Sunday, January 13, 2013

dilaudid ala carte

You know what I just love? Those people who come in thinking that they are going to dictate what happens.  You know, the kind of person who requests what medication they want and how they want it.  They tell you what tests they want. They even tell you they want to be admitted and don't plan on going home.

Well, guess what folks? This isn't a cafeteria with different don't get a menu to choose from here.  You do what the doc decides.

Entitlement comes from all levels of society.  From the poor, who expect that you are going to arrange for a cab home to the upper middle class folks who think they can dictate how the visit is going to go. Espeically  irritating are those who say they know somebody in the administration or they know a doctor who works here. So what.

This happens a lot in triage, where people become irate because their doctor didn't call us to say they were coming. . I have seen people treat the triage nurse like shit calling them a liar, when told their doctor didn't call.   They think they will get in ahead of everybody else.  Not. they


Mal said...

Be fair. Some people know their own health problems, and can tell you what tests, medications and procedures they are likely to need. They're not all entitled, some are just trying to help you, get the care they need, and get out of the ER.
These are, however, not the ones asking for Dilaudid.
I'm one of them. 'Liability issues mean I need to get checked out here, because I passed out in your hospital and some moron called the crash team, but you're wasting your time. I have POSHT and hypoglycemia, and I had a syncopal episode, my foot twitches are a medication side effect from Venlafaxine, and not a seisure. Test my blood glucose, and my blood pressure sitting and standing, give me some paracetamol for the bruises, and some glucose for the shakiness, a drink of water in case I'm a little dehydrated, and I'll be good to go.'
Listen to me, and this will take five minutes, don't, and I'm checking out AMA and screw your liability issues, because you're going to take five hours to confirm what we both already know, which is that I really don't need to be here.

Anonymous said...

I do this too. People with chronic health problems, or decent medical knowledge often do know what's wrong with them, and what they need.

I went through this several times with my gallbladder in my early 20s. I was having complications and my liver wasn't doing its job, and I was having episodes of jaundice, severe pain and vomiting, so I ended up going to the ER a few times. If people listened to me, I got IV fluids painkillers, liver function tests, and was admitted for observation until things settled down. If they didn't listen, I got the exact same thing - after ultasound, CT, surgical consult, repeated examinations for Murphy's sign, and many, many bloodtests.

girlvet said...

Sorry guys, its up to the doctor what you get. Of course, the information you tell them may help determine what that is.

Nurse Lily said...

I'm with you on this one. I've seen it time and time again. Allergic to morphine, "don't even try the benadryl cocktail with me", etc. Somehow the only thing that works is "a minimum of 4 of dilaudid". Really, now...very interesting. You know, that hangnail DOES look pretty Hard not to get jaded.

hoodnurse said...

One of the NPs I used to work with would always say "she thinks this is Burger King and she can have it her way. Too bad it's the ER."

Christy Ryman said...

I'm one of those, too, to an extent. I get really bad migraines, and it's hard enough to get drs and nurses to take me seriously what with you guys assuming everyone's a drug seeker. When I do end up in the ER, which is only a couple times a year, I always ask the dr what they suggest. But I also tell them if they've suggested a drug that gives me particularly bad side effects, or I ask for the nausea med I know works best. It's frustrating to lay there in pounding pain while I humor the dr and let them try the meds they want to and after they don't work I can finally ask for what I know what works.

Anonymous said...

There is a difference between providing information to a doctor/nurse and telling them what to do. If you are telling a dr what test to run and what meds to give, then obviously, you do not need to be in an emergency room! Plain and simple. The reason you are there is you have an ailment and wish for it to be treated. Let the people with a degree do what they know to do.

Anonymous said...

You really need to find a more objective way of looking at your position. And I'm going to say to you what I have been DYING to say to attitude-fueled nurses for the past 15 years:
If you don't like your job, QUIT IT. There are hundreds of good-hearted, genuine nurses who are in their position for the love of caring for people. You are quite obviously not one of them.

