Why am I being profiled as a drug seeker by ER staff?
July 14, 2018 5:40 PM Subscribe
I have several questions, and I'd particularly like to hear from medical professionals.
1. Are EMTs and MDs allowed to lie to patients?
2. Insult them?
3. Profile them?
4. What is gained by ER staff treating people like garbage?
5. Are there any repercussions for ER staff who wrongly profile patients in real pain?
6. Why do I keep getting profiled as a drug seeker, when it is so easy to establish that I am not?
7. Why do they refuse to talk to my doctor or look at my records?
8. Should I complain to the hospital again, sue, go to a different hospital, or what, to ensure this does not happen again?
Last fall, I injured my back, not for the first time. The first time was when I was 24, and since then when the old injury has flared up, I treated it as it was treated the first time: lie flat, take pain meds, do tiny core-strengthening exercises until it heals. I have taken prescribed opioids for pain (medical and dental) many times in the past four decades. I don't take them when I am not in pain, they just make me sleepy.
This injury was different. It didn't go away, it got worse. I called the local nurse line and was advised to go to the ER. She thought it sounded like kidney stones. So I called an ambulance, since I couldn't drive and there was no one available to take me.
The ER staff, in particular the resident MD in charge, profiled me as a drug seeker. She lied to me, accused me of faking my pain, and advised me to go score meds on the street because "her" ER would not be giving me any. I repeatedly asked her to call my doctor and look at my medical record (I've been using this hospital for over 25 years, my primary care doc works there, my back injury and prescription history are well documented). She refused and had security escort me out.
I spent the next three weeks in excruciating pain (some days the pain was so bad I threw up to the point of dry heaves. I lost ten pounds that week) while I waited to see my doctor. She prescribed hydrocodone and sent me to a physical therapist. I ended up having to take three months of short term disability, which cost me $4,000 in reduced salary. This was largely attributable to the delay in getting treatment.
I was understandably furious. I wrote to the hospital patient advocate and the state licensing board. I wanted them to reassure me that when I next have to visit that ER (I'm 64, have asthma and had a pulmonary embolism a few years ago, both treated in this ER. I drove myself and walked in both times), my pain would be taken seriously and I would get the care I needed, not lies, abuse, and humiliation. Of course, they assured me. They were terribly sorry.
Two weeks ago, I started having terrible pain in my right leg and hip. I called the nurse line. She told me to go to the ER. I called the ambulance, because I literally could not stand or walk without horrific pain. In the ER, three people had to help me take off my pants. And then they did it again!
It turned out the EMT lied to me in order to confirm his suspicion that I was a drug seeker. He told me the stretcher would not fit into my bedroom, so could I try to walk to it? It never occurred to me that he was lying, so I hobble-hopped, supported by both of the EMTs, about ten feet, in great pain. Anything to get to the hospital and the end of the pain. I would have crawled if necessary. He said he wanted to give me fentanyl, was that OK? and squirted what I'm pretty sure was water up my nose. At the ER, the resident told me the EMT told her I walked unsupported to the stretcher and asked for fentanyl. Again, they refused to call my doctor or look at my medical record. The resident told me to get dressed, go home, and "tough it out." I had to demand help to get dressed and a wheelchair. It was provided grudgingly.
This time, luckily, my doctor prescribed pain meds without seeing me, and referred me to an orthopedist. Last week I had an MRI, which confirmed that I have a herniated disc in my lumbar spine that is pinching a nerve. The orthopedist is appalled about the way I was treated in the ER. He says the pain I've been experiencing is worse than a broken bone or childbirth.
I am beyond baffled by this behavior. I don't lie to medical professionals. I expect them not to lie to me. I've heard that ER staff can tell a liar who is faking pain in order to get drugs a mile away, and yet they cannot seem to tell that I am not a liar who is faking pain. I don't get it. I am a 64-year-old single white woman homeowner with a full time job and good health insurance (I pay plenty for it). What is it about me that screams "opioid addict"?
Neither my health nor my finances will support continuing to go to the ER only to be denied treatment and subjected to abuse. I don't want to go through my old age like this.
1. Are EMTs and MDs allowed to lie to patients?
2. Insult them?
3. Profile them?
4. What is gained by ER staff treating people like garbage?
5. Are there any repercussions for ER staff who wrongly profile patients in real pain?
6. Why do I keep getting profiled as a drug seeker, when it is so easy to establish that I am not?
7. Why do they refuse to talk to my doctor or look at my records?
8. Should I complain to the hospital again, sue, go to a different hospital, or what, to ensure this does not happen again?
