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?

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.

“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!”

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.

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.

BULLSHIT. ER doctors specialize in saving your ass when you’re teetering between life and death.

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.

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!

“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…

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?

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?