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10 August 2009

Chronic Pains

My primary diagnosis for many of my patients last night was "Acute on Chronic _____." I don't know what it was about last night, but a lot of people just couldn't face waiting until Monday a.m. to see their PMD's. Of course, a percentage of my patients don't have PMD's (that's Primary Medical Doctor) and come to the E.D. to get their primary care; as well as a couple of shots of Dilaudid or Lortab.

The local media discussed one such patient who is a daily visitor to the E.D.; mostly at ECMC, but we see him on occasion at BGH. Last night, I got several more of the "regulars" who decided to come in. I also got the "I've been admitted multiple times and left because I didn't feel like staying around any more" group; patients who regularly need to be admitted because they have legitimate medical problems (like one patient who is daily killing heart cells because he refuses to stay in the hospital long enough for surgery to be done) but who have worn out their welcomes with the medical staff.

I did get a couple of emergencies: a gentleman who started having a GI bleed and also a heart attack, a new onset diabetic who was initially thought to be having a stroke because he had been having strange symptoms for over a week, another known diabetic who suddenly started having problems when they couldn't keep any food down, and a another lady who was rapidly filling up with fluid to the point she couldn't breathe any more.

But it's those chronic pain people that drive us crazy. Now, I have said many times that I have never had a broken bone, and I have never been shot, but I can imagine that it would hurt... badly. But when you're told to not eat fatty foods because you have gallstones and it's going to hurt if you do, and then you go out and have the cholesterol special at your favorite fast food joint, I can't quite draw enough sympathy. Oh yeah, and the first words out of the patient's mouth were, "I have Chronic Pain Syndrome so the usual dose of pain meds doesn't work for me."

Sigh. I am all about being a patient advocate. I threatened my "killing my heart cells" patient with "if I see you back in the E.D. without a new hole having been cut in your chest, I will do it myself." Seriously, I just spent 10 minutes on the phone presenting a case arguing how they had already been cleared for surgery, this time they "promised" that they would stay and not leave AMA (against medical advice), and they really should be given one more chance.

Maybe I am too hopeful. Maybe I believe in people too much. Or, maybe I am playing a similar game, the one played in "The House of God" known as a Turf... or as we call it, the Dispo. Luckily, our Dispos don't bounce, oh wait... yes they do.


a corgi said...

I would always wonder about that; the kid had ear pain for 5 days and the mom decided to finally bring him in to Urgent Care after 5 o'clock on a Friday afternoon? what with that? it has to be frustrating for the healthcare professionals dealing with them


Julie said...

We get those chest pains turfed to our department with the same complaints of chest pain they have every other day. They get medication, MS because gee, nitro doesn't work and a complete workup, again, and then when everything comes out neg they leave and go to the next hospital or come back to ours in a couple of days. "The only thing that really helps my pain is dilaudid, the full 2 mg dose please and I need it at least every 2 hours, oh and throw in a lortab or 2 to take in between". Sheesh.

And I never could understand not having a PMD. Why go to an expensive ER. that should only be for emergencies and that cough and runny nose you have had for 3 days does not count. Hope your patient stays for the surgery.

Lisa said...

Honestly, I wouldn't have the patience or personality to deal with some of those people. I'm sure they do spout off they have chronic pain syndrome ~ they always let you know what they have it seems.

Julie said...

I love the graphic by the way. It is so true for someone who does have pain.