics onboard? Didn't think so. I sure don't.

One of our newer docs refuses to give Demerol. At all, which is kind of interesting. She might order morphine, with a Vistaril chaser (which stings like a mad bastard when you inject it I might add). One of the co-dependents now claims morphine as an allergy.


I will say that some of the other docs are interested in coming up with unified plan. We are all feeling like pushers.


Come to find out, without fanfare and without warning the hospital pharmacy had decided to take Demerol out of the formulary as of June 1 (basically a list of meds the hospital carries....we aren't CVS, you know).


Apparently one of the migraneurs was forewarned, and must have thought it meant that we were no longer stocking Demerol in our satellite ER only, because low and behold, there she was on June 1............at the downtown main ER. Hmmmmmm.

7 comments:

Mystery Medic said...

It makes me angry that as a nation we can decide to require ID for the purchase of OTC pseudoephedrine so people can't make methamphetamine but we don't require an ID to fill a narcotic script.

Anonymous said...

Hi,

Great Blog!

I just want to point out that not every patient with migraines is drug seeking. (Though I must admit when you see people taking turns driving, that is a fair conclusion to make.) I have been battling chronic intractable migraine for 11 years. I have been to the ER on occaision for migraine when nothing could stop it at home and my neurologist told me to go. I have been treated with respect most of the time.

On one occaision, I was treated as a drug seeker and it was horrific.I was at acollege at the time and my neurologist was located in another city. I did have his telephone number and information. (Note- I had been to this hospital once before. ) I went to the ER under the direction of my neurologist. I was called back. I explained the problem to the doctor who ordered demerol. When I told him that I have terrible side effects to that medication he said, "Well, let's try it anyway." After recieving a shot and getting violently ill, he asked about the headache. I said it was the same. He then gave another dose with anti-emetic. It did not help. My friend asked if they could try a different medication. He c ame back in told me that "I was a drug seeker and that he needed the room for a real patient." I was crying by this time.

At the time, my migraines did not respond to much usually a combination of benedryl, phenergan and steroids. I now have an implanted nerve stimulator and arragements to get any IV treatment at the outpatient IV/home health center.

I hate the fact that people use migraines as a way to get medication. It certainly makes it harder for those needing treatment for migraines to recieve it.

I completely agree with your ides of offering some form of addiction treatment to those you suspect or who have a record of abiuse.

I'm sorry if I ranted too much. I guess I just hate the fact that many doctors don't take migraine seriously because so many people abuse the term for medication alone.

Thanks for reading.

sailingm

Diana said...

Ditto on the migraines..I have had them since around 13 or 14,I am 58 now. Every once in awhile I am out of my meds and have to go to the ER. Besides being treated as drugseeking(even if I am vomiting and dry heaving) I am some sort of experiment for the ER doc to try something new on. I always ask for Imitrex...because it always works. There can be rebound but at least I can get through the day/night and to my own MD. They don't listen!! WHY?Each person is not a carbon copy of preceding patients.

EDNurseasauras said...

Yes, but why are you out of meds? Surely with a chronic painful problem you would make it a priority to contact your provider well in advance so you DO NOT run out; this is what reasonable individuals do who are taking responsibility for managing their health care. "I've run out of my meds and haven't had time to contact my doctor" is often how individuals seeking narcotics present to the ED. This is not to paint everybody with chronic pain issues with the same brush, I am merely pointing out why you may be treated like a drug seeker when you say you hae run out of meds. You must understand that most of us working in emergency departments see the same individuals all the time with the same chronic complaints; most of these patients could be well controlled with medication if they are diligent. But that is my point, so many want only the narcotics. Their histrionics and constant drama suck the life out of us and take us away from legitimately sick patients. No, not everyone is a carbon copy, however when 9 out of 10 individuals with these chronic types of pain issues IS a carbon copy perhaps you can begin to see the problem.

EDNurseasauras said...

Yes, but why are you out of meds? Surely with a chronic painful problem you would make it a priority to contact your provider well in advance so you DO NOT run out; this is what reasonable individuals do who are taking responsibility for managing their health care. "I've run out of my meds and haven't had time to contact my doctor" is often how individuals seeking narcotics present to the ED. This is not to paint everybody with chronic pain issues with the same brush, I am merely pointing out why you may be treated like a drug seeker when you say you hae run out of meds. You must understand that most of us working in emergency departments see the same individuals all the time with the same chronic complaints; most of these patients could be well controlled with medication if they are diligent. But that is my point, so many want only the narcotics. Their histrionics and constant drama suck the life out of us and take us away from legitimately sick patients. No, not everyone is a carbon copy, however when 9 out of 10 individuals with these chronic types of pain issues IS a carbon copy perhaps you can begin to see the problem.

Anonymous said...

Can you just let your front desk personnel know that patient with X description needs a cab called for them? That is what they did for me the other day. The cab was there in five minutes. I know you can't keep an eye out for the dishonest people, but you can 1. warn them that if they drive while under the influence of narcotics they can be taken to jail and 2. call them a cab before they even get discharged. I know, it isn't your job but it might just help joe blow who could be in an accident with one of these fools who thinks they are just fine to drive while on mind altering drugs.

Cynic in Scrubs said...

Where else can you get a pure fix of grade A narcotic mainlined at the expense of the taxpayer.
We are the candyman!