So, my hospital, as well an many others I suppose, have certain criteria as to whom they send their Press Ganey patient satisfaction scores to. The policy is (and should be) that they do not send them to patients who present with psychiatric symptoms and/or alcohol or substance abuse related complaints. It does not have to do with what the ultimate diagnosis is (ie, it would easy if you could just make the dx of someone who presented for abdominal pain and demanded narcotics with “personality disorder”), but what the complaint is. The complaint is whatever the non-medically trained “greeter” writes into the computer when the patient presents. Often it is completely wrong – meaning the real reason the person is there is something completely different. Therefore, I frequently change it (or correct glaring misspellings) to the correct reason they are there. This gave me an idea. I personally find it perfectly appropriate to change “migraine” or “med refill” to ” requests Dilaudid” or “Ran out of Percocets” after I interview and examine the patient and realise the only reason they are there is to score narcs. Of if they are drunk and making whatever unrealistic demands, I change the presenting complaint to “intoxicated” or something else that makes it clear the main reason the person is there is because they had too much to drink. I mean, I am not going to be judged and have my administration rate me based upon when or not I hooked some seeker up with drugs.
Thus, when I had a recent patient storm out when I would not give her Dilaudid and Ativan for her chronic abdominal pain, and offer threats of “I am going to trash you on your satisfaction score!!!!”, I simply smiled and thought to myself, “well, you ain’t getting no STINKING form!”
I was waiting in the waiting area with my friend (she broke her ankle) and a woman came out with her friend very pissed. “I’m in pain and I don’t use drugs!”
I overheard (I have very good hearing) a few of the people who work in the front (receptionists?) talking to the triage nurse who came out to see what the commotion was. “I have never heard/seen someone be so adamant about not being a druggie.” Eventually, as my friend was getting her ankle cast, I over heard the doctor mumble, “if your tests come back cocaine positive and being pregnant and are in no life saving emergency I might decline your request for Vikodin (I guess her way of saying it) for the groin pain.
I sure hope that lady gets some help. Blech.
I guess I was a good patient with my recent visit to ER as I got the form to fill out and gave everything the highest,glowing remarks. My ER is new and I must have been there on a slow night as I got immediate and continual attention.
Oh, I also needed no meds for my kidney stone, but did leave with a retention catheter.
These scores are such a flip of the coin. Yeah, I think we do need some form of reminder to be more compassionate and kind to patients and their families. But give me a break when these forms do fall into the wrong hands, such as the addict in your post. I should have bought stock in PG!
Have a good day.
My favorite patient complaint letter written about me was the girl with the sore throat, yes, a sore throat, who wrote me up for not asking the MD for a 3rd mg of IV dilaudid and instead “discharging her” (as was ordered).
Ironically, why is the MD ordering IV dilaudid for a sore throat in the first place? For these silly patient satisfaction thingies, of course.
Well, all of these posts help explain why a set of ER docs was so shocked by me–this was 30 or so years ago and I had a hand injury, a crush fingertip amputation up to the first joint. I got to the ER which was super busy, I was taken for X-rays which involved moving my hand this way and that, went back to wait, the films didn’t come out well enough, so I had a second set done. I hadn’t had a thing for pain. When I heard I had to have the X-rays done again I asked if I could have “maybe some aspirin because this is starting to be pretty painful.” Doc about swooned. Who knew? I have later in life heard some really funny drug-seeking conversations in ERs, based on the rule that it is NOT evesdropping if it is harder to NOT hear than to hear.
I have to admit that a drug seeker came to the ER today and wanted percocet. Rather that argue I gave her a few and said good bye. It was just too busy to take the time to deal with her and it was easier to give her a taste and dismiss her from the ER without confronting her issue. I only did it because its been 2 years since her last visit and I gave her the 1 time benefit of doubt. She was nice to me. That goes along way with me. Be rude and suffer the motrin consequence with an added ultracet $100 rx. That med is worthless and cost a fortune.
Don’t have press ganey surveys in Canada but it seems that some patients find a way to retaliate no matter what…
I work at a hospital that serves only one ethnic people group. If you are not of that ethnicity they will treat you in the ER and and you to another hospital. Considering there is a ethnically neutral hospital about 2 minutes down the road you have no reason to go there unless there is no other option. Unfortunately the population that the hospital I work at serves has little tolerance for alcohol (or illegal substances) so we get a lot of patients who come in for alcohol and narcotic related causes and because of that our press ganey scores are not all that great. Considering the number of patients I have had that have liver failure even though they are in their early thirties most of them don’t get major pain killers like vicodin anyway.
Hi, just found this blog off a link from another. This post kind of bothered me. I am a chronic pain sufferer due to a rare genetic condition and recently moved. My old pain management place gave me a 3 month supply of my meds. But by the time we got the insurance figured out and could get in to see a pain management doctor in the new town I was going to be 10 days shy of my medication (even after ’skimping’ a bit on the dosage to try to extend the script). Normally I would have said ‘okay, so I’ll be in pain for a few days’, due to my condition I don’t experiance withdraw like a ‘normal’ person, might have some increased pain and difficulty sleeping but nothing bad. But I’m pregnant, and can’t stop the drugs without seriously indangering the baby. I spent 4 weeks (when I realized I would be short) calling the pain management clinic to check for an earlier appointment, the high risk OB clinic to see if they could get me in for an early appointment, and every general practitioner I could find to see if they would be willing to see me for a possible temporary refill. My pain management clinic from back home offered to call and/or fax records to anyone willing to see me so they could be sure this was a valid prescription/dose. It didn’t matter. No one would see me, no one would prescribe, everyone was too afraid I was a ‘drug seeker’. I ended up having no choice but to go to the ER (the first time I’ve ever been there for a non emergent medical condition) to get my script refilled. Thankfully the doctor asked me why I took it, checked the scripts/dates on the bottles I gave her, and said ‘obviously you are pregnant and can’t just stop it, we’ll give you a 2 week script.’ It was an extremely frustrating, depressing, and stressful month. Which could have been completely avoided if just one of the dozen doctors I had contacted had looked past the ‘patient wants a refill on pain medicine’ and the preconceived notions that apparently go with it.
Sorry Jespren, there is more to this story. Your previous pain management doctor could call in 10 days of additional medications. He/She could also mail the hard copy to the pharmacy depending on the schedule of the drug.
“I am a chronic pain sufferer due to a rare genetic condition…due to my condition I don’t experiance withdraw like a ‘normal’ person.”
“…But I’m pregnant, and can’t stop the drugs without seriously indangering the baby…”
Jespren’s moving plea for a little more open-minded understanding of refill requests has quite hilariously illustrated exactly why we (in acute services) can’t and won’t, made as it is of such blatant BS.
I notice there are two types of posters on here- the ones in the business and the complainers who search these sites out to tell us how horrible we are. Wanna get mad at someone- get mad at the thousands of drug addicts we see who lie like hell to try to get us to get them a fix. These people often outnumber the legitimate patients 2 to 1. Just today, I had 5 back pains and three “toothaches. Of those 8, only one was legit. So today, it was 8 to 1.