There are some people in the blogosphere who have to chill. I have received a boat-load of vociferously angry comments on this site over the last two days – it appears that many of these commenters are either: A. Overly sensitive to any discussion of obesity that does not remove all blame from the patient. B. People who suffer from chronic pain conditions (legitimate or otherwise) and Cushing’s disease/syndrome and C: People who just don’t get what it is like to work in an ER. Some are all of the above.
Thus, in this post, I will address my view (and very likely others’ in the health care field – especially those who work in the ER) on obesity, chronic pain, psychiatric illness, and what it is like to work in an ER. Take this into account when you read any future posts that concern these issues – and don’t immediately jump down my throat saying things like “You are not compassionate”, “You should be a garbage man, not a doctor” and “I would report you to the medical board if I knew who you were”. Please try to keep comments at least somewhat constructive or they will be deleted.
Any other health care providers please feel free to chime in.
A. Obesity. Everyone agree that it is an epidemic in this country now. Just take a look at the average personal health record. Unfortunately it is getting worse and worse in our youth for a myriad of reasons. The other sad fact is that our obesity seems to be spreading across the oceans to other countries as well. Our country’s obsession with fast food apparently is being exported. Even in France all places, American-style fast food is making inroads, bringing obesity along with it. So, with that said, what to make of obese patients. First, any patient who is having an emergency will be treated appropriately with compassion in my ER. This of course includes those who are obese. However, the sad fact is that many people feel that obesity itself is not at all in any way even at least partially the fault of the obese patient. I do not believe this. Yes, there are a minority of patients who suffer from conditions where they are bound to be obese no matter what they do. Those who have adrenal diseases (like Cushing’s disease or syndrome), are severely disabled, have hypothyroidism, fat storage and metabolic diseases, etc really cannot do much to prevent themselves from becoming overweight unless they starved themselves. People who really have these conditions have truly been dealt a very bad deck. Many others are obese at least partially for psychiatric reasons. They eat because they are depressed – food is their drug of abuse. However, many, many people are obese because they simply eat too much unhealthy food and do not exercise enough. Many of these people live in subcultures within America where obesity is not only tolerated (mostly in women), but is praised, despite the well known health hazards. Obese patients are treated with respect in my ER – however, if they are disrespectful to the staff, demanding, and make a nuisance in my shop, they will get rebuked,just like any one else. Additionally, just like with smoking, I feel it is a doctor’s duty to reprimand patients for unhealthy behaviour – and this includes unhealthy eating and subsequent obesity.
B. Chronic Pain. Here is hot-button topic if ever there was one. Chronic pain is HORRIBLE. Chronic pain is debilitating. Chronic pain is sad. However, chronic pain is not to be managed in the ER! If truly have chronic pain, go to a pain management specialist! Often they can recommend many treatments besides narcotics to control it. I am sure there are millions of these sufferers who do indeed go to specialists and guess what – we never see them in the ER! Or, if they do come in, it is only once in a blue moon. The ones that come in day after day after day with diagnoses like “tooth ache”, “migraines”, “fibromyalgia”, “back pain ” (often with no documentation of getting any real work up for the cause their pain) , etc and claim to be “allergic” to everything except Demerol, alter our Rx’s, and overtly fake or exaggerate symptoms are a different breed. They are manipulators and often criminals. The should be arrested. They are lucky they just get thrown out with Naprosyn. They may be a minority of chronic pain sufferers but they drain our resources, waste our time, and cost the taxpayers money.
C. Psychiatric Conditions. Psychiatric disease is widespread. Many, many, many people have some form of it. In fact, I cannot recall the study but I remember reading one a while back where where the investigators went to a busy ER waiting room. The did not ask what the people sitting there were there for – they just asked them to fill out a professional questionnaire used by Mental Health providers to screen for anxiety disorders. About 40% of the people that responded there were determined to be suffering from some anxiety disorder! So, you can see how often we in the ER have to deal with it! Anyway, people who suffer from these disorders need help. In fact the ER is a great place to come when you are truly down to the point where you are suicidal or at your wits end. It is not a great place however if your symptoms are milder. We are simply not trained for and do not have the luxury of time to spend with each person who has a complicated psychiatric history. We have to juggle an ER with sometimes dozens of patients, some of whom are in danger of dying at any moment. We cannot do much for you except admit you or make a referral.
