While I am normally a pretty compassionate person willing to give most people I see in the ER the benefit of the doubt, there are some people that are pretty much beyond hope. I am sure Nurse K would love this case. We had a 44 year old man the other day who is making himself out to be a great abuser of the health care system. He had been admitted 10 days ago to another hospital with an MI. He promptly signed out AMA the next day. He then returned several days later with recurrent pain and was re-admitted. He was transferred to another hospital where they perform cardiac cathetisations – he was cathed and told he needed medical optimisation for his heart disease but no stents were needed. He decided shortly thereafter that he would rather sign out AMA again and go drinking. While drinking, his pain recurred and he called EMS. As soon as he arrived in our hospital he wanted “pain medication” – ie specifically narcotics or “whatever strong stuff we can give him” since he has “just lost a lot of money in the stock market”. He was mildly intoxicated and his EKG was slightly abnormal. Unfortunately, because his legitimate medical problem is not under control (BP sky high, noncompliant with meds), he had to be admitted. I bet he signs out the next day to go back and drink and waste our time and money.
We have a similar patient at our facility. Call it denial, addiction, or just plain stupid. I hate these people. They treat their bodies like crap, then expect a quick fix (narcs), just so they can abuse their bodies more.
People like him aren’t just wasting our money they are wasting your time and education. And the people who have taken care of themselves but find they need your help anyway and are willing to do whatever it takes to get better and go home can’t always get the doctor’s full attention or a reasonably timed appointment because you are dealing with these jackholes.
Common sense isn’t so common, is it?
What an ass. Here, we joke that such patients are in need of “Pillow Therapy,” because any other solution to their problem will ultimately fail. Can’t save people from themselves…
Around here, they smoke crack, flare up their CAD, get admitted c/o the taxpayers, and leave to go smoke crack again. Wash, rinse, repeat. I think antebuse and campral would be good “cardiac” meds in this case.
Exactly the kind of EMS call I hate. 2 a.m., drunk, belligerent and seeking meds for pain. Ugh.
Lets hope he has insurance and we can bill them for the multiple admisions and make a few dollars for the ER group and the hospital.
May I ask something? There are many evident-based studies on medicating abusers of alcohol and of drugs with metadone, codeine and buprenorphine in America. Are these drugs somehow out-of-range or not recommended by superiors or why haven’t I seen any lines of better experiences from ERP or amongst the comments?
Compliance is necessary and many people don’t follow the strict regimens. Also, Methadone can easily kill you. However, these drugs are used in a certain set of patients.
Thanks ERP. I asked simply because in here doctors are very seriously adviced to think twice before they refuse a Methadone or a Buprenorphine prescription. It is clear that many abusers are not able to start or maintain a course of M. or other similar drug because they are not trusted and the conditions are made too tough. Like 3 times totally sober. It is so difficult when the problem is in the brain.
I think it would have been to the patients advantage to have a Psych consult BEFORE he decided to leave AMA.
If this guy had cardiac problems then he most likely needed oxygen as well. Perhaps he wasn’t able to process right and wrong, or what is socially acceptable behavior?
I find patients like this one feel as if the only control they have IS signing AMA.
Considering this patient had a history of signing AMA, I would have asked for a psych consult.
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Psych consult, please. 2 am at a community hospital. What planet do you live on?
Sounds like one of our frequent fliers. This dude signs in every 2-3 days with the same complaints: nausea, vomiting, abdominal pain and out-of-control blood sugars (over the 600 range). He doesn’t know the meaning of the word “compliance”. Nor has he heard of “regimen”.
Always wants pain meds, pain meds, pain meds.
He’s had so many CTs and X-rays done that some days I swear he positively glows from all the radiation. He’s had so many IV sticks that his veins are utterly shot – can’t even get the one by his pinky toe anymore!!
For a while we quit bothering to check – he’d straightaway get a central line! Now he’s managed to convince/con some surgeon into implanting a port in his chest for access…
He’s a whiny, pathetic, disgusting manipulator and the nurses, docs and techs are sick and tired of his bullshit.