sk732 Posted September 10, 2016 Share Posted September 10, 2016 So my last tour, on two seperate days, by two separate people, we get CC's in the ER of "NEEDS refill of Cialis/Viagra"...these were older middle aged dudes without Reynaud's. NEEDS were written on the CC sheets in capitals by the folks concerned. Add to that - neither of these guys have any labwork or apparent attempt at cardiac/ED/DM workup done on them in the three years I looked back on their provincial lab histories...which are standard of practice here (or at least where I worked in family med previously). I put this to you - since they're priority 5's, I essentially contiued to bump them down the wait list until they left or my shift expired - doc with me did the same thing both times incidentally, as there were always people in there that were actually sick or injured. In cases like this, I honestly wish that our provincial ministry of health would grow some gonads and send at least a shadow bill to the patient concerned to let them know how much money they cost their fellow tax payers for showing up for this sort of thing. Am I a bad person or more importantly, a bad PA? Discuss... Link to comment Share on other sites More sharing options...
JohnnyM2 Posted September 10, 2016 Share Posted September 10, 2016 Not a bad person in my opinion. Men who want Viagra or Cialis shouldn't be wasting ED time to get it. Sent from my SM-G900V using Tapatalk Link to comment Share on other sites More sharing options...
jcash Posted September 10, 2016 Share Posted September 10, 2016 No not a bad person. The ED is for emergencies. A pending erection is not an emergency!!! Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
CAAdmission Posted September 10, 2016 Share Posted September 10, 2016 Personally, I admire them. The only reason I would need viagra is so I don't accidentally roll out of bed at night. Link to comment Share on other sites More sharing options...
Guest Paula Posted September 11, 2016 Share Posted September 11, 2016 I had an elderly gentleman come in to the previous UC I worked at (5 years ago). First he went to ED for his ED meds and they promptly sent him over to the UC. What about getting a refill of Viagra is urgent, I ponder to myself? Good grief, it's Saturday evening! Why does he need them TONIGHT?? Then I remember where the clinic was located and the fame or infamy of the area. I think about the strip clubs over in Hayward, famous in the bootlegging days to having the brothels hidden in the back behind fake walls. The beer parlors and joints still carry on the history and I see the strippers now and then in the UC. Some for their pelvic complaints (no, they say, I do not trade sex for money), some come in for biceps tendonitis and achilles tendonitis due to the pole dancing and high shoes. Some for their anxiety and insist they need their alprazolam refilled before going to work. Some for STI testing One in particular came in with her finesse pimp who get calling her while in the exam room with me. She was pretty beat up, lacerations to her hand and a boxers fracture and inner thigh bruising. She was exactly the same age as my daughter, just turned 18, living in a hotel with the scumbag. Pretty sure she was being trafficked, counseled, offered to sneak her out and to a women's shelter, gave her the 800 traffic victims number, patched her up, and released her as she refused all services. I still have thoughts about this young lady every now and then and it grieves me. I think too much about the above scenario and send the guy off without a prescription. No records to review, no local PCP, so what other conclusion should I have come too? No, you are not a bad person, but I am judgmental Link to comment Share on other sites More sharing options...
LKPAC Posted September 11, 2016 Share Posted September 11, 2016 Going to the ER for Viagra! This is what is wrong with health care in our country. Until we crack down on ER abuse, we'll never control the cost of health care. Link to comment Share on other sites More sharing options...
Lyrical M Posted September 11, 2016 Share Posted September 11, 2016 Perhaps I'll think differently when I'm working in the field, but part of me wonders if these are just "poor guys" who don't know any better, have no PCP, and believe that the ER is the place to go for any and all medical complaints. Which, in some countries, it is. My mom teaches foreigners, and sometimes has to tell them "NO! Don't go to the hospital because you have a sore throat. We have other clinics and offices for that." And the people just didn't know. I feel like I'd eventually see them, and then educate them a bit on why I can't prescribe that in the ED and why it would be in their best interest to connect with a health center or provider who can best help them with their needs. Then send them off with referrals. No, you're not a bad person. I'm just bright-eyed and bushy-tailed, waiting to have my soul crushed when I start PA school in 1 year. Link to comment Share on other sites More sharing options...
medic25 Posted September 11, 2016 Share Posted September 11, 2016 Not a bad person in my opinion. Men who want Viagra or Cialis shouldn't be wasting ED time to get it. Sent from my SM-G900V using Tapatalk To be fair, it's FDA approved for ED; why wouldn't you go to the ED for your prescription? Link to comment Share on other sites More sharing options...
