sickle cell and cocaine use

[BatmanMD]

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I had a pt a while back. Sickle cell pt with pain. ok. no problem. Do some tests and send a UDS. Cocaine +.

I had residency in Detroit, where we would no longer give narcotics and essentially D/C them. If they had fever, systemic issues, thats obviously different.

Now on my own, I did the same, by both instinct and reflex. I showed them the drug screen report and explained why cocaine is harmful and told them they are welcome to stay, under no circumstances would narcotics be given. They left... Of course b/c of press ganey, was polite and courteous.

What does everyone else do?

 

[Flopotomist]

If it is a person who doesn't come to the ED often, wouldn't you rather err on the side of treating a cocaine user who might be in real pain than denying a drug user who might be faking?

 

[kungfufishing]

I treat them. The only drugs I usually test for are those with a quant level that will change what I do. The only person I've denied pain meds to recently was a "migraine" who declined compazine or any other therapy in the ED, requested we just give him a prescription for his mepergan "that I always take for my headaches" and subsequently provided a bum social security number and offered no ID to our registrars. Walked out the door saying "I'm going to go get my ID, it is in my car".

Now, not that I would have any experience with this, but it was reminiscent of trying to buy beer at age 17 - you get to the counter, the clerk says "where's your ID?" and you uhh left it in your car...

 

[BatmanMD]

Part of our job is also to teach pts. If they are using cocaine, and have sickle cell, thats a bad combo. I'd rather tell them and avoid a CVA.

I don't order drug screens on everyone, but there are some cases where I feel its necessary.

She wasn't in a lot of pain. She was talking to her boyfriend on the bed, while playing with her gameboy.... And asking for 4 of Dilaudid...
I may have over-reacted, and thats why I'm asking, but I have a hard time giving that much narcotics to someone who, clinically, does not need anything.

 

[southerndoc]

Of course b/c of press ganey, was polite and courteous.

You didn't give her what you wanted, therefore you will be rated as all 1's. Doesn't matter how compassionate you are, how much you listen and time you spend with the patient, etc. If you don't give a patient what they want, you get dinged as being the worst doctor in the world.

 

[bartleby]

As a wise and worldly man named Mick Jagger once sang:

You can't always get what you want
But if you try sometime
You just might find
You get what you NEED

It should be on a plaque in every ED waiting room.

If you don't give a patient what they want, you get dinged as being the worst doctor in the world.

 

[mdfirst]

Judging is not very good in these cases. There are several SC patients who arent looking for drugs who really are in pain.