The sheer level of medical malpractice in America horrifies me. What the fuck kind of asshole doctor do you have to be to immediately assume a patient in distress is a criminal and go Cop Mode on them :doomer:
I understand the concern that you don't want to fuel an addiction since there is a small population that will go ER shopping to get some opioids. Like if the person is saying they're in 10/10 pain, worst pain in their life and they're just non-chalantly watching TV while laughing on the phone, I'm going to have my doubts. There might be pain still, but not as significant. On the other hand people also have learned how they have to play the system. They know that 5mg oxycodone will manage their pain, but the doctor put them on 2.5mg for 4-6 pain so they just say they're in 10/10 pain when in reality they're probably at a 6 or 7. Going from working in a hospital to a short term rehab though, there's a bit less gatekeeping in pain management. I still have coworkers that will gripe about certain patients that will ring on the dot for when their next dose is due. It's not particularly difficult to just get into an unofficial schedule with people and in the end as long as you manage their pain, they're not going to be annoying.
The author sounds like a frequent flier in the local hospital which usually doesn't come with the benefit of the doubt. Hospitals in particular are heavily incentivized to avoid having repeat admissions since readmitting someone <30 days after discharge impacts the hospital's rating with Medicare which will impact the amount of compensation provided. This also counts should they go to a different hospital and be admitted. So you have the unhinged bloated management screaming downwards at the medical staff telling them to watch out for drug seeking behavior and avoid readmits. You'll get called into the office, have strongly worded emails sent, and have your general job security threatened if you don't tow the line properly.
Hospitals in particular are heavily incentivized to avoid having repeat admissions since readmitting someone <30 days after discharge impacts the hospital’s rating with Medicare which will impact the amount of compensation provided.
Reminds me of the quote "A measure ceases to be useful when it becomes a goal."
When I saw her list of diagnosis at the bottom my internal alarms went off. Especially given that her stories about thr hospital are related to her likely haveing developed a liver damage form too many pain meds. If she isn't a med seaker then her situation is simply outside the scope of what hospitals can manage.
To the first point though, I don't belive he would get better care. More care for sure, absolutelyyou are correct. However there is just a hard limit to the extent of what we can figure out given the goals and methods of our system. Past a point it is just doctor's bravado, so if you pay enough a doctor will give you a diagnosis. He just might have made it up though.
Depends on the unit. Where I have worked they'd be perfectly content to run the tests but of those diagnoses I recognized none of them would be observable at below a specialist level. Which means at our low level is on the honor system if she has them or not. It is entirely possible for a person to have every single untraceable nonspecific pain condition at the same time. It is not likely. It is highly convenient. So we have to weigh how much we like DEA paperwork vs the risk of her ODing.
In general we have a very poor syatem for pain management and it sucks. It is soul crushing to work those cases where you know you aren't going to be ablw to help. Me personally I feel like we should just give people pills that ask. I get why that is a bad idea though. And for her it probably isn't helpful. However I don't think that our system the way it is will likely offer her meaningful treatment for her situation. So that sucks. Those kinda cases are the ones I know I problem drink over after work.
I went to an ER with status migrainosus (full-intensity migraine lasting longer than 72 hours) once and they accused me of being hungover. I guess I should be relieved I wasn't arrested? Death to America.
I am of minds on this. One, we should just give them the drugs at this point. On the other healthy people don't seek drugs so we should actually be treating them.
On the other healthy people don’t seek drugs
If you say so chief.
Yeah, if you roll into the ER for pain you have some serious issues that need to be adressed and pain meds probably aren't gonan fix it.
The whole obsession with punishing "drug seeking" with opiates can lead to vile outcomes, and I got a personal story to back that up. I've told this before on this website.
So one night after my swing shift there was a guy waiting for me outside my job's building, he was formerly homeless, and he told me one of my homeless friends was fucked up and needed help. Apparently they had met in rehab. So we hop in my truck (with a bed cover) and drive to the parking lot of one of those big box stores. My friend was sitting on a bench and in a ton of pain. He had been discharged from the hospital and they gave him like 2 pills for the pain - because of this "drug seeking" bullshit. He had fallen in the woods and he'd crawled out. He couldn't walk anymore. They didn't even give him an X-Ray, they just assumed he was drug seeking for opiates because he was open about being a heroin addict. Turns out his femur was fractured or maybe even broken - its been a long time and I can't remember the details. So we carry him and put him in the back of the truck so he could keep his leg straight. He was moaning in pain the entire time. Then we drive to the formerly homeless dude's apartment, a real Section 8 kinda place (government housing, for those not in the USA) with a lot of crime. Pretty fucking ghetto. We start trying to carry him up the stairs but we can't manage without my friend being in so much pain he kept screaming. Out of nowhere a dude shows up, cig hanging out of his mouth, and offers to help us. The kindness of strangers is something I will always appreciate. We managed to get him up there with as much comfort as we could muster and plunk him on the couch.
A few days later a member of the homeless community comes and finds me. My friend was in real bad shape. Really bad. So I drive over to the bus stop where he was being attended to by other members of that community, trying to comfort him. He's moaning in pain and kinda delirious. I took some first aid courses way back in the day so I touch his leg. It was swollen. It was hard to the touch. It was extremely warm. My immediate guess was Sepsis. Dude had blood poisoning. We couldn't afford or call an ambulance so we called a cab and I paid the fare and they all piled in there and got him to the hospital.
The doctors finally gave him life saving emergency care and a course of antibiotics and he lived. But he was really close to shit going so bad he might have lost the leg or died. I moved away a couple years later. I hope he's still alive. God damn whatever doctor or nurse that decided he didn't need an X-Ray. Blessings to the guy who came and got me, and the homeless who took care of him in that hour of dire need. And fuck forever the USA healthcare system. Motherfuckers almost killed someone because god forbid you "support a habit." Hard drugs are bad, needle drugs are worse, and fuck heroin. But also fuck the moralists and their bullshit that leads to these preventable outcomes, especially if you are in healthcare. "First do no harm," you pieces of shit. Don't discharge a person from the hospital because you don't want to bother doing a proper examination.
Y'all listen to the recent Death/Corner series on this? Dude's been coming off years of opiode addiction for the past year or so, and documenting its effects while also detailing the history of opium and the opium industries.
He spends a fair amount of time on the fucked up doctor stuff he's had to deal with, including prescribing meds w life-threatening contraindications when combined with other meds for which he already had prescriptions.
American hospital workers have to take on a ton of scenarios because the US lacks the social programs necessary to deal with the negative outcomes of its socioeconomic system as well as simple human diversity (e.g., neurodiversity).
Frontline receptionists, nurses, and doctors have to deal with addicts, folks going through mental health crises, people who are not in crisis but still without a firm grasp on reality or interacting with other people, and people dealing with pain who don't fit into these categories, if that makes sense.
I can understand how jaded nurses and doctors get, for example. They start to see patterns in their work and they don't have the training or resources to provide the "right" thing: they can either provide drugs or not. The system doesn't really give you other options.
But yes the outcomes for the populace are... bad. It's a bad system.