Reality Check 2 Posted September 11, 2016 Share Posted September 11, 2016 Not a bad person and NOT a bad PA. Crap like that doesn't belong in any ER anywhere. I got so sick of folks coming to the ER for "years of knee pain". One told me he came to the ER because he knew he would get X-rays and he couldn't afford them otherwise. I reminded him that NOTHING in the ER was free and actually cost more because it was considered possibly Life and Death. He just stared at me. We should be able to issue certificates stating that there complaint does NOT warrant EMERGENT evaluation and let their insurance bill them 100% for the visit. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 11, 2016 Moderator Share Posted September 11, 2016 Neither one of those. They absolutely do not belong in the ED. Link to comment Share on other sites More sharing options...
sk732 Posted September 11, 2016 Author Share Posted September 11, 2016 To be fair, it's FDA approved for ED; why wouldn't you go to the ED for your prescription? Thanks, I needed that, lol SK Link to comment Share on other sites More sharing options...
Febrifuge Posted September 11, 2016 Share Posted September 11, 2016 Going to the ER for Viagra! This is what is wrong with health care in our country. Until we crack down on ER abuse, we'll never control the cost of health care. Countries. OP is Canadian, and working in the Great White North, eh And RC2 said: We should be able to issue certificates stating that there complaint does NOT warrant EMERGENT evaluation and let their insurance bill them 100% for the visit. Back when I pushed carts and hauled bedpans at the County ED, they would do that. Document that the required 'medical screening exam' had been done, the issue was felt not to be emergent, and to use your example, specify that X-rays were not indicated for today's issue, given the history and physical. From time to time, depending on how logically and respectfully the requests are made, I've done similar with the affluent suburbanites in the UC as well. Link to comment Share on other sites More sharing options...
sk732 Posted September 11, 2016 Author Share Posted September 11, 2016 Going to the ER for Viagra! This is what is wrong with health care in our country. Until we crack down on ER abuse, we'll never control the cost of health care. ER abuse is an issue here too, since the Canada Health Act prohibits us from kicking people who are able to walk into the ER under their own steam to the curb...we can divert ambulances, but we can't kick out walk ins. One province I was posted to in the Army actually cracked down on things by empowering senior triage nurses to turf family medicine issues (much like this) to the FMD - only thing in the standing orders where they had to consult the ER doc first, just as a balance (it'll never happen in this province due to some ongoing, high profile stuff from some local ER's where people weren't seen and were found dead after a number of hours...and the lobby groups behind these folks). Saved some money in the end that could be spent elsewhere. I had a guy wander in to get his Mantoux read, since his doctor told him he could "just go anywhere to get it done" - since it was a pre-employment screening, the patient is technically supposed to pay out of pocket, since it's not something that's covered by the provincial health scheme, so I figured he didn't want to fork over another $25 or 50...I'm hoping he gets a bill, though in all fairness, his FMD should be getting half, if in fact he told him to go where ever. His FMD got a shitogram from my SP du jour, who just happens to be our EM Medical Director. SK SK Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 11, 2016 Moderator Share Posted September 11, 2016 maybe they thought they had to go the ED to treat their ED sorry Link to comment Share on other sites More sharing options...
Katera Posted September 11, 2016 Share Posted September 11, 2016 Personally, I admire them. The only reason I would need viagra is so I don't accidentally roll out of bed at night. Lock broken on my gate, it helps me pole vault over the fence so I can get in my back door at night. Useful stuff! Link to comment Share on other sites More sharing options...
CAAdmission Posted September 11, 2016 Share Posted September 11, 2016 Lock broken on my gate, it helps me pole vault over the fence so I can get in my back door at night. Useful stuff! My old boss was such a jerk he took Viagra and temporarily got six inches taller. Link to comment Share on other sites More sharing options...
