My Emergency Room Horror Story

[Aristus]

26. I agree.

If you're strapped to a backboard, and take an x-ray that reveals a fracture, you're in a pretty good place to be believed (by a competent provider) that you are in real distress.

The ED doctor took as his starting point the notion that everyone with a history of narcotic treatment is a drug-seeker, which is a dick thing to do.

The signs I look for include:

1. A complaint of pain, especially 10/10, but no visible distress.
2. No verifiable acute injury or history of properly evaluated chronic pain.
3. A patient-reported 'allergy' to everything that isn't a narcotic.
4. A combative insistence on a prescription for narcotics.
5. A highly-attuned familiarity with the various narcotic pharmaceuticals.
6. A patient falteringly trying to 'remember' what medication 'worked' before. "Umm... I think it was called.....oh...let's see...tr...tram-...uh, tr...tr...tramadol?"
7. An insistence on leaving the ED against medical advice. "Well! I'll just go somewhere else then!"


I ran into that last one just the other day. Jus as the afternoon session was getting started, my scheduler came back to my office to tell me about someone who wanted to establish as a new patient. The scheduler told me the potential patient had actually said to her: "Ask him if he'll prescribe me Oxycodone and Xanax so I know not to waste my time!"

She was practically admiting to drug-seeking...