January 20th, 2010 by Shadowfax in Better Health Network, True Stories
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The ER is a highly effective bottom-filter for society. When you work in the ER you are in daily contact with the worst that mankind has to offer: addicts, sociopaths, criminals, and the many many varieties of personality disorders with which a loving God has imbued humanity. I say this not as condemnation: they are my people. I know them and accept them for who they are. I am here every day to serve them in their various needs, from the heroin addict who is dropped off blue and apneic to the homeless guy who just wants his unwashed feet looked at.
One of the refreshing features of many members of the lumpenproletariat is their candor regarding their habits. Sure, it’s by no means universal, but it’s entirely common for me to ask someone quite directly: “Do you use meth?” and have the patient respond in the affirmative and without the least trace of self-consciousness expand on the degree and nature of their drug use. The hardest question for me to learn to ask without blushing was “do you ever have sex for money or drugs?” (And yes, I do ask that of both men and women, when it seems potentially relevant.) But people on occasion forthrightly admit that they turn the odd trick to support their habit. Read more »
*This blog post was originally published at Movin' Meat*
January 13th, 2010 by Edwin Leap, M.D. in Better Health Network, Opinion
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This is my column in EM News for the month of January. Sometimes, being a physician means saying no and being disliked. It’s not a popularity contest! It’s about doing the right thing.
Most of us went into medicine because, in addition to being good students, we wanted to help people. How many oceans of ink and forests of paper have been used explaining that point to admissions committees we’ll never know. Suffice it to say, it felt very good when our professors wrote us glowing letters of recommendation. Of course, we were also saying, “I want to feel good about helping people. I want the recognition associated with the act of helping!” Premedical students, medical students, and physicians tend to be those people who desire accolades and who are naturally well-suited to attaining them. Read more »
*This blog post was originally published at edwinleap.com*
January 5th, 2010 by Edwin Leap, M.D. in Better Health Network, Humor, True Stories
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My genius partner, RKM, was lately confronted by a patient seeking pain medication. Due to a very nice system instituted by the state of SC, providers can search for their patients’ prescription histories. Turns out this individual had received multiple narcotic prescriptions from multiple providers all over the state, and had done it using at least three separate addresses.
Ever the resourceful doc, my partner confronted this patient with the following information:
‘Sir, it appears that you have been the victim of identity theft! Fortunately, we were able to discover that someone has used your information to obtain narcotics under false pretense! But rest assured, we have contacted the authorities and we’ll catch the SOB who did this to you!’
He was met, I am told, by wide-eyed, open-mouthed silence.
No prescriptions were dispensed. Though it is entirely possible the patient will be needing a big bottle of Jim Beam for his nerves, and adult diapers for irritable bowel, for the next several weeks.
Bless you, RKM, for the theatrical, perfectly passive-aggressive genius you are!
Edwin
*This blog post was originally published at edwinleap.com*
December 13th, 2009 by GruntDoc in Better Health Network, News
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Horrible.
Perry doctor killed by patient
SUSPECT HAD BEEN REFUSED PAIN PILLS EARLIER IN DAY
By Dori Hjalmarson, Bill Estep and Karla Ward – dhjalmarson@herald-leader.com
CORNETTSVILLE — A man seeking prescription painkillers shot and killed a doctor at a Perry County medical clinic Tuesday morning, according to state police. Read more »
*This blog post was originally published at GruntDoc*
July 29th, 2009 by KevinMD in Better Health Network, Opinion
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When it comes to opiate drugs, like morphine, there is a bitter debate between patients who are in chronic pain, and the doctors who are vilified for under or over-prescribing these medications.
But there are some other subtle influences that push doctors to prescribe these drugs, in some cases inappropriately. An ER physician talks about the issue, saying, “when dealing with a patient who is in pain, or appears to be, it can be impossible to sort out when a patient needs opiates for legitimate reasons, and when it is merely feeding a long term addiction. We are trained to provide comfort and relief from suffering to our patients, and we generally will err on the side of treating pain, rather than withholding addictive medications.”
There is also the pressure to provide “patient satisfaction,” and indeed, low scores in this area can place a doctor’s job in jeopardy. Taking a stand against those who inappropriately request opiates will result in low patient satisfaction scores, and “will often times result in arguments, profanity, and calls and letters to administration.”
What’s the answer? Perhaps a little less reliance on these scores, since a good patient satisfaction score is not necessarily correlated with proper medicine.
*This blog post was originally published at KevinMD.com*