D. Life in the ER. Simply put, if you have not spent any significant time either working or volunteering in an ER, you really don’t know what it is like. People are at their WORST in the ER. Sometimes it is because they are sick or a loved one is sick. Sometimes it is just their true colours coming out. If many of you extremely touchy-feely types actually had to work a shift in the ER you would probably want to kill someone. Why? Because you don’t realise it but much of the population is either nasty, manipulative, violent, malingering, antisocial, and or disrespectful. Of course the majority of people we treat are not, but I guarantee if you have to deal with even 4-5 out of the 20-30 you might see on a given shift, you will re-think things. Imagine getting threatened by people who you are trying to help. Getting spit on. Getting told what do by people who don’t know anything about the practise of medicine except what they read on blogs or in newspapers. Witnessing the gross indifference people have for sick loved ones. Witnessing child abuse regularly. Dealing with intoxicated persons who want to kill you. Listening to people bullshit you about their medical conditions so they can either get out of work, get disability, or get narcotics (often for resale). Imagine getting zero respect from people for the years of training you have. Our oath forces us to deal with and treat people the rest of you in the outside world would just walk away from, ignore, or call the police about. I signed up for this so I know I have to do it so don’t accuse us of whining. This is whining. And on top of all this, you have to treat the TRULY sick people – ie people have to be intubated, recussitated, cardioverted, sutured, and transfused. Those 4-5 “bad” patients severely inhibit you from what you are trained to do – take care of the sickies. They waste your time, sap your energy, and burn your resources. How do we cope? We develop morbid senses of humour. We develop tough exteriors. We tell those off who need to be told off. Nowadays we vent on the internet. (this blog partially serves this purpose for me) You won’t last a month if you don’t develop these survival skills. That said, I would not change my job for anything. Why? Because there are also always some people per shift who really do appreciate what you do for them (even if it just telling them they are OK and they have nothing to worry about). There are people you bring back from the dead who look back at you in thanks. There are people that make you laugh. There are people who help restore your hope for humanity. That and the fact that you never get bored working in the ER -which I consider worse than dealing with drunks! And finally, we don’t get rich working in the ER. We do all right and I am grateful for the living I earn, but don’t lump us in with high profile surgeons like Dr 90210.
All that said, it really comes down to respect. If you are not in true extremis (ie about to code, severely short of breath, just got shot, or have a bad fracture in which case I will of course forgive you), then I will do almost anything for you when you come to my ER as long as you can show some respect and thanks to me and my staff. I have gone on the internet to help people figure out their insurance and find them a provider that takes it, I have called 10 relatives all over the patch to keep them informed as to a patient’s condition, I have spent hours arranging a transfer for people not out of medical necessity, but for their personal preference. I have given people money to get home on the bus. I write generous work notes. I have spent eons explaining a diagnosis to patient while the whole ER backs up. I will give you 25 percocets just because I don’t want you to run out over the weekend. I have spent 30 minutes with families who just lost a loved one.
Don’t say I am not compassionate
However, if you try to pull a fast one on me by lying, faking illness,exaggerating symptoms, or making threats, or you are just plain disrespectful and nasty, don’t let the door smack you on the ass on your way out. (Cushingoid, or not)
In Dedication to Nurse Arkie:
Foundations of Nursing: Caring for the Whole Person – Google Books Result
by Lois White – 2000
pg.1154-references neurogenic shock can occur in response to severe pain
Pathophysiology: A 2-in-1 Reference for Nurses – Page 209
by Lippincott Williams & Wilkins
References severe pain as a cause for neurogenic shock.
Here is an article abstract and an excerpt :
“The body’s response to acute pain can cause adverse physiological effects. Pain can impede the return of normal pulmonary function, modify certain aspects of the stress response to injury, and alter hemodynamic values and cardiovascular function. It can produce immobility and contribute to thromboembolic complications. In addition, pain can slow a patient’s recovery from surgery and contribute to increased morbidity” from the following abstract with link and article included
http://www.ajhp.org/cgi/content/abstract/51/12/1539
“Effect of analgesic treatment on the physiological consequences of acute pain
KS Lewis, JK Whipple, KA Michael, and EJ Quebbeman”, American Journal of Hospital Pharmacy, Vol 51, Issue 12, 1539-1554
Copyright © 1994 by American Society of Health-System Pharmacists
These are obviously manuals used for educating medical professionals and would have to have been written based upon research and not mere anecdotal evidence.
