How to Get a New Narcotics RX in the ER.

[ChileRelleno 7,071]

Advice From An ER Intern On Obtaining Narcotics RXs

.......................................................................

 

OK, I am not going to lecture you about the dangers of narcotic pain medicines.

We both know how addictive they are: you because you know how it feels when you don't have your Vicodin, me because I've seen many many many people just like you.

However, there are a few things I can tell you that would make us both much happier.

By following a few simple rules our little clinical transaction can go more smoothly and we'll both be happier because you get out of the ER quicker.

 

The first rule is be nice to the nurses.

They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think.

When you are tempted to treat them like shit because they are not the ones who write the RX, remember...

I might write for you to get a shot of 2mg of Dilaudid, but your behavior toward the nurses determines what percent of that Dilaudid is squirted onto the floor before you get your shot.

 

The second rule is pick a simple, non-dangerous, (non-verifiable) painful condition which doesn't require me to do a four thousand dollar work-up in order to get you out of the ER.

If you tell me that you headache started suddenly and is the 'worst headache of your life' you will either end up with a spinal tap or signing out against medical advice without an RX for pain medicine.

The parts of the story that you think make you sound pitiful and worthy of extra narcotics make me worry that you have a bleeding aneurysm.

And while I am 99% sure its not, I'm not willing to lay my license and my families future on the line for your ass.

I also don't want to miss the poor son of a bitch who really has a bleed, so everyone with that history gets a needle in the back.

Just stick to a history of your 'typical pain that is totally the same as I usually get' and we will both be much happier.

 

The third rule (related to #2) is never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine.

I've seen people in a 10/10 pain and you sitting there playing Tetris on your cell phone are not in 10/10 pain.

10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm.

Even when I passed a kidney stone, the worst pain I had was probably a 7.

And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8.

That means to me you are hurting by you might not be lying. (See below.)

 

The fourth rule is never ever ever lie to me about who you are or your history.

If you come to the ER and give us a fake name so we can't get your old records I will assume you are a worse douchetard than you really are.

More importantly though it will really really piss me the fuck off.

Pissing off the guy who writes the RX you want does not work to your advantage.

 

The fifth rule is don't assume I am an idiot. I went to medical school.

That is certainly no guarantee that I am a rocket scientist I know (hell, I went to school with a few people who were a couple of french fries short of a happy meal.)

However, I also got an ER residency spot which means I was in the top quarter or so of my class. This means it is a fair guess I am a reasonably smart guy.

So if I read your triage note and...

 

1) You list allergies to every non-narcotic pain medicine ever made.

2) You have a history of migraines, fibromyalgia, and lumbar disk disease.

3) Your doctor is on vacation, only has clinic on alternate Tuesdays, or is dead.

 

I am smart enough to read that as: you are scamming for some Vicodin. That in and of itself won't necessarily mean you don't get any pain medicine.

Hell, the dumb shit cocksucker who list and allergy to Tylenol but who can take Vicodin (which contains Tylenol) are at least good for a few laughs at the nurses station.

However, if you give that history everyone in the ER from me to the guy who mops the floor will know you are a lying asswipe who is scamming for Vicodin. (See rule # 4 about lying.)

 

The sixth and final rule is wait your fucking turn.

If the nurse triages you to the waiting room but brings patients who arrived after you back to be treated first, that is because this is an EMERGENCY room and they are sicker than you are.

You getting a fix of Vicodin is not more important than the 6 year old with a severe asthma attack.

Telling the nurse at triage that now your migraine is giving you chest pain since you have been sitting a half hour in the waiting area to try to force her into taking you back sooner is a recipe for making all of us hate you.

Even if you end up coming back immediately, I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances.

And I firmly believe that if you manipulate your way to the back and make a 19 year old young woman with an ectopic pregnancy that might kill her in a few hours wait even a moment longer to be seen...

I should be able to piss in a glass and make you drink it before you leave the ER.

 

So if you keep these few simple rules in mind, our interaction will go much more smoothly.

I don't really give a damn if I give 20 Vicodin to a drug-seeker.

Before I was burnt out in the ER I was a Progressive Liberal and I would honestly rather give that to ten of you guys, than make one person in real pain (unrelated to withdrawal) suffer.

However, if you insist on waving a fluorescent orange flag that says 'I am a drug seeker' and piss me and the nurses off with your behavior, I am less likely to give you that RX.

You don't want that. I don't want that. So lets keep this simple, easy, and we'll all be much happier.

 

Sincerely,

Your friendly neighborhood ER doctor

[Salt1219 176]

an interesting read. I always liked the nurses better than the doctors, the nurses do all the work and the doctor comes in and asks the the same freaking questions i answered 4 times already then leaves.

 

(when i go to hospitals its because i might die, for everything else theres drug stores and clinics)

Edited February 12, 2012 by Salt

[DogMan 2,343]

I hope I never end up in this guy's hospital. He's sounds very jaded. He should be writing each RX based on sound medical principals, not on who gets their ass kissed, or other little games.

