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What Would You Call This?

By jmj11
in Neurology

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jmj11

Posted

I'm sharing this for the humor value as well as real-world case study (not funny in many ways). I'm sure the ER PAs here this all the time. This was a dialog from yesterday.

 

New Headache Patient. A 36 year old man referred by a FP doc 60 miles away (who is notorious for getting everyone in his small town hooked on Vicodin).

 

Patient: "Dr. X said that he was going stop prescribing my Vicodin, so he is sending me to you for you to prescribe it."

 

Me: "Hmm. Ain't going to happen. I'm in the business of helping people get better, not acting just as a Vicodin dispenser. Narcotics only have a limited role in headache treatment. I only consider Rxing them when I've gotten to know the patient, they are doing everything I'm asking them to do . . . and then, I may give them 10/month for rescue. The only other time I Rx them is for a taper for a patient motivated to get off and work on preventative care."

 

Patient: "What am I going to do. I need at least 90 per month and I'm not tapering off."

 

Me: "I guess you have to ask Dr. X about that. He is the one who started them."

 

The patient's face is turning red.

 

Patient: "Listen. I am on disability for a personality disorder. When I don't get my pain meds, it upsets my mental health and I become very aggressive. I spent 10 years in prison for what I did the last time my brain chemistry was upset."

 

I won't tell you what I said yet, but I want to see if you read it the way I did.

  • Moderator
Grand Master

ventana

Posted
  • Moderator

the joy of owning your own place "thank you sir and I appreciate your thoughts but I must ask you to now leave and never return, thank you....."

 

our local ED is starting a new program to not prescribe narc's for every hang nail and boo boo - can't wait to see what will happen

 

also, local doc made all his pateints taper or change provider as he said "something is going to happen in January...." anyone know of anything happening in law enforcement in Jan??

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Grand Master

EMEDPA

Posted
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No more chronic narcotics unless you're pain clinic in FL

or WA...unless you take a special class...why would anyone want to take the class and be on the short list of chronic narc prescribers....

Newbie

HopefulPA

Posted

I actually had 2 consecutive pts admitted to the hospital yesterday that had "ALLEGRY" to Diluadid yesterday! ("makes me itchy"). Now I just need the pt that is allergic to Dilaudid, Benedryl and Phenergan! I have already had the pt that was "Allergic" to everything including oral Dilaudid and ONLY pain med she was not "allergic" too was IV Dilaudid! Needless to say I could risk giving anything for her "pain" with the extensive allergies she had.

Newbie

doubledown10

Posted

That's a not so subtle threat, but like most ER guys on here, I get threatened at least once a day and it's always from the same type of patient, the chronic pain medicine folks. Usually when they threaten me, which I love, I say something like "You're here because you state you can barely walk because of your 10/10 pain and you think that you want to throw down with me in the ER because I won't give you IV hydromorphone?" at which point I say "you can leave, or you can leave in handcuffs, your choice." Cue the dramatic scene, the "publicity stunt" behavior of grand hand gestures and body language, expansive voice and dramatic exit with a touch of "I'm going to sue you!" To which I usually reply with something along the lines of "Sir, you are wearing two different shoes and have no teeth, I'm quite certain that you don't have an attorney at 3am."

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