My knowlege of shock being caused by severe pain was what would consider to be common knowledge that I thought in society most people knew about including training my husband had received for first aid, but also I had a friend who was in medical school and reference had been made to shock as a result of acute pain in one of her pain management books because she had shown me. My friend was studying to be an physician until she got sick. It was written by nurse practioners I believe for educating physicans and med students. Pain in extreme cases can cause shock, and shock can kill if not treated. I studied with her help because I had an interest in helping others because I was studying psychology and was also interest in the concept of chronic pain and its effects upon mental health and also on the human body. The comment made that pain is not an emergency by someone who claims they are a nurse on here is rather frightening. Chronic pain is not an emergency unless it becomes so severe that it would possibly precipitate suicidal ideation. But in cases of severe pain,if pain is severe enough it is an emergency or associated with an illness that might be one and it should be evaluated. I stand my ground that Pain can kill even if along a string of linear events that take place. If pain can cause shock in extreme events, and shock can cause death, then pain can inadvertently kill someone. If pain leads to depression and depression is a direct result of a person’s suffering, and the person chooses to take their own life..then pain can kill. I do not believe in everyone needing to take narcotics for pain, because that is irresponsible and stupid. That is why there are doctors for such. Just as pain can be deadly so can the effects of drugs.
Here are some other various topics and blurbs of interest :
Liebeskind JC (1991), Pain can kill. Pain 44(1):3-4.
http://www.fsu.edu/profiles/berkley/
Bedside Clinics in Surgery By M.L. Saha pg.540-shows a listing of the causes of shock in patients with burns, and neurogenic shock has severe pain listed beneath it
The Effect of Pain on Leukocyte Cellular Adhesion Molecules
Biological Research For Nursing, Vol. 7, No. 4, 297-312 (2006)
DOI: 10.1177/1099800405286071
Suicidality in chronic pain : a review of the prevalence, risk factors and psychological links
Author(s)
TANG Nicole K. Y. (1) ; CRANE Catherine (2) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) Department of Psychology, Institute of Psychiatry, King’s College London, ROYAUME-UNI
(2) Department of Psychiatry, University of Oxford, Oxford, ROYAUME-UNI
http://cat.inist.fr/?aModele=afficheN&cpsidt=17712185
http://www.cirp.org/library/pain/porter_1999/
Porter FL, Grunau RE, Anand KJ. Long-term effects of pain in infants. J Dev Behav Pediatr 1999;20(4):253-61
http://www.ccri.edu/nursing/pdfs/2040neuroshock.pdf
(obviously some kind of worksheet or presentation showing information on neurogenic shock)-and if you see it says pain is one of the causes
Romano, Thomas J, Chronic persistent pain can kill: a
clinician’s perspective, Am J Pain Management. 2005
April; vol 15 no. 2, p. 59-65.
http://www.aapainmanage.org:8080/literature/PainPrac/V11N3_Romano_CanPainKill.pdf
A full article:Chronic Pain Conditions and Suicidal Ideation and Suicide
Attempts: An Epidemiologic Perspective
Gregory E. Ratcliffe, BSc,* Murray W. Enns, MD, FRCPC,*w Shay-Lee Belik, BSc (Hons),*w
and Jitender Sareen, MD, FRCPC*,Clin J Pain 2008;24:204–210
http://myuminfo.umanitoba.ca/Documents/2033/Chronic%20Pain%20Conditions%20and%20Suicidal%20Ideation%20and%20Suicide%20Attempts.pdf
Nurse Arkie, I agree that Mere anecdotal reports are not evidence of things. I know this. Like I said before…correlation does not necessarily imply causation. But, basically you are calling all of those who have put their time into writing medical manuals and doing research ignorant of any relationship between pain and its varied effects on the human body if you think that pain cannot affect the immune system, does not ever lead to shock, does not lead up to possible suicidal ideation, and that it is not an emergency.