Last fall, I injured my back, not for the first time. The first time was when I was 24, and since then when the old injury has flared up, I treated it as it was treated the first time: lie flat, take pain meds, do tiny core-strengthening exercises until it heals. I have taken prescribed opioids for pain (medical and dental) many times in the past four decades. I don't take them when I am not in pain, they just make me sleepy.
This injury was different. It didn't go away, it got worse. I called the local nurse line and was advised to go to the ER. She thought it sounded like kidney stones. So I called an ambulance, since I couldn't drive and there was no one available to take me.
The ER staff, in particular the resident MD in charge, profiled me as a drug seeker. She lied to me, accused me of faking my pain, and advised me to go score meds on the street because "her" ER would not be giving me any. I repeatedly asked her to call my doctor and look at my medical record (I've been using this hospital for over 25 years, my primary care doc works there, my back injury and prescription history are well documented). She refused and had security escort me out.
I spent the next three weeks in excruciating pain (some days the pain was so bad I threw up to the point of dry heaves. I lost ten pounds that week) while I waited to see my doctor. She prescribed hydrocodone and sent me to a physical therapist. I ended up having to take three months of short term disability, which cost me $4,000 in reduced salary. This was largely attributable to the delay in getting treatment.
I was understandably furious. I wrote to the hospital patient advocate and the state licensing board. I wanted them to reassure me that when I next have to visit that ER (I'm 64, have asthma and had a pulmonary embolism a few years ago, both treated in this ER. I drove myself and walked in both times), my pain would be taken seriously and I would get the care I needed, not lies, abuse, and humiliation. Of course, they assured me. They were terribly sorry.
Two weeks ago, I started having terrible pain in my right leg and hip. I called the nurse line. She told me to go to the ER. I called the ambulance, because I literally could not stand or walk without horrific pain. In the ER, three people had to help me take off my pants. And then they did it again!
It turned out the EMT lied to me in order to confirm his suspicion that I was a drug seeker. He told me the stretcher would not fit into my bedroom, so could I try to walk to it? It never occurred to me that he was lying, so I hobble-hopped, supported by both of the EMTs, about ten feet, in great pain. Anything to get to the hospital and the end of the pain. I would have crawled if necessary. He said he wanted to give me fentanyl, was that OK? and squirted what I'm pretty sure was water up my nose. At the ER, the resident told me the EMT told her I walked unsupported to the stretcher and asked for fentanyl. Again, they refused to call my doctor or look at my medical record. The resident told me to get dressed, go home, and "tough it out." I had to demand help to get dressed and a wheelchair. It was provided grudgingly.
This time, luckily, my doctor prescribed pain meds without seeing me, and referred me to an orthopedist. Last week I had an MRI, which confirmed that I have a herniated disc in my lumbar spine that is pinching a nerve. The orthopedist is appalled about the way I was treated in the ER. He says the pain I've been experiencing is worse than a broken bone or childbirth.
I am beyond baffled by this behavior. I don't lie to medical professionals. I expect them not to lie to me. I've heard that ER staff can tell a liar who is faking pain in order to get drugs a mile away, and yet they cannot seem to tell that I am not a liar who is faking pain. I don't get it. I am a 64-year-old single white woman homeowner with a full time job and good health insurance (I pay plenty for it). What is it about me that screams "opioid addict"?
Neither my health nor my finances will support continuing to go to the ER only to be denied treatment and subjected to abuse. I don't want to go through my old age like this.
I have been treated like this when I have gone to the ER for my very severe, very real migraines. Some ER staff seem to hate their patients and simply assume that everyone who doesn't have immediately obvious trauma is a drug seeker. It's horrible, and I am sorry you were treated that way.
posted by all the light we cannot see at 5:58 PM on July 14, 2018 [3 favorites]
posted by all the light we cannot see at 5:58 PM on July 14, 2018 [3 favorites]
Do you have health insurance? Your health insurance company would probably be very interested in hearing about this. They’re paying these claims for you not actually receiving adequate care.
