Tag Archives: Drug Seekers

How to Say No to a Drug Seeker

30 Oct

smoker blog

The reason why I chose the above photo is because many of us are addicted to substances.  Coffee, cigarettes, alcohol,  drugs, all can lead to unhealthy consequences.  That’s me up there smoking.  Just kidding.   I’d like to think that I looked that good when I smoked.   After recently quitting, I can tell you first hand that habits suck.  I always try to have compassion with my patients, but often fail miserably with drug seekers. When someone comes to the ER with the goal of getting narcotic pain medications to feed the “beast”, I have to take a breath and try to remember that they probably aren’t real happy with themselves either.

There are many legitimate reasons  for drug seeking at an ER.

1) Kidney Stones

2) Bear Mauling

3) Severing/Breaking of Limbs

4) Abscess (especially if in a “sensitive” area)

5) Rupture of Any Internal Organ

This is not an exhaustive list.  These patients have an underlying medical or surgical condition that require emergency intervention that will likely include pain control.  The people that come in for chronic issues, or for a fix,  push to the waiting room those who may have more serious illnesses.  (The little old lady with a red leg for 2 weeks is less of a priority than the 45 year old writhing and retching with three months of abdominal pain.) The person who comes in with abdominal pain for the sixth time that week may have developed a true surgical pathology, like an appendicitis, so the key is to push aside your bias and look at the patient with fresh eyes each time.  After you have ruled out any medical or surgical emergency, its time to give the patient the bad news.  The following is a  mock conversation to give you a few ideas about how to respond to the patient.

Practitioner: We found nothing in your work up today that requires narcotic pain medication.

Patient: But  I am IN PAIN!  Isn’t it your job to help people?!?”

Practitioner: I feel that the best way to help you is to encourage you to get to your (primary care, gastroenterologist,  neurologist).

Patient: The last doctor gave me Percocet!

Practitioner: I’m looking at your symptoms and concerns for today’s visit, and I don’t feel that narcotic pain  medication is going to be helpful in the long run.  Here is a list of things you can do at home to help with your symptoms.

This may be where things get really ugly.  My suggestion is that you remember that it is not the patient talking, but the beast that is their addiction.

Patient:  You are a #$%^@!  You don’t even understand what this feels like!  Have you ever been in pain?!?

Practitioner: I am sorry that you are in pain, but we are not sending you with narcotic pain medications.  If you are having chronic pain then you need to see a specialist for that.  I am going to get your paperwork for your discharge.

Mic Drop!  

Do not let this portion of the conversation go on and on.  You might cave and fuel the beast, which is actually hurting the patient.  Here’s the kicker.  Many times I have literally been walking out of a patient room when they throw out a new complaint.  I had a patient that came out of her room, followed me to my work station, and then complained of new chest pain.  I explained that if she is having new pain that we need to discuss that in her room.  The patient then stormed out and said that I wasn’t going to evaluate her chest pain and that I was going to be in “big trouble”.  I covered my bases, documented well, and let it go.  That’s all I could do.

To summarize, always treat a patient with respect, rule out any true pathology, stick to your guns.  There is a designer drug addiction epidemic in the US and as ER clinicians we are the first line of defense.  Use your best judgement, but sometimes you will have unsatisfied “customers” and that may be an indicator that you are doing a good job.

Have you ever had a difficult patient?  How did you respond?  Please comment below!

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