Guest ERCat Posted September 12, 2016 Share Posted September 12, 2016 OMG, you are a GOOD provider for pushing a CC like that to the end of the line. That's absurd. I get so tired of some of the crap that comes to the ER. There's so much abuse. I have had patients that come into the ER with their chronic knee pain, unchanged from baseline, to get an MRI because their insurance won't cover it yet through their PCP. I had a lady come in today begging me to take her cast off early so she could go on her vacation and not have to wear her cast. She also requests refills on ALL of her meds including Soma and Fiorcet so that she had enough meds for her vacation. Link to comment Share on other sites More sharing options...
DogLovingPA Posted September 13, 2016 Share Posted September 13, 2016 I tried to explain to a guy once why I wasn't going to refill his Viagra because we are urgent care and that was not an urgent matter. He looked at me and said "It's urgent to me". Lol. He still left without a prescription. Link to comment Share on other sites More sharing options...
newton9686 Posted September 13, 2016 Share Posted September 13, 2016 The only thing better is the guy who comes to the ER at 2am in the morning with an STD (that he's had for weeks if not months) because she won't let him "hit that" until he's clean. MI be damned, THATS an emergency. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted September 13, 2016 Share Posted September 13, 2016 The only thing better is the guy who comes to the ER at 2am in the morning with an STD (that he's had for weeks if not months) because she won't let him "hit that" until he's clean. MI be damned, THATS an emergency. In the public hospital I trained in - the nurses gave those guys their 2 million units of Pen straight out of the fridge - ice cold without a Ztrack and with a HUGE needle. Frequent fliers got 2 separate shots of the lower dose vials as punishment. Bad behavior begets some sort of poetic justice. In the case you describe, I would have handed the dude a handful of condoms and waved bye-bye...... Link to comment Share on other sites More sharing options...
sk732 Posted September 14, 2016 Author Share Posted September 14, 2016 I remember when we started dosing people with Ceftriaxone for gonorrhea. Army medics are generally pretty proud of their injection technique (our lives sort of depend on it actually) and couldn't figure out why were dropping dudes like hot potatoes...we were giving a gram at a time in those days IM...sans lidocaine. We eventually clued in that the stuff was very corrosive, so added the lido...for first time offenders only. Had a guy sign out AMA on me the other night because he was supposed to be leaving for his winter Snowbirding to Arizona in two weeks and instead bought a tour on De Nile...he was sent to us from endoscopy with in a new onset A Flutter and denied any symptoms.. We couldn't convert him lower than 120 with IVP and PO diltiazem - he decided that nothing was wrong, so he was going home...this way, he wouldn't have any new meds on his file to mess up his travel insurance...I explained to him he now had a predisposing medical condition, so his insurance was essentially null and void if something occurred, like an MI or stroke, as a result of him not getting treated. He didn't care. I predict I'll be coding him this weekend when I'm on. SK Link to comment Share on other sites More sharing options...
cinntsp Posted September 16, 2016 Share Posted September 16, 2016 Maybe these guys had severe pulmonary hypertension. Link to comment Share on other sites More sharing options...
sk732 Posted September 16, 2016 Author Share Posted September 16, 2016 Maybe these guys had severe pulmonary hypertension. Nope...checked their available electronic data banks...hadn't been worked up for anything in years and were getting homoepathic numbers of pills per dispense. That's ED. SK Link to comment Share on other sites More sharing options...
cbrsmurf Posted September 16, 2016 Share Posted September 16, 2016 99% sure these guys were using it for recreational use, but how do you know they hadn't been seen in some PCP's office who is still on paper or their EMR/records aren't linked to your ED? cialis is also used to treat BPH, which is probably not an emergency in any case, seems like a pretty limp reason to go to the ed Link to comment Share on other sites More sharing options...
Reality Check 2 Posted September 16, 2016 Share Posted September 16, 2016 99% sure these guys were using it for recreational use, but how do you know they hadn't been seen in some PCP's office who is still on paper or their EMR/records aren't linked to your ED? cialis is also used to treat BPH, which is probably not an emergency in any case, seems like a pretty limp reason to go to the ed You get the Boo Hiss bad pun of the day award........................... Link to comment Share on other sites More sharing options...
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