Health insurance companies HATE paying claims.
posted by bilabial at 5:59 PM on July 14, 2018 [32 favorites]
Health insurance companies HATE paying claims.
posted by bilabial at 5:59 PM on July 14, 2018 [32 favorites]
I’m not a medical specialist so I can’t answer most of your questions. I do think you need to go to a specialist now that you know what’s wrong and fix the herniated disk whether through surgery or whatever else they suggest so you can bypass ER altogether. In the meantime get your normal doctor to give you strong enough pain meds in case it flares up in the meantime so you don’t have to go back to an ER. If you do have to, go to a different one. Have paperwork with you from your doctor confirming that it’s a legitimate issue. But the problem needs to be fixed which ER can’t do anyway.
Opioid abuse is an epidemic and I think the ER docs just see so many drug seekers with “back pain” they get frustrated and put even those with a legitimate complaint in the same basket.
I feel very badly for you, I know a few people who have the same issue and the pain is indescribable. At this point though your focus shouldn’t be on retribution towards the ER (though I get why you feel that way) it should be getting back on your feet. Everything else is just a distraction. Feel better soon.
posted by Jubey at 5:59 PM on July 14, 2018 [2 favorites]
Opioid abuse is an epidemic and I think the ER docs just see so many drug seekers with “back pain” they get frustrated and put even those with a legitimate complaint in the same basket.
I feel very badly for you, I know a few people who have the same issue and the pain is indescribable. At this point though your focus shouldn’t be on retribution towards the ER (though I get why you feel that way) it should be getting back on your feet. Everything else is just a distraction. Feel better soon.
posted by Jubey at 5:59 PM on July 14, 2018 [2 favorites]
What you experienced is not uncommon, especially with people who ave a hard time getting a diagnosis. I have a friend who was finally diagnosed with several kinds of Lyme disease. He spent years being told he was drug-seeking, and this was before the opioid epidemic. Medical professionals don't seem to believe in pain sometimes. I agree that you should tell your insurer.
posted by irisclara at 6:23 PM on July 14, 2018 [1 favorite]
posted by irisclara at 6:23 PM on July 14, 2018 [1 favorite]
I’m an ER nurse. Questions 1 through 4 are not asked in good faith so I can’t help you there.
5. Not really - the patient will probably follow up with their PCP or a specialist until their pain is treated.
6. It’s actually not easy to establish that anyone is or is not a drug seeker. 40 year old men on suboxone with a history of IV drug use (who you might profile as a “drug seeker” from their chart) can injure their back and show up in excruciating pain. Or a 70 year old lady who has been stealing her husbands pills (ie - chart would not suggest drug seeking behavior) can claim she fell down the stairs and can’t move.
7. Im guessing the ER staff won’t contact your doctor because they are busy. They are definitely looking at your chart if they are concerned about drug seeking behavior, unless they switched to a new computer system or something that makes it difficult to access records.
8. Definitely complain again! To the director of the ER if you can. I don’t think you’ll get anywhere by sueing them since it will be hard to prove that their inaction caused you harm - I realize that it sounds like they missed a giant problem that got worse. This happens ALL THE TIME. It totally sucks and I think you should go to a different ER, definitely.
posted by pintapicasso at 6:24 PM on July 14, 2018 [32 favorites]
5. Not really - the patient will probably follow up with their PCP or a specialist until their pain is treated.
6. It’s actually not easy to establish that anyone is or is not a drug seeker. 40 year old men on suboxone with a history of IV drug use (who you might profile as a “drug seeker” from their chart) can injure their back and show up in excruciating pain. Or a 70 year old lady who has been stealing her husbands pills (ie - chart would not suggest drug seeking behavior) can claim she fell down the stairs and can’t move.
7. Im guessing the ER staff won’t contact your doctor because they are busy. They are definitely looking at your chart if they are concerned about drug seeking behavior, unless they switched to a new computer system or something that makes it difficult to access records.
8. Definitely complain again! To the director of the ER if you can. I don’t think you’ll get anywhere by sueing them since it will be hard to prove that their inaction caused you harm - I realize that it sounds like they missed a giant problem that got worse. This happens ALL THE TIME. It totally sucks and I think you should go to a different ER, definitely.
posted by pintapicasso at 6:24 PM on July 14, 2018 [32 favorites]
This is so awful.
YMMV, because I'm in Canada and the system here may be different, but can you request your medical records from the hospital to determine if there's something in there (as I imagine there is) causing this issue? Around here, there's a cost associated with this - unless you have your family physician do it on your behalf. From there, you may be able to request an amendment.