You should have access to a heck of a lot more research then any of us “laymen” have.
Perhaps it is time you renewed your interest in reading up on it even if you do not believe there is any research supporting pain and detrimental effects on human emotion and physical well being that could result in death. It would at least be good to know that your patients coming into the ER with severe pain wouldn’t be considered as a waste of time because of your “Pain is not an emergency comment”. Perhaps you meant “Chronic Pain is not an Emergency”. But what you wrote seemed otherwise. I would think that being a nurse would also include having the knowledge and empathy for those who truly are suffering from even pain. Isn’t that why you go into the field in the first place, to help those who are in pain and are sick?
You’re on Shrink Rap.
HumblyTruthful, what’s with the personal attacks. I haven’t insulted you personally so I expect the same courtesy. I do assure that I AM a nurse. I don’t know what gave you the idea that I work in the ER. I never said so and it’s not a requirement for commenting here as evidenced by your own posts. I do have family and friends who work in the ER. I also have experience with managing medical emergencies and critical patients.
If you had kept up with my comments, you would have seen that I specified that I was speaking of chronic pain (the focus of ERP blog post – remember?). As I was speaking of chronic pain, your articles focusing on acute pain are irrelevant. I am aware of the problems associated with acute pain.
Lest you think I am ignorant of the effects of chronic pain, let me tell you that in 2005 I was diagnosed with very late stage cancer which I was not expected to survive. I underwent high dose radiation and an aggressive chemotherapy regimen. High doses of IV steroids were part of my treatment protocol. I experienced multiple life threatening issues including intercrainial bleeds and extensive blood clots. I also experienced pain. Lots and lots of pain. I was even dependent on narcotics for a period of time. So, I know pain.
I am also aware that chronic pain can be associated with suicide. I do agree that suicide ideation is an emergency. But it doesn’t logically follow that medically speaking pain was the cause of death.
Chronic pain is not an emergency. Because of the afore-known status of the condition it could have been (and should have been) managed earlier. Emergencies are unexpected, sudden, acute, unforeseen, etc.
Many times people live with chronic pain that is not controlled properly. They may experience drastic worsening if they run out of medicine. However, that does not mean that it becomes an issue that should be seen in the emergency room. They should anticipate this and arrange for it ahead of times.
Some people may be completely unable to arrange for physician services so they come to the ER because by law they can’t be turned away. The ER has become a catch-all for people who fall through the cracks of medicine. This does not make it a proper use of the ER. The staff are not trained to deal with these issues and doing so takes resources away from true emergencies.
People who abuse the ER are causing the entire system to fall. ERs are being shut down across the US. When the system fails completely, who will take care of the emergencies?
Whoops! Sorry for the grammar and punctuation mistakes. I accidentally clicked the message through before proof reading.
Hi Nurse Arkie,
“It’s an EMERGENCY room. Pain is not an emergency!!! People do not die or lose limbs from pain. Wait until the morning and see an appropriate physician. If you choose to come to the emergency room anyway then sit down, shut up and be grateful that your non emergency is being taken care of.”
This statement from the other post was what alarmed me. I assumed because of this that you worked in the ER. MY Bad…
I also assumed because of your statement, that you were not a nurse because from my experience, and those in my family who work in the medical field, and my old friend who was in medical school…that pain never being an emergency and/or never could cause death was very shocking. Perhaps there is a dichotomy in what some in the medical field think as opposed to others. I would believe there is a consensus for what constitutes
nonesensical use of the
ER for no matter what the reason and with this I do not dispute. People should not abuse the ER unless they have an emergency. Sadly enough, emergency can have a wide array of meaning.
I wrote another statement admitting my own flaws and my opinions and as an apology. That also went for any mean things I may have said to you.
But, I took on your initial challenge and provided you with at least some research and what I consider fair support.