[Scott Kenny 144]

Note that the dude never said that you would not get an RX if he didn't think you needed it. Or even that he wouldn't give you an Rx if you were probably a drug-seeker.

 

But don't be stupid about your story and you will be out faster!

 

Speaking as a guy who is actually allergic to both latex and morphine, with a history of kidney stones and a massively traumatized back, I really wish I could take heavier pain meds.

[bernerz 11]

This was not written by an intern,they aren't that jaded yet. Most of us who work in an ER know the BS stories even before they start. With the advent of narcotic prescription reporting and centralized pharmacy records, drug seekers will find the ER a disappointment.

 

[U.S. Pratorean 1,234]

Very interesting indeed. I give anesthesia for a living. I don't care if you are a junkie just don't lie to me when I ask if you do drugs,OK? Why, because I had to explain to a family once that their relative would no longer be with us because she decided to lie about the street drugs she was taking and they interacted in a very bad way with the anesthetics she received and could not be resucitated and their response was " Oh, she has been taking that for as long as we can remember" Really? well thanks, now you can find a mortitician.

[DogMan 2,343]

Just a few little quotes that, if he really means it, might mean it's time to find another venue to practice medecine. He's already borderline psychotic.

 

"I might write for you to get a shot of 2mg of Dilaudid, but your behavior toward the nurses determines what percent of that Dilaudid is squirted onto the floor before you get your shot."

"More importantly though it will really really piss me the fuck off. Pissing off the guy who writes the RX you want does not work to your advantage."

"........you are scamming for some Vicodin. That in and of itself won't necessarily mean you don't get any pain medicine."

"I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances."

"I should be able to piss in a glass and make you drink it before you leave the ER."

"I don't really give a damn if I give 20 Vicodin to a drug-seeker."

[siminov 164]

I was in the er 2 weeks ago with some weird alternating pain and numbness in my side. Lucky me, I got shingles, yay! Anyway, while the nurse was checking me out the theme music to mash started blairing over the ceiling speakers. It took them a minute or two to shut it down on their computer. They looked alittle embarrassed about it so when I stopped laughing I assured them it was great. Everyone there was very pleasant, I did not require any pain meds but the doctor did ask.

[poolingmyignorance 2,191]

I watched my wife suffer for two years of idiot obgyn's who told her she was fine. And countless er visits for intense abdominable pain only to have some dip shit RN and ultra sound tech say there was nothing wrong with her and try to send her to counseling for drug seeking behavior. It wasnt untill we got refred by a friends dr to a new obgyn, and one MRI revealed FOUR baseball size cysts on her ovaries. One simple examination, one Dr who actually gave a shit, a simple oneday out patient procedure, and her quality of life was back to normal.

Its arrogant, jaded peicies of shit like the author who are only interested in collecting a paycheck and feeling special about their degree that cost us all thousands of dallors and cause many unjust suffering. Because once some know it all shit head puts "drug seeking behavior" in your file, you can forget about getting any expedient medical treatment lest you have some sort of open wound.

As such became the case as one of those countless er visits to quell the pain caused by those cysts, they were so kind as in infect her with c. diff. Colitis. 1year in and out of the hospital longest stay ws 8 weeks over $200,000 in med bills later. Shes fine..how does this relate? Well that little note in her file from before kept them from looking any closer at her when she came in. They all sent her away saying she merely had the flu. Which is really funny cause they CAN test for that. So the author is exactly the same type that caused us so much grief. I wouldnt put one fucking cent of worth to anything that somebody like that thinks.

[siminov 164]

I watched my wife suffer for two years of idiot obgyn's who told her she was fine. And countless er visits for intense abdominable pain only to have some dip shit RN and ultra sound tech say there was nothing wrong with her and try to send her to counseling for drug seeking behavior. It wasnt untill we got refred by a friends dr to a new obgyn, and one MRI revealed FOUR baseball size cysts on her ovaries. One simple examination, one Dr who actually gave a shit, a simple oneday out patient procedure, and her quality of life was back to normal.

Its arrogant, jaded peicies of shit like the author who are only interested in collecting a paycheck and feeling special about their degree that cost us all thousands of dallors and cause many unjust suffering. Because once some know it all shit head puts "drug seeking behavior" in your file, you can forget about getting any expedient medical treatment lest you have some sort of open wound.

As such became the case as one of those countless er visits to quell the pain caused by those cysts, they were so kind as in infect her with c. diff. Colitis. 1year in and out of the hospital longest stay ws 8 weeks over $200,000 in med bills later. Shes fine..how does this relate? Well that little note in her file from before kept them from looking any closer at her when she came in. They all sent her away saying she merely had the flu. Which is really funny cause they CAN test for that. So the author is exactly the same type that caused us so much grief. I wouldnt put one fucking cent of worth to anything that somebody like that thinks.

 

 

I didn't even think about that until your post. That's horrible, I hope your wife is ok.