I don't know the structure of the hospital, but the moment you are feeling well enough, I think it's appropriate to complain to whomever possible. (It's easier to do this when you're not simultaneously trying to advocate for your health care and in overwhelming pain.)
Also, even if someone is drug-seeking, I'd still say that this behaviour from the ER isn't humane or appropriate.
posted by VioletU at 6:32 PM on July 14, 2018 [1 favorite]
YMMV, because I'm in Canada and the system here may be different, but can you request your medical records from the hospital to determine if there's something in there (as I imagine there is) causing this issue? Around here, there's a cost associated with this - unless you have your family physician do it on your behalf. From there, you may be able to request an amendment.
I don't know the structure of the hospital, but the moment you are feeling well enough, I think it's appropriate to complain to whomever possible. (It's easier to do this when you're not simultaneously trying to advocate for your health care and in overwhelming pain.)
Also, even if someone is drug-seeking, I'd still say that this behaviour from the ER isn't humane or appropriate.
posted by VioletU at 6:32 PM on July 14, 2018 [1 favorite]
So, healthcare social worker here:
Ultimately , anyone can be an addict. Even people just like you. It's hard for doctors to figure it out and harder on patients who suffer. I'm sorry this happened to you.
It is complicated and there isn't a great answer for this, and sometimes there is just nothing you can do because some people are assholes. This is something that happens across ER in the country so changing hospitals may help, but it might not.
Things that may help:
1) focus on the change of condition that brought you to the ER. Concrete examples of what you could do that you now can't. If there was an event when it started, let them know.
2)request tests for figuring out what is wrong and if it's fixable, not the pain meds itself.
3)bringing someone to advocate
Ultimately, getting the tests run that justify the pain medicine would be more likely to get you it( if they can see what is wrong) but you didn't seem to make it that far. Of course be honest about your pain, but try not to make it the focus if you can.
At this point you'll likely end up seeing outpatient doctors for follow up pain management and the ER wouldn't treat (as it's not the initial onset)anyway. A relationship with an outpatient doctor to handle pain management is by far the best way to get pain treated.
posted by AlexiaSky at 7:08 PM on July 14, 2018 [14 favorites]
Ultimately , anyone can be an addict. Even people just like you. It's hard for doctors to figure it out and harder on patients who suffer. I'm sorry this happened to you.
It is complicated and there isn't a great answer for this, and sometimes there is just nothing you can do because some people are assholes. This is something that happens across ER in the country so changing hospitals may help, but it might not.
Things that may help:
1) focus on the change of condition that brought you to the ER. Concrete examples of what you could do that you now can't. If there was an event when it started, let them know.
2)request tests for figuring out what is wrong and if it's fixable, not the pain meds itself.
3)bringing someone to advocate
Ultimately, getting the tests run that justify the pain medicine would be more likely to get you it( if they can see what is wrong) but you didn't seem to make it that far. Of course be honest about your pain, but try not to make it the focus if you can.
At this point you'll likely end up seeing outpatient doctors for follow up pain management and the ER wouldn't treat (as it's not the initial onset)anyway. A relationship with an outpatient doctor to handle pain management is by far the best way to get pain treated.
posted by AlexiaSky at 7:08 PM on July 14, 2018 [14 favorites]
I used to work in emergency medicine. I'd suggest asking your primary care doctor how to make sure your complaints are taken seriously in the ER - since your doc both knows you and knows their own hospital, they might have the best suggestions on how to bridge that communication gap. As for why you were considered a drug seeker, for your first ER visit, you don't tell us anything between the time you got on the ambulance and the time the doctor decided you were a drug seeker, so it's hard to make any kind of guess. For your second visit, if they looked in your record, they saw you had previously been in the ER for pain and had to be escorted out by security, which isn't a good foundation for your visit to start on. Now you have 2 ER visits documented this way, which is all the more reason to talk with your doctor or someone else and make sure the problem doesn't keep compounding.
posted by sdrawkcaSSAb at 8:41 PM on July 14, 2018 [14 favorites]
posted by sdrawkcaSSAb at 8:41 PM on July 14, 2018 [14 favorites]
Because you may in future have to use the ER again (whether this one or, ideally, another one), you might want to put together some documentation from your doctors to take with you when you go. It might not always help, but it seems worth the try. You should also discuss with your doctor if there's anything else you can do in that situation. Would they be willing to give you their cell number, to be used only in that circumstance? Would they be willing to call the ER themselves and tell them to expect you? Can they talk with the ER now and have your record cleared up?
posted by trig at 8:44 PM on July 14, 2018 [3 favorites]
posted by trig at 8:44 PM on July 14, 2018 [3 favorites]
I would do whatever you could to get your record corrected and possibly annotated, so that a physician will see a note from your doctor, and maybe a link to relevant x-rays. If it takes filing suit, well, that would be interesting.