If I said anything that came off as an attack, again I am sorry. My other questions were meant to be rhetorical. I believe that people need to be more openminded in general and that having a narrow view can be a dangerous thing. SO if
nothing else, I have learned a lot more from seeing what healthcare workers feel and see and what they have to deal with that many of us are not exposed to every day. I would only wish that healthcare workers who hopefully have been treated with respect when they are patients could understand how hard it is to be a patient who is struggling and has become fearful because of some very bad care or rude comments. The stigma associated with chronic pain keeps many from getting treatment. The stigma of being
obese already in society has in some
circumstances caused a patient to have something else going on, but only a “fat” person is seen. The stigma of being mentally ill (not so much as it used to be), carries over and can cause patients with mental illness to be treated like everything is in their head. These are generalities, but people really do feel this way….not just me. I included things associated with chronic pain as well not just acute pain.
There is a whole hodge podge of resources listed here, and I read the excerpts or articles or websites.
I am sorry you have had to suffer with cancer and the pain associated with it.
I cannot presume where you are at this time in your illness, but it sounds like you are a survivor. I can only hope and pray that it goes away and/or does not come back. Hopefully it is gone and you can have many many years to do what you do best.
As for assuming or not assuming you are a nurse, just as in anything else. We can only go by someone’s word. Again, I apologize. I can only go by the words on the screen that alarmed me.
I have given the research. I have not asked you for any. I took up your challenge. I feel I covered it extensively. Now, I think we should agree to disagree.
Pain can kill…
I agree with the statement that patients need to be respectful toward ER staff, but it would be nice to see that level of respect reciprocated as well.
All of our local ERs are also advertised as walk-in care clinics for people on vacation, between doctors, or who cannot get an appointment to see their local doctors. The reason behind this is that we’re very rural and the ER often has only one or two patients in it at a time. They advertise that they have affordable care, but when you go in and specify that you’re there for the walk-in care, you get a $500 bill just for setting foot in the ER. Then the service is really poor and the lack of respect is disgusting.
I’ve never abused prescription medications or taken illegal drugs, yet I was accused of seeking pain meds when I came in with uncontrollable upper-back spasms. I was asked to touch my toes and could; when I tried to explain that I couldn’t stand upright, I wasn’t listened to. Instead I was lectured that most people would love to have the flexibility I had. And I was given a strep test when my complaint had nothing to do with my throat. I was told it was standard and everyone has to have a strep test. (I was also given one years later when I had weeded poison ivy and it had gotten into my bloodstream, causing a very serious reaction.)
Another time I came in with a swollen, infected, hard lymph node in my neck and was told that I was just faking an illness because I’m a teacher and I was due to return to work the following week when summer vacation ended. Following that comment, the doctor also asked that I visit an ear/nose/throat specialist for a biopsy of the lymph node because it could be cancerous. My final prescription: go home and rest and come back if I wasn’t feeling better in two days! I wasn’t aware that rest cured cancer, but an ENT specialist was able to prescribe antibiotics for an infected lymph node and diagnose me with mono and strep a few days later.
I agree with your post that a lot of us create our own issues due to obesity and smoking, yet I am neither obese nor a smoker, drinker, or drug user. I’m a normally healthy person, eat a balanced diet, exercise daily; and the few times in my life I’ve walked into the ER hoping to receive good medical care and respect, I’ve been seriously disappointed and treated disrespectfully. My last ER visit was a little over 7 years ago, and I dread ever having to return again. I hope I never actually need urgent care at our local hospitals!
I have been working in the ER as a scribe for a little over two months now. Your post has helped me understand so much of what I have been observing. Some of it I had figured out, but this makes things so much more clear. I just wanted to say thanks.
I lack the temerity to try and insert my opinion on many of the issues already raised in this compendium of rants, and rants about the right to rant, and, most troubling of all, the rants about who has the right to read (or in any other way receive) said rants.
But nothing angers me more than the assumption that medical education (whether measured in length of time, extent of rarefied air, or monetary cost), in and of itself, should be met with an attitude of automated respect. The worst assholes I have ever met have also been the most famously educated, and — similar to some of the medico bloggeurs — thoroughly confused as to why diplomas, degrees, and “time-served” situations have nothing to do with the quality of their work or the worthiness of their character.
Yes, everyone is deserving of respect. Without **qualification**. I’m not sure I’ve made any sense — I hope that something meaningful has trickled through. Thanks for serving as a touchstone for conversation.