At 18 years old, 2nd year in college and what should have been a very exciting time for me, I was diagnosed with Von Willebrand's Disease and Hemophilia Factor 8. I have since I had 24 blood transfusions, and literally countless transfusions of IV ferrous sulfate (ferrilicit - iron), due to the fact that my body does not absorb iron - hence, will not make red blood cells. I thank God everyday for the kind nurses who have taken care of me through these many, many trying stays on the oncology/hematology floor, surgeries, and lengthy visits to the ICU. But, it never fails, there is always a nurse like you. Somebody who thinks she knows not only more than the doctor, but more than the patient.

A good patient is one who KNOWS their maladies (particularly if it is a recurrent one or something of a serious nature), and can dictate the necessary treatments when presented with a new hospital setting and a staff who hasn't had experience with the patient. And guess what? I know exactly what my body does and doesn't need. I know exactly what kind of pain I am experiencing and where and why its taking place. I know why my resting heart rate is acute tachycardiac. Most nurses and doctors have praised my insistence to be involved in my care, educated about my disorder, and being my own advocate. Nurses like you are the reason I hate going to the hospital, and dread it so much, even when I absolutely HAVE to go, because it is obvious that my H&H is dangerously low.

Reconsider your job options. You are obviously not meant to be a nurse.

Anonymous said...

Oh, and just a quick side note...

To all of the commentary stating to "let the people with degrees do their jobs" and "if you are saying what tests you want run, you don't belong in the hospital." Well, I'm excited for you and yours that you apparently have your health, and have never had to deal with more than a sprained ankle or a bad case of the flu. You have no idea what someone with a REAL disease has to deal with on a daily basis. Look up the word 'empathy' in Webster's, and really try and absorb the definition, for the good of yourself, as well as the good of any family/friends who may suffer severe illness in the future. I bet THEN you will be singing quite a different tune.

It took doctors and hematologists *7* years to discover what was 'officially' wrong with me. It took years of pain, blood transfusions, severe weakness and constant vomiting and flu-symptoms, small injuries that would bleed endlessly due to the absence of clotting, and a complete lack of an immune system (which, naturally, led to my getting sick all the time), before a team of doctors finally joined together, alongside my GP, to insist on figuring out just what was happening to me. These were great doctors, who take time out of their days that they did not have to, just to help a random girl and her family get some answers and assistance for countless maladies we did not understand. And most of the nurses working alongside those doctors were fantastic, kind-hearted and worthy caretakers.

Don't comment on something when you have no idea what you are talking about. I'm sure there are plenty of people who take heavy advantage of the medical system to obtain narcotics, attention, or to placate their hypochondriasis. And that is unfortunate, because it hurts the validity of patients who genuinely need help.

Generalizing is just childish and shows a lack of compassion and education. Gotta do better. *eyeroll*

Emily A. said...

I'm 19 and have had FSGS (a kidney disease) since I was 2 and a half. I've gone through numerous surgeries, had sepsis and internal bleeding. That being said, I always feel really bad sticking up for myself when I tell nurses what to do in the ER. I know my body but since I am so young, some medical care people don't take me seriously. I can tell when someone wants to tell me off when I say that I NEED Dilaudid because weak ass drugs like Tylenol don't work for me anymore and dialysis patients can't have morphine. I may be 19, but I've gone through a lot more than doctors give me credit for. And just because I'm crabby today, I hate when I'm not taken seriously when I tell people that I'm a very hard stick. I had this doctor tell me that she was the "best" at putting IVs in... Lo and behold, it took her 7 tries; she finally got it in my f**king foot.(My dad even said after the third stick, "I thought you said you were the best!") My dad and I have a theory that the cockier the doctor, the worse they are at IV access.

Another fun story; I wasn't taken seriously enough when I kept going to the ER at 3 am with extreme stomach pain. They did CT scans each time, told me I was extremely constipated, filled me with GoLightly and enemas then sent me home... After a month of that happening every week, my bowel burst and I went into septic shock. I KNEW something wasn't right but no one took me seriously enough to really look into it! My heart stopped twice and I lost my hand and toes because of it!

And yes, I may be a bitch especially when I'm in the ER but I get tired of answering questions 8 million times, not being taken seriously because I'm young, GAHHH! I know myself better than most doctors do, goddamnit!

Sorry for the rant, I've beenn holding this in for a while...

Anonymous said...

Wow are constipated and had bowel isssues due to bowel decreased motility from all of the narcotics you have used......duhhh