I am not sure the above wouldn't have negative repercussions, but in your situation, I would at least explore the possibility, maybe starting with some kind of advocate through your insurance company.
"Baffled" as your descriptive word makes me want to hang out with you. I bet you have a good sense of humor.
posted by amtho at 8:54 PM on July 14, 2018
I am not sure the above wouldn't have negative repercussions, but in your situation, I would at least explore the possibility, maybe starting with some kind of advocate through your insurance company.
"Baffled" as your descriptive word makes me want to hang out with you. I bet you have a good sense of humor.
posted by amtho at 8:54 PM on July 14, 2018
I am appalled at the people who seem to be saying that you were treated reasonably since so many other people are drug-seekers. (That's aside from the issue that the "opioid epidemic" was largely caused by pharma companies wooing doctors into over-prescribing.)
If there are many patients acting like scam artists or criminals to seek drugs, the solution is not, "treat every patient who says they're in extreme pain as a drug seeker and tell them to tough it out; if they're in real agony, they'll get worse and come back."
I wish I could tell you that you should sue. You probably have grounds for a lawsuit - the loss of wages and the mistreatment sure look like medical malpractice. But the current attitude is, any amount of cruelty is justified to prevent people who don't "need" opioids from getting them.
You should talk to a lawyer, but don't get your hopes up. Odds are better if you've got strong documentation: dates and times of every event, notes of who-said-what as best you can remember, and so on.
posted by ErisLordFreedom at 9:26 PM on July 14, 2018 [25 favorites]
If there are many patients acting like scam artists or criminals to seek drugs, the solution is not, "treat every patient who says they're in extreme pain as a drug seeker and tell them to tough it out; if they're in real agony, they'll get worse and come back."
I wish I could tell you that you should sue. You probably have grounds for a lawsuit - the loss of wages and the mistreatment sure look like medical malpractice. But the current attitude is, any amount of cruelty is justified to prevent people who don't "need" opioids from getting them.
You should talk to a lawyer, but don't get your hopes up. Odds are better if you've got strong documentation: dates and times of every event, notes of who-said-what as best you can remember, and so on.
posted by ErisLordFreedom at 9:26 PM on July 14, 2018 [25 favorites]
I'm deeply curious as well. I ended up in the ER via ambulance in extreme pain. I was ambulatory but in distress getting into the ambulance, and received one dose of pain medication but denied the next few (but they were administered anyway). The ER doc thought I was a heroin addict based on the fact that the amount of medication administered should have stopped my breathing.
Nothing in my past medical history was indicative; this was a first-time one-off and the issue had never been seen at the ER before (I was a repeat patient at the ER for other, lethal reasons which don't require pain medications).
And yet I was treated like a heroin addict because, I suppose, I was in too much pain for the opioids they'd administered to have an effect.
So I think it's just a side effect of the epidemic. Can't do nothin'.
posted by Nyx at 9:48 PM on July 14, 2018 [3 favorites]
Nothing in my past medical history was indicative; this was a first-time one-off and the issue had never been seen at the ER before (I was a repeat patient at the ER for other, lethal reasons which don't require pain medications).
And yet I was treated like a heroin addict because, I suppose, I was in too much pain for the opioids they'd administered to have an effect.
So I think it's just a side effect of the epidemic. Can't do nothin'.
posted by Nyx at 9:48 PM on July 14, 2018 [3 favorites]
I was treated like this once in the 90s when I went into an ER (for the first time) terrified and incapacitated with pain. They left me screaming for hours, refused to give me medication, were just all around terrible. I was a young woman, alone. The memory ranks as maybe my all time worst. For years I avoided the ER even when I needed it, it had been such a grim experience.