My asking for respect is not because of the money I spent on my education. It is because I am doing something to help you – I am taking care of (or at least trying) your problem. I am respectful to staff in any business I have to go to – not just a medical office. I don’t march in and make demands. I expect the same, that’s all. Now, if I am being an arrogant ass in my conversation with you, you have the right to tell me I am being one! Just like I have the right to refuse to accept your abusive behaviour as well.
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First off, great blog. I used to work as an EMT but have since gone to college and am now in law school. Needless to say, I can empathize with your view on drug-seekers, addicts, drunks, nasty/ungrateful patients, and worst of all, those who refuse to accept responsibility. In my experience in both the field and in the ER, most EMTs, nurses, and doctors give back what we receive behavior wise. If you are in duress for a seemingly good medical reason, we take you seriously and provide the necessary care. However,in my experience, those patients are the vast minority, less than 20% I’d say. It is a well known joke among EMTs that we are little more than glorified ambulance drivers for drug-seekers, system abusers, and those who want taxpayers to pay for their ride to the hospital. Accordingly, I think your professional composure is a necessary defense to the overwhelming number of patients who are manipulative or simply nasty human beings. For all of those who have posted comments criticizing your attitude towards patients, especially obese ones, walk in our shoes. Try lifting a 400 pound man out of an automobile after an accident or telling someone that their chest pain and high blood pressure might have something to do with the fact they haven’t eaten a vegetable in the last decade. Woe and behold if you give medical advice that involves lifestyle change, requires personal responsibility, or doesn’t come in pill form. Keep the blog going, it’s great for those like myself who have seen the darker side of humanity to feel we’re not alone in our pessimism.
CAM said: “Your a ER DR, you really don’t specialize in anything.”
BULLSHIT. ER doctors specialize in saving your ass when you’re teetering between life and death.
“You still show your true colors of being overly judgemental of others”
Ummm kinda like thw judgemental statement that you just made?
“I am not a doctor or nurse…”
Here’s an idea stick toy your field of expertise and I’ll stick to mine. If you think you can do a better job than me bring it.
YOU do know what you are getting yourself into when you decide to be a ER Nurse or Doc. You made a choice don’t complain about it when you have to treat a drunk and disorderly, it’s your job.”
NO NO NO!!! It’s my job to take care of patients with true emergencies. It is not my job to deal with drug seeking, obese, fibromyalgia, migraine dirtbags that use my ER for their convience and then get pissed because they have to wait while I’m trying to save someones life.
WOW cam I’m sure when you talk down to the staff in ER like this they are just falling over each other to help you. Right???
“Honey, I hate to say this but I will..and furthermore I don’t give less a chit whether you believe me or not. I am a lot of things, but I am not a liar. I have accolades out the wazoo, I have two beautiful teenage children in high school. Both who are in high honors, not by accident. A grandfather who went to Brown and then obtained a Law degree from Harvard. My Father graduated from Annapolis then went on to obtain his masters degree form Columbia. I went to Emerson with a BA in communications. I have done well. I am currently fighting a Chronic Disease, I am 1/4 of who I was 5 years ago…but I bet you that I drive a car that is worth 3xs your salary and that’s if you work in the Northeast. I float in the Atlantic on my 33 ft Formula on Sunday afternoons just to catch the rays. My pedigree alone would cause you to wince. I am not without disease despite my pedigree. I am strong! I don’t whine and complain. I push on everyday and struggle with the who I am vs. what I am. I am expected more of then you can ever fathom, or what you are capable of accomplishing in a lifetime. Just know that! Bank teller? laughing out loud. My GG-Grandfather was the Co-founder of what all of you now know as CHASE MANHATTAN BANK… and that my sweetie is NO LIE! Still….it doesn’t change how I feel about simple humanity. Period end of story!”
“One does not have to be in medical school to have an opinion if they have an interest in a topic, or have known people in the medical profession.”
Yeah I know someone that knows someone that knows someone too. Does that mean I can have an opinion too. Wait of course I can I went to college and got my degree so I could work in healthcare.