[Dad2142Dad 6,559]

Been there with that and the wife. Different illness, less total time but same bullshit. You are spot on about some just wanting that insurance check and passing it off as flu. Here just take these pills is a common answer. Found one guy who actually did his job and saved my wife's life. He was the 6th doctor! Seems its easier to find a good mechanic than a decent healer.

 

Back on this pill pusher, you don't have to do any of that shit. All you have to do is find one who just wants the insurance payment and does not give a rip, they will write you for anything. How do they get away with it? Any oversight is done by doctors, the fox runs the hen house.

 

For those in the medical profession, I do realize that there are caring and good people out there. Just way to many dirtbags in your ranks. Think of it this way, there are quite a few jobs if you make a mistake, you get fired. I don't think that happens very much on the medical side.

[poolingmyignorance 2,191]

You would NOT believe how hardt it is to get a doctor to witness for you against another dr. They have so to speak an "honor amoungst theives" the doctor that finnaly caught the cysts my wife had's first words were "this is unacceptable, he shoud be sued" well when the time came...her lips were sealed. No surprise. While she's definately more diligent than the others she was too worried about being ostricized by the professiona community. It's like prison apparently. Rat once, rat for life. The only ones you can trust are lawyers....cause you EXPECT them to fuck you.

[IndyArms 10,186]

What I find totally amusing is that the original post text is probably just some MADE UP BULLSHIT designed to cause a stir and is completely FABRICATED... and everyone jumps on the drama bandwagon... Come on peeps... REALLY?!?!?!?

 

 

[poolingmyignorance 2,191]

What I find totally amusing is that the original post text is probably just some MADE UP BULLSHIT designed to cause a stir and is completely FABRICATED... and everyone jumps on the drama bandwagon... Come on peeps... REALLY?!?!?!?

 

 

I considered that, but it's really close in character to what I've personally experienced. So fabricated or not...I know there are those out there that think and behave this way.

[Lone Eagle 839]

Yes, part of it is perfectly made up, but part of it is the truth. Look at poolingmyignorance's story, and remember it well. All a doctor has to do is make one teensie note in your records, and you are screwed......especially if it's a W/C injury. Ask me how I know.

[DogMan 2,343]

What I find totally amusing is that the original post text is probably just some MADE UP BULLSHIT designed to cause a stir and is completely FABRICATED... and everyone jumps on the drama bandwagon... Come on peeps... REALLY?!?!?!?

 

 

Well...........is it just some made up bullshit or not? It seems like you would want to establish that first before you jump in and umm.....stir up drama.

[kevin.rose0@gmail.com 62]

I watched my wife suffer for two years of idiot obgyn's who told her she was fine. And countless er visits for intense abdominable pain only to have some dip shit RN and ultra sound tech say there was nothing wrong with her and try to send her to counseling for drug seeking behavior.

Rad techs and nurses don't interpret results. They might well know what the results mean, but legally it's a physican who interprets the results, and where I work every study eventually gets looked and signed off by a radiologist. It's a bad sign when the tech looks at the screen and tells you to wait right there while he/she goes to get the doctor, but they should not be providing a diagnosis of any sort. So that sounds pretty screwed up.

Edited February 12, 2012 by KevinInNM

[Dad2142Dad 6,559]

What I find totally amusing is that the original post text is probably just some MADE UP BULLSHIT designed to cause a stir and is completely FABRICATED... and everyone jumps on the drama bandwagon... Come on peeps... REALLY?!?!?!?

 

 

 

Sorry to put drama in your day Indy

[unclejake 428]

I hope that my wife or myself never have to set foot in the ER again in our lives!! Been enough!! Check this out.. My wife gradually started suffering from dizziness, and very wobbly on her feet, and listed to the left. Had problems falling when she would turn too quickly After a NASTY fall, she shattered her right shoulder, well surgeon patched that up. Six weeks later, she turned around too quickly and fellagain...you guessed it, same arm, same break. I took her to the ER. We were not dressed to the nines as we were at home, so the ER Dr. was making snide comments easily overheard by us about the "hicks" out there with the broken arm. The triage nurse asked her in front of me if she was being abused BY ME IN FRONT OF ME mind you. (Thats a question you ask a patient AWAY from the hubby!

Anyhow to shorten this up, several Dr.'s later, one found out that she used Nutrasweet in cola's, coffee, etc. Turns out the crap is a neurotoxin, was supposed to have been taken off of the market in "06" (we see that didn't happen)

It had built up in her system for years and after 30 days off of it, the symptoms went away completely!!! Just took a Dr that gave a crap and knew what he was doing!

[Scott Kenny 144]

Hey, Indy? Read this blog: http://ambulancedriverfiles.com/

 

Dude's been an EMT for about 20 years. They really do see shit like that in the ER, and tend to get a really lousy attitude for people abusing the emergency medical services system for pain meds.

[e30eternal 7]

As a person who lives with terrible chronic back-pain,

I still find it both funny and sad that people actually go to an ER for existing pain.

This country has a serious problem on its hands.