More recently I went to a (different) ER, again for kidney stones, this time accompanied by my husband. I was treated like a QUEEN. Quick triage, dilaudid, sympathy, a referral to a specialist, the works.
All I can suggest is maybe get someone to go with you if possible? Ideally a man.
And I'm sorry this happened to you. I'm terribly sorry and 100% sympathetic. I won't give you my theories about the "epidemic" but yes, it's disgraceful and appalling that it's being used as an excuse to withhold pain treatment from patients. It isn't the first time that notions about the dangers of intoxication have been used as an excuse to cudgel puritanical virtue fantasies onto the powerless.
posted by fingersandtoes at 10:22 PM on July 14, 2018 [28 favorites]
More recently I went to a (different) ER, again for kidney stones, this time accompanied by my husband. I was treated like a QUEEN. Quick triage, dilaudid, sympathy, a referral to a specialist, the works.
All I can suggest is maybe get someone to go with you if possible? Ideally a man.
And I'm sorry this happened to you. I'm terribly sorry and 100% sympathetic. I won't give you my theories about the "epidemic" but yes, it's disgraceful and appalling that it's being used as an excuse to withhold pain treatment from patients. It isn't the first time that notions about the dangers of intoxication have been used as an excuse to cudgel puritanical virtue fantasies onto the powerless.
posted by fingersandtoes at 10:22 PM on July 14, 2018 [28 favorites]
Do you have anybody at all who is a white man who can go with you if you need to go again? Studies show that women and people of color are not only treated worse than white men across the board by medical practitioners, but that abuse of women (this has been more studied than the others) and people of color is occurring both via unconscious bias and deliberate opportunistic actions. Because that's fun, apparently.
There probably is a way to hire someone to be your boyfriend/son/nephew in an emergency, though I'd probably ask around my social network first to see if anyone's got one who's medically knowledgeable and trustworthy before casting a wider net.
posted by Lyn Never at 11:35 PM on July 14, 2018 [17 favorites]
There probably is a way to hire someone to be your boyfriend/son/nephew in an emergency, though I'd probably ask around my social network first to see if anyone's got one who's medically knowledgeable and trustworthy before casting a wider net.
posted by Lyn Never at 11:35 PM on July 14, 2018 [17 favorites]
I don't work in an ED, but I've consulted in them. As others have said, the message that anyone can become addicted is being heavily pushed (my state required 3 hours of opioid training before it would let me renew my license, of which at least half was about "dispelling myths" about what addiction looks like, and maybe 5 minutes was about how to help someone recover). Also, once someone has been burned by a drug-seeking patient (whether that's a patient death from overdose or being named in a lawsuit or even just anger at themselves for "being tricked") they are going to be hyper-suspicious of everyone requesting pain meds for a while. This doesn't excuse the way you've been treated, but might explain some of the background of what's been going through the minds of the ED staff in the days/weeks before you came in last fall.
Many electronic medical records have flags that pop up when you open the chart -- in mine, History of Drug-Seeking Behavior is one of them. Once that flag gets attached to your record, it will bias any provider you see at that facility. Can you ask your primary if a flag has been attached to your record, and if so, can they get it removed? Rare intermittent opioid use over decades doesn't sound like it would trigger an automatic flag. One really crappy possibility is that someone (EMS, triage, RN) intended to flag someone ELSE's chart but accidentally clicked on yours.
posted by basalganglia at 12:20 AM on July 15, 2018 [10 favorites]
Many electronic medical records have flags that pop up when you open the chart -- in mine, History of Drug-Seeking Behavior is one of them. Once that flag gets attached to your record, it will bias any provider you see at that facility. Can you ask your primary if a flag has been attached to your record, and if so, can they get it removed? Rare intermittent opioid use over decades doesn't sound like it would trigger an automatic flag. One really crappy possibility is that someone (EMS, triage, RN) intended to flag someone ELSE's chart but accidentally clicked on yours.
posted by basalganglia at 12:20 AM on July 15, 2018 [10 favorites]
Could your doctor advocate for you? Ask for the ER record, and call someone in the administration on your behalf? I'm a doctor not in the US and I would have called in this situation but I am not sure how feasible this is stateside.
I would also file a written complaint with documentation signed by your doctor.