Wow Doc,
You really ticked some folks off & then they started defending you. I’ve done plenty of ‘splaining about my horrendous health issues (trainwreck, although trainwrecks are, indeed, fun to watch) & have done my rounds on sticking up & sticking it to pain patients using ER docs as a quick fix, but golly, why can’t fat folks take a flippin’ joke? I am cushingoid & rotundly fat, pushing 270, & I know that I should also be more careful of my food choices & to get up off my lazy arse more often, to not blame my blubber on the steroids & literal “water weight” that has thickened me (just so the pseudo medical experts know, I also have PCOS, but diet & exercise, along with medication had literally melted 90 lbs. off of me before having to go & stay on steroids for 5 years now, so stop the lame excuses or just “suck it up” if someone points out that you are fat!) & for all of you pain patients out there: either get a pool, or a membership to a gym with a pool, you will find a zen moment to have your pain alleviated & you can exercise, which will not only help your physical health, but your mental health as exercise releases endorphins.
As for those wanting a kinder, gentler, more PC ERP blog, please go take a long walk off of a cliff! I am so tired of people fearing for their livelihood because they are speaking the truth about touchy subjects. I’m tired of seeing comments hijacked by whiners & frauds. If you don’t like what the good doc has to say, DON’T READ HIS BLOG, duh! Move on out & find the “cuddly, cutesy, I see pain, suffering, agony, horror, & intense drama everyday between catering to nincompoops whose hobbies seem to revolve around being the center of attention in the ER, even if there’s nothing wrong with them & then be subjected to both verbal & physical abuse, but I’ll tell my stories to the masses with a shit eating grin on my face & keep lying to myself that I am better than Jeebus & deserve appreciation, if not outright celebrity, from the readers who are anonymous, but mean ever so much to me” type of blogs. Those sort of sites are more of a vomit inducer to me than ipecac! I want to read the sincerity, feel the humanity & enjoy the “joie de vivre” of his humour, because it displays that he is truly a person, with feelings, wit, has a deep respect & appreciation of his art. Medicine is an art. Don’t you forget that folks.
As people, we all have different likes & dislikes, & just like buttholes, we all have opinions & we’re bound to disagree plenty of times. However, I find it ridiculous for people to come & read ERP’s blog RELIGIOUSLY, only to rag at him & tell him how much they dislike his writing or even go lower & declare they don’t like him, but they are junkies, who just keep coming back. Being a “professional patient” (& there’s more to my medical background, that’s solely for me to know)I LOVED Braden’s take on the pushy, self centered type. I’ve had to be parked next to these types (& have even been as much of a butthead as this type) & I would get more & more pissed (my pressure once went from my happy go lucky, but still sort of sickly 135/90 to 160/95 & my heart rate got all tachy after having to listen to some rich, snobby, “look at me, I’m so sick” type who’s complaint was “severe backache & dark urine.” After a few hours of treating the docs & staff as her personal valets & fighting with the doc for the meds & tests ordered, every damned step of the way, proclaiming she was allergic to everything (she even tried using the more recent blog post’s topic of: “well the other docs give me at least 200 milligrams of stuff that sounds like dill-addit!) & just when I thought this farce couldn’t get worse, here comes her husband & a parade of relatives & friends (young kids & infants included!) It was all a sham. Her urine was clear & light, labs & vitals all were dandy & when she was given an A-OK to leave, she & her parade demanded that he call Dr. So & So, get consults from internal mess & nephrology. I so wanted to assist her in getting admitted by inducing pillow therapy, just long enough to keep that lizard brain chugging along & then guilt tripping these folks into donating her organs.
If you are using the ER as you primary care source: STOP IT! If you are a fatty, either deal with it & be proud, or do something to make it change, stop expecting others to accept your excuses. You may not be sick now, but if you remain ham beast sized, you will certainly tax your body & if lcuky, wind up with treatable issues, otherwise: you’re literally gonna’ blow (heart or head). Just stop it already! Coming from a mega fatty, you folks have no more cards to play & it’s time to own up to reality. As for the drug seekers & abusers (not chronic pain pts.), you are doing yourself & the world a major disservice, breaking the law & breaking the hearts of those who love you. God forbid you are ever in need of real relief from pain due to a traumatic event, as NO doctor is going to give you the needed amount it will take to control your pain & you can die from that. For those who are against ERP’s written words: go screw! Go whine to those who will listen. Just remember, you’re truly pathetic & nobody likes you.
