Friday, May 23, 2008

Already be startin' somethin'

I don't think anyone is reading this yet and may not for some time (ever?). But, I'm about to say some things that someone will eventually get their knickers in a knot about.

As previously mentioned, I work in pain management. Let me level with you: I hate pain management. I love the office I work in and I especially love my coworkers. But, 70% of our patient population has a critical dx of waaahhitis secondary to mental instability or victim mentality. I work on the clinical team and as a surgical coordinator. I could diagram you the ways in which people annoy me, but Blogger doesn't have the space. So. I'm going to present a little list of bad touches that pain management patients inflict on our staff:

10. Stay off of your cell phone. I know that your 10/10 pain requires constant conversation despite signs everywhere that specifically state NO CELL PHONE USE, but even so, I will ask you politely once to hang up. If you don't comply in 10 seconds, I'm moving on with another patient and you will have to wait until I'm free. You will not cause other patients to needlessly wait nor will I waste my time watching you yammer.

9. There are two crucial pre-procedure instructions that clearly state no NSAIDs 5 days before a procedure and no ABX one week beforehand. Should you oopsie on either and neglect to call to inform, you will be canceled when you sashay your little self into the office. The rules DO apply to you, snowflake, and no matter how long Dr. X has treated you or that you were patient #1 when his office had one exam room (amazing how many of you there are), you will still be canceled and told to reschedule when you are smart enough to treat.

8. We use this handy thing called EMR. Aside from notes, it keeps track of how many times you have "lost" your prescriptions, had them stolen, what drug stores you use and various other fuckery you employ to gain our sympathies and try to outwit the system. Chances are you won't win. And if you do, it's temporary. You will be caught, discharged and turned over the the appropriate authorities who we all know quite well.

7. Yes, you have to piddle in a cup for the tox screen. Again, snowflake, rules. 20% of our patients abuse their meds or someone else's. No pee, no Rx. Nothing personal.

6. If you schedule a surgery, regardless of how minor, keep the appointment. Despite what you may think, it requires clinical staffing, anesthesia and time alloted just for you. And your last minute cancellation could have been a procedure done sooner on a little old lady who cringes at the thought of tramadol. I love them. BTdubs, if you could stop salivating over the thought of the narcotic buffet long enough after you got the referral to our office to read the mission statement, we're therapy-driven, not medication. Just, um, something to consider.

5. If you are 23 and on the highest dose of Duragesic possible, use breakthrough narcotics, a muscle relaxer, two antidepressants, Lyrica, anti-anxiety meds AND have a spinal cord stimulator, but you feel like nothing is working, give up the ghost, sister. We can't help you any longer.

4. No matter how many names you sweet talk us with, it's not going to get anything done more quickly. Your crocodile tears intermingled with agonized cries of how abandoned you've been really do nothing to help your situation. I don't know where the idea started that childish foot stomping greases the wheel, but asking for something reasonably is pretty much all I need.

3. "I wish you could be in the amount of pain I'm in everyday!". This has quickly become an old chestnut. In my office, there are 3 breast cancer survivors (one just recently in remission), an Iraq vet with shrapnel in his body and daily pain, and many who have daily achy backs (and hell, probably as much DDD as any patient) from lifting patients who are pushing three bills and wonder why they have low back pain. I have rheumatoid arthritis controlled nicely by non-narcotic therapy. So, we know pain, and as a bonus, wake up every day to be productive members of society. Don't make assumptions. You kind of look like an asshole in the end.

2. If you are: laughing/talking on your cell phone/talking to anyone about anything other than pain/not crying/not begging to be put out of your misery and have normal vitals, please hear this: YOUR PAIN IS NOT A 10/10. Listen, people. I know pain is subjective. But, there are certain facts that belie the amount of pain stated vs. patient appearance. Ugh. This makes my brain hurt at 10/10.

1. For those who will tell me I lack compassion, you're so far from correct, you're just living in Wrongland. I have all the compassion in the world for people who suffer with pain and are in need. Like those with cord injuries, MS or the kids with CP that we treat for spasticity. I'm there and I love it. But, for those of you draining the system and my will to live at times, you get the perfunctory civility and not a whole hell of a lot more. That's how I roll.

This has been a Somnabulant, future-BSN PSA.


prnpenguin said...

Number 2: so true.

Reminds me of a patient, that I once had, who would consistantly give rediculous pain ratings - consistently 8.5-10/10. After many, many explainations of what the 1-10 scale means, his pain was still sooo 10/10.

After a quick n=1 trial of effectiveness of pain scale education in numbnut patients on an acute care ward, involving a convenience sample of 1 numbnut, utilising a quasi-therapeutic nipple cripple to recalibrate the patient's pain scale, the problem was solved.

Turned out his ain was really a 2/10.
Innapropriate? Yeah.
Effective? Hell yeah.

Ain't EBM grand...

somnambulant said...


It's funny when you put pain in perspective for people. The office I work in is divided into "hallways" -- each doctor has their own. My side is very no-nonsense and we'll often ask patients when getting a 10/10, normal vitals and pain med list as long as my arm, "So, I could saw your arm off right now and you wouldn't notice? Awesome.".

The whole pain scale has become a huge thorn in my side.

But don't even get me started on the patients who warble, "Well, my neck is an 8, my back a 10..." on down the line.