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Advice from an ER doctor

Discussion in 'Emergency Medicine' started by Chinorean, Apr 25, 2007.

  1. Chinorean

    Chinorean Senior Member 5+ Year Member

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    Jun 21, 2005
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  3. IntheDraft6

    IntheDraft6 7+ Year Member

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    Feb 13, 2007
    Land of Choas
    Wow. I think someone may need a few days off. He/she also gave away some of our secrets and may make it more difficult for us.
     
  4. shortbread9

    shortbread9 5+ Year Member

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    Mar 4, 2006
    somewhere out there
    couldnt have said it better myself.
     
  5. FISKUS

    FISKUS Gimme a sammich 2+ Year Member

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    Nov 27, 2006
    Beautiful... I find my self getting a little veklempt
     
  6. Apollyon

    Apollyon Screw the GST Physician Lifetime Donor Classifieds Approved 10+ Year Member

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    SCREW IT!
    The irony is the timing, because I essentially said the same thing this week while working (parts, at least). As I told the staff, "these people think they are so sly and so brilliant, but I am smarter than they are". One of the nurses said that "someone is always smarter than you", and my response was "but none of them are in any of these beds!"

    I say, repetitively, "don't lie to me". The last vagrant I gave money to? A dude that says, "I'm drunk, but not drunk enough." I gave him a couple bucks for being honest with me.

    I will give patients a shot in the ED, but no Rx to go. Moreover, some people should be careful for what they wish for, as they may get it (as I interpret it). 5mg oxycodone x #5 - is that worth your wait? Also, when I tell you that, if your headache responds to Dilaudid or "that drug that starts with "d" and end in "emerol", but I can't remember the name" (again, I'm not that stupid), that it's not a migraine, that's a hint. An even bigger hint is when I tell you that I am not giving you any Dilaudid or Demerol (and you may even get the MPTP story from the 1980s, in less than a minute).

    Where I'm at now, Lortab is Rx'd like candy - I had a streak of 10 patients in a row last weekend that all were chronically on Lortab, prescribed by their doctors. I don't Rx Lortab (well, one guy who was just dumb got 5 to cover him over the weekend, as I was in the next day, and didn't want this guy to be puking and having diarrhea, and being a pain in MY butt).
     
  7. Ceez

    Ceez Senior Member 10+ Year Member

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    Mar 31, 2002
    damn, am i going to be that cynical one day???
     
  8. Apollyon

    Apollyon Screw the GST Physician Lifetime Donor Classifieds Approved 10+ Year Member

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    SCREW IT!
    It's not cynical - it's realistic. People really in pain will take anything you offer them - 325 of Tylenol? Some spit in a cup over ice?

    Cynical is denying people really in pain, pain medicine.
     
  9. southerndoc

    southerndoc life is good Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Atlanta
    It's a fine line that you will walk. Prescribe pain meds to someone who is abusing them, and you could risk losing your license if you do it often. Don't prescribe pain meds to someone who really needs them, and you're really putting someone through torture.
     
  10. Arctic Char

    Arctic Char 10+ Year Member

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    Sep 23, 2005
    not fishing . . .
    fun read, i must say
     
  11. Croooz

    Croooz Senior Member 10+ Year Member

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    Sep 3, 2003
    Maryland
    Now I understand why the doc who saw my wife in the ER last week questioned my wife's allergy to Tylenol. We had all eyes on us up until he just came out and asked her if she wanted anything else. We were both confused because after the benadryl and steroids what else was there? I brought her in for an allergic rxn to a fatburner she bought at GNC. She looked worse than Will Smith in "Hitch" and her airway was closing up.....however the focus was on the Tylenol allergy? I can see why now. I guess druggies come in all shapes and sizes....even business suits at 7am in the morning. ;)
     
  12. southerndoc

    southerndoc life is good Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Atlanta
    Yes they do, and some of them are wearing Rolexes and driving a Benz.
     
  13. deejayshakur

    deejayshakur Member 10+ Year Member

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    Aug 1, 2002
    good stuff.

    we taking bets on which ED this is coming from?
     
  14. Aloha Kid

    Aloha Kid Senior Member 10+ Year Member

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    Mar 9, 2001
    Not sure if the ED doc was interested in whether or not your wife was a druggy. Allergic reactions don't really get narcotics. Tylenol is a very uncommon med to have an allergy to. This may be the reason why he/she questioned it intently.
     
  15. Painter1

    Painter1 Junior Member 7+ Year Member

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    Mar 16, 2006
    yea, my gut tells me the doc was interested in the acetaminophen allergy since it isn't at all common. i've seen a handful of NSAID allergic reactions in my short intern career but no acetaminophen reactions.

    about drug-seekers. got to admit, they can really annoy the crap out of your day. for the most part, it's obvious they are seekers. lately, I've seen a number of drug-seekrs specifically ask for dilaudid AND benadryl. not sure if benadryl is poteniating the high. apparently, the high from dilaudid is significantly better than heroin. got this straight from a junkie.
     
  16. Seaglass

    Seaglass Quantum Member 10+ Year Member

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    Winston Salem, NC
    That is absolutely not true, at least not for us (EPs). If you give it to someone whom you KNOW is abusing them or diverting them then yes - you're in trouble; but we generally NEVER have that level of certainty about our patients. I've certainly run my share of drug seekers out of the ED but not because I'm afraid of losing my license.
     
  17. southerndoc

    southerndoc life is good Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Atlanta
    Reread my statement. The keyword was often. I know one physician who was disciplined by the medical board because he was filling narcotic scripts a little too much.
     
  18. SCER2005

    SCER2005 Junior Member 5+ Year Member

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    Aug 14, 2004
    I think douchetard is my new favorite word. F'ing brilliant.
     
  19. SomeDoc

    SomeDoc 10+ Year Member

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  20. EM2BE

    EM2BE Elf 7+ Year Member

    One of the ED's I've been in had a running list of names with their known used alias (and some had about 20), with their true and false SSNs. If their name was on the list, no drugs for them. Do other EDs use this method?
     
  21. Seaglass

    Seaglass Quantum Member 10+ Year Member

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    Winston Salem, NC
    Was he an EP?
     

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