I have been reading your blog all day and besides thanking you for the great entertainment, wanted to tell you my recent horror story of a Doctor visit! Anyhow, my husband is active duty which means we are blessed (sense the sarcasm) by dealing with military Docs.
Two and a half months ago I came down with a common cold. For some reason I never shook the cough which kept me up EVERY night. I finally gave in and made an appointment at the clinic. Dr. “Happy” came in and I explained my symptoms and asked if he could order a x-ray. In the mean time had a coughing fit which resulted in me gagging, tearing up, etc. I explained that I have been a smoker for 15 years (bad, I know). He then says in a thick African accent, “You do not need an x-ray, you need to quit smoking.” “Yes Dr. I fully understand that, but am a little concerned. My best friend was just diagnosed w/ stage IIIc, triple negative breast cancer so I am a bit more paranoid then the average person.” He then says, “You are too young for cancer” (I’m 30). “Well sir, my best friend is 36 and she just lost both of her breasts.” We went around and around, him winning.
I then tell him that my 3 herniated discs, degenerative disc disease, etc had been acting up and was told by my usual Dr. (who was on leave) that I needed to reavaluate it with an MRI if it was not feeling better. I asked him for a referral for that, to which he responded, “I have no reason to believe what you are telling me.” I asked him to look in the computer and read the results of an xray in 07 confirming the degenerative disc disease. He did and repeated that he did not believe me because the MRI results were not in the computer. I explained to him that the MRI was performed by a civi Dr before I had married my husband. I gave him the name, State it was performed and expressed my permission to call for records. He then repeats, “I have no reason to believe you.” He asked what I took for this and I told him ibuprofen (daytime) flexiril (night). He looks at the computer and again tells me he does not believe me because the ibuprofen was prescribed in 2008. Umm… sir, have you heard of a thing called advil? I explained to him that I was not asking for any meds, just a re-evaluation of my back. He then says, “You are too young for back herniation.” I again told him I disagreed, being my husband (who is 6 months older) just had a 2 level lumbar fusion and in the process of having another surgery for a 3rd herniated disc.
Long story short, I convinced him to finally listen to my lungs, noting he never even heard my level 5 (not sure if that’s the right terminology) murmur that I have because of congenital pulmonary stenosis (yes, another reason I shouldn’t be smoking). Did he actually listen? Probably not. He never did order a chest x-ray, back x-ray or MRI. He just sent me on my way after calling me a liar and then berating another Doctor who prescribed me percocet for my big toenail that was surgically removed 14 months prior. I almost feel like taking in my MRI records to prove that I am NOT lying. As a warning Doctor… us radiation seekers are around every corner! :oP
Thanks for the wonderful blog though…. you have given me a reason to avoid housework for the day! Do you think that is standard to deny a chest xray in this case?
I have so much respect for ER docs. As a child I was a “frequent flier” but for genuine medical problems, usually severe asthma (I’ve also had a concussion, appendicitis, and dislocated hip). My ER care always exceeded expectations.
I’m embarrassed by the huge population of disrespectful patients. But based on your blogs and what you’ve posted here, you’re “killing them with kindness”, which is all you really can do sometimes.
Applause. I have to agree with this. Thanks for the post
I can’t figure out why bing sent me to your blog but I can say I have become pretty intrigued by the blog content you have sourced together. How much effort did it take to end up with so many hitting to your blog? I am very new to this.
You just do a lot of posts. Takes mucho time….
Just wanted to say how much I’m enjoying reading all the way through your blog. And – boy did you rattle some cages here!!! Wonder if we have as many seriously sensitive people in GB. I don’t think we have as many A&E abusers as you seem to on your side of the pond though (sorry – ED abusers) except maybe in London where it also seems to substitute for primary care due to a lack of general practitioners. I think that nowadays a lot of your patients would be shown the door in GB as being “abusive” – you don’t even get to raise your voice above normal speaking dB before that is levelled at you and I was on the receiving end from a consultant and her nurse who obviously couldn’t tell the difference between abusive and seriously distressed. Hey ho – I survived and probably benefitted because an underlying chronic ailment was finally diagnosed and treated as a result. So now I’m fat because of the treatment – but I’m mobile and pain-free so I’ll take being extra-cuddly and keep working on it. :-)