Tuesday, February 05, 2008

You Are Crazy If ...

Every physician has their "oh no" patient. This is the patient with the medical condition that you just cannot bear to deal with, typically because you don’t fully understand their condition and don’t know how to effectively manage it. As an example, gastroenterologists would probably consider patients with irritable bowel syndrome (IBS) as their “oh no” patient. There probably is a legitimate origin causing the symptoms of IBS, but we just haven't discovered them yet. As such we cannot offer good treatment, thus making interactions with those patients difficult and unsatisfying.

As for me, my “oh no” patient is the crazy patient. Yes, the crazy patient. Who is this crazy patient? Here’s a non-exhaustive list of those who quickly get that label. If I know you satisfy one of these, I expect you will be nothing but trouble during your stay at the hospital. So, I’m gonna call you crazy if…
  • You have a pan-positive review of systems – in other words you answer “yes” to everything on the review of systems (our flurry of questions to see if there are any other symptoms you're having: chest pain, shortness of breath, constipation, weakness, etc.) This is a classic one. Those of you who answer yes to everything -- or even 3 items -- have nothing wrong with you ... except your heads.

  • You have an Actiq (Fentanyl lollipop) in your mouth as you walk in through the door, or as you're talking to me as I interview you.

  • You admit to having more than 3 allergies. Very few people are allergic to that many things. Trust me, this is a telltale sign!

  • You have fibromyalgia. Don’t even get me started. I am not denying that pain syndromes don’t exist; it’s just that people who like to have this label have lots of other, um, issues.

  • You ask specifically for IV dilaudid. If you are my patient and you ask for this, please, just get the hell off my service. Your words scream drug seeker. (And briefly, as long as we’re on the topic of drug seekers, it’s not just me … we all hate you.)

  • Finally, the “frequent flyer”. The patient that’s in and out of the hospital every other month, week, or day (yes, day). Words cannot begin to describe how much I loathe you people. Who in the world prefers the hospital to their own home?

6 comments:

Anonymous said...

So...the person who comes to the ER and said they were suicidal and they just took some pills....

Sure...we are crazy...
but would we drive you crazy?

Anonymous said...

I have lived with chronic pain for years. I got hurt while i was in the army,fractured c3,c5 and a compound fracture of my femure. For years i have went round and round withs Docs about pain med.Having no insurance except for veterans affairs they were the only ones i could see. The pain clinic gave me MS contin 30mg 3x a day. At first it worked, then it didnt, i told them that so the next month they went down to 15mg 3x a day. Their reasoning was that they didnt know what else to do for me. A month later i moved to another state. The va doc here doesnt want to give any narcotics to me because i was trueful to him and told him that i started to drink alot, basically self medicating (oh, it had been over a year since i had went to a doc about my pain) and when i say alot, i mean ALOT, enough to give me a couple of seizures. I had since quit drinking and my wife was their to verify this.He ended up giving me loratabs which hardly phase me,maybe if i took 10 or so at once. One night i went to the ER the same doc that treated me for my drinking treated me that night and ended up prescribing me Ms contin which helped wonderfully of course i had to act like i had never heard of the med or i doubt i would have got it,he probably would have tagged me as a drug seeker. I ended up showing the meds to the va doc who finally conceded and started giving me the meds 2 30mg a day. He must not have my records from the previous pain clinic in ms. i havent voluntered the info either, nor have i voluntered that during my "self medicating time" i was a major "drug seeker" dalaudid, 100 mcg fentanyl patches, oxycontin basically whatever i can get my hands on. This time around i doing it right, the right channels, not asking for more meds for fear of being labled a drug seeker. I know that 5 30mg ms contin a day does the trick, my hip doesnt hurt neither does my neck or knees from walking with a limp. Needless to say when i take 5 my quality of life improves dramatically. Oh,yeah and im back at work after two years. Of course im up the creek when i run out. Im thinking of doing like afriend of mine, he sees two different docs every month and ens up with enough to make it through the month....Basically Axis, dont judge a book by its cover(so cleche) you never know a patient could tell you what kind of meds work and they know this from dealing with pain meds for years. I hate it because i have no i dea how to approach my doc to get him to up my meds, because im scared he will take them away..Take care and be more sympathetic.

MedStudentGod (MSG) said...

Wow, anon 4:31...don't judge a book by its cover? But you just fit the VERY essence of drug seeking behavior - denial, contradiction, lying, overuse, self-medicating, etc. Thanks for clearing that up.

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Anonymous said...

ahhhh, former od-er and cutter here...and yes, crazy and i know how much all of the ED hates me...

Michael said...

Thanks so much for your article, quite helpful material.
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