Chief Complaint:
Abdominal pain or pain due to condition that doesn’t cause pain.
History of Present Illness:
This is a really, really annoying patient with a given age and sex presenting with an acute exacerbation of a symptom or condition that cannot be disproven with repeated negative objective data. It started when the patient last left the hospital and intensifies anytime a nurse or doctor walks into the patient’s room. The pain is a 45 out of 10, associated with every other symptom a human being can ever possibly experience, made worse by everything in life including a gentle breeze, and relieved only “with that pain medication that starts with a D.” Patient notes constipation (surprise, surprise).
Past Medical and Surgical History:
Chronic nonsense syndrome
Pseudoseizures
Fibromyalgia
Medications:
Patient denies medications, though the state prescription drug monitoring program and calls to local pharmacies reveal otherwise.
Allergies:
Acetaminophen, aspirin, NSAIDs, tramadol, morphine, epinephrine, air, water, health care practitioners, discharge planning.
Family History:
“Can’t you just read my chart?”
Social History:
Denies smoking, alcohol, or illicit drugs though actively smoking, reeking of alcohol, and holding “a water pipe.”
Review of Systems:
Positive for everything, including itchy nails and tooth spasms.
Vital Signs:
The stablest of stable.
Physical Exam:
Patient comfortable playing with a smartphone and watching TV. Exam normal, notable only for the stench of BS.
Labs:
CBC and chemistries unremarkable. Urine drug screen either refused or positive.
Imaging:
Always negative.
Assessment & Plan:
F**k me.
This is a liar presenting with acute on chronic BS and narcotic deficiency, admitted because the patient fooled an unsuspecting but well-intentioned health care practitioner. Plan for daily confrontations and arguments over drug-seeking behavior. Plan to spend thousands upon thousands of healthcare dollars trying to prove this patient wrong but inevitably fail. Plan for this patient to suck resources away from genuinely-ill patients who actually deserve my time, energy, and patience. Plan to get threatened with a negative patient satisfaction survey or, better, a lawsuit. Suspect patient will be discharged with help from administration or leave against medical advice (AMA) in about a week’s time.
Hypodilaudism, tragic. Every.Single.Time
lol chronic nonsense syndrome. my folks are more like, “chronic nonsense syndrome, malarkey subtype, rapidly cycling shenanigans”
The ER nurses and doctors see pain daily. It is a well known symptom. If you have a documented condition that causes ACUTE pain we are happy to help you. If your pain is: chronic, exacerbated by your non-compliance, or you are a frequent flier who won’t go get a PCP then we cannot abide your requests for pain control because you will decide that our ER is your new pain control home. We don’t have time for it. We don’t have compassion for it. We already miss lunches, stand up 16 hours straight, miss bathroom breaks, and have management crying about complaints and documentation. For the emergent acute treatment you have our deepest sympathy and support. For your daily fibromyalgia or sickle cell….those are chronic, stay away.
Why do bank robbers rob banks? Because that is where the money is. Why do drug seekers go to the ER because that is where the drugs are. Every time I get fooled by a drug seeker I feel that my compassion for my fellow humans is still intact. I would not want to live like they do. I love saving lives in the ER. I love my profession. Dealing with drug seekers is part of the price I pay for the privilege of getting to help save lives. I recently had a pneumothorax and 4 broken ribs. I could not stand dilaudid, it made me have the dry heaves not a good thing for fractured dribs, morphine worked much better and no dry heaves. I couldn’t get off the narcotics fast enough and get my mind back.
Hahaha
Sucks that society is so fucked up that when people with real pain issues go to ER for relief they get treated like a drug addict. Cannot blame the nurses or Drs for judging though. Us with serious pain visit the ER not that often. Those nurses and drs are there and have to deal with the drug fix bullshit everyday. When i get out of my mind in pain and have to go in, i just use the upmost manners. I let them know tgat i will wait til more serious patients are seen first.
I agree…Its a shame..the ones WHO ARE IN REAL PAIN…get judged too.
People with REAL PAIN dont refuse…and being a MAYTYR ISNT ALWAYS THE SMART THING…Judge…isnt that what you did to everyone ” Im hoping none of you are ever a patient in the ER” ??
then why did you respond if youre bored with ?
Why? This topic is the gift is the gift that keeps on giving!
No one is discounting real pain, article is a satire piece about repeat visitors who do not seem to have a legitimate pain source/issue and just seek the med high.
Most of the RNs I know could spell the names of their fractured bones correctly and if you ever practiced in an acute care setting you would understand why this is funny…..
And why do hospital admin actually investigate their stupid spurious complaints and make good staff want to run screaming from the place?
My personal favorite docusate !
Horse shit. Saying you’re allergic to morphine but can tolerate dilaudid is horse shit. They are both opiates. Saying you NEED it with benadryl because you’re “allergic” is horse shit. If you’re allergic to something, find an alternative. Or accept that cutaneous itching is a normal response to opiates. Having no signs of disease isn’t 100% accurate. But if you keep coming back to the ED and NEVER follow up outpatient for your persistent abdominal pain that shows nothing, that is also… horse shit.
We know the signs. And not everyone falls into them, so we don’t lob everyone into this basket.
Legitimate sources of pain deserve legitimate treatments.
You obviously missed the information on the form then. Scans. Reveal. Nothing. Broken bones are legitimate. Mental health referrals are undervalued in the ED.
Go for it. But this is how some of us deal with increasing pressure from administration to please everyone, even if we’re doing more harm than good.
And haldol.
This is way I hate ER’s….as soon as u complain about pain they treat you like you are a lying and drug seeking patient….I have never worked in an ER but know there are a lot of drug addicts out there…but this is how everyone is treated…..which im not a fan!
I am hoping none of you are ever a patient in the ER if so remember this.
I was thinking same thing
I have a 7.5cm mass on my spinal cord (meningeal) surgery pending. If I have a rare flare up i always go to the hospital that has my MRI on file. They can just pull it up and see the (benign) mass and how it s eroding my sacrum.
I would add that medication starting with ‘D’ causes intense itching relieved by iv Benadryl and nausea relieved only by phenergan
Hahaha!!!
Solid article
Someone show this to Mike Knoll!
Robyn Whittaker, Suzanne Berghofer, Christine Hedditch, Danielle Scalora, Angela Clark,
Hope Wiltse
Hahahaha
Jill Garabedian ha!
Forgot narcan allergy !
yawn. can we please find a new topic to joke about?
Perfect!
I want to make a joke about apomorphine but it’s really just too early
I can’t breathe
Can someone get this template put on Epic? :) Maybe make it a flowsheet?
Katie Cottle actively lolling. want to quote best bits but all spot on.
Richard Zegarra
David Lamb
“That medication that starts with D”…….dyphenhydramide!!!!! Got it! ;-)
Patrick Nelson
Needs Dilaudid for chronic paper cut.
Bahahaha!
Bahahaha!
Lmfao!!!!
Lmfao!!!!
Rachel Carty Moehlmann lol.
Rachel Carty Moehlmann lol.