If you are going to complain, make sure to use factual language "I was informed that the stretcher would not through the door of my apartment and so walked through the door despite intense pain" "I was given incorrect information by X, namely...", "I was refused treatment and no tests were performed" "I offered my doctor's contact information but it was declined"
Do not speak of "being treated like garbage". No emotional language, no rhetorical questions (like your 1-4). Have your doctor or another person you trust to be calm and level-headed read through your complaint before you file it. Then file it. This shouldn't have happened.
In your complaint, ask to have your record corrected. If you receive any response/ apology, take it with you in case you end up going to the ER.
posted by M. at 12:31 AM on July 15, 2018 [16 favorites]
I would also file a written complaint with documentation signed by your doctor.
If you are going to complain, make sure to use factual language "I was informed that the stretcher would not through the door of my apartment and so walked through the door despite intense pain" "I was given incorrect information by X, namely...", "I was refused treatment and no tests were performed" "I offered my doctor's contact information but it was declined"
Do not speak of "being treated like garbage". No emotional language, no rhetorical questions (like your 1-4). Have your doctor or another person you trust to be calm and level-headed read through your complaint before you file it. Then file it. This shouldn't have happened.
In your complaint, ask to have your record corrected. If you receive any response/ apology, take it with you in case you end up going to the ER.
posted by M. at 12:31 AM on July 15, 2018 [16 favorites]
This happened to me too! As far as I can tell the ER staff and EMTs have been recently encouraged or ordered to judge who is a drug seeker but provided no real way to do so other than their personal feelings. Most of them seem to hate their patients or at least think they are all stupid and this seems to have caused an EXTREMELY toxic culture where staff are able to be wildly unprofessional to patients and patient groups they don't like for any reason then say it was because they were drug seeking. For perspective one of my friends who is an MD quite ER last year to take a position in a men's prison and she says it's much lower stress and she likes the people she works with better. Prior to that not a week went by without some horrific story about one of her ER colleagues missing some terrible diagnosis because they were just judging people by their gender, socioeconomic status or looks instead of examining them. She got real tired of fighting the hospital on it. The whole culture needs to change and the doctors need more time off or something. Everyone I've ever met was fucking miserable.
When it happened to me what I did was go back and have a sit down meeting with the hospital manager where we discussed the staff and I went over the treatment I got (nothing but a lecture on how painkiller are bad m'kay even though I specifically told them I didn't want any as they make me sick and I was already very sick) and the medical condition I had that was not treated until I went to another clinic (internal bleeding, MF'ers- they wrote back pain and migraines on my discharge paperwork, they refused to do any tests and wouldn't examine me). I heard later that the MD left or was fired over it. He was clearly a total burn out and needed a long vacation so I think that was a good outcome. If I were you I would push for a full review of the MD in question and also make a report to the medical board of your state, although most are useless.
I received one dose of pain medication but denied the next few (but they were administered anyway). The ER doc thought I was a heroin addict based on the fact that the amount of medication administered should have stopped my breathing.
It's very possible you got saline for the later doses and someone on staff pocketed the drugs fyi. Apparently that is a huge problem.
posted by fshgrl at 2:27 AM on July 15, 2018 [18 favorites]
When it happened to me what I did was go back and have a sit down meeting with the hospital manager where we discussed the staff and I went over the treatment I got (nothing but a lecture on how painkiller are bad m'kay even though I specifically told them I didn't want any as they make me sick and I was already very sick) and the medical condition I had that was not treated until I went to another clinic (internal bleeding, MF'ers- they wrote back pain and migraines on my discharge paperwork, they refused to do any tests and wouldn't examine me). I heard later that the MD left or was fired over it. He was clearly a total burn out and needed a long vacation so I think that was a good outcome. If I were you I would push for a full review of the MD in question and also make a report to the medical board of your state, although most are useless.
I received one dose of pain medication but denied the next few (but they were administered anyway). The ER doc thought I was a heroin addict based on the fact that the amount of medication administered should have stopped my breathing.
It's very possible you got saline for the later doses and someone on staff pocketed the drugs fyi. Apparently that is a huge problem.
posted by fshgrl at 2:27 AM on July 15, 2018 [18 favorites]
I agree that Visit 1 probably got you flagged in this particular ED (and its associated health system, if any) and that you can and should follow up with them to try to get it removed before you need the ED again. More broadly, in the current moral panic over opioids, I would be very wary of using most EDs for orthopedic pain short of very narrow and acute circumstances, such as a weekend or obvious broken bone, suspected spinal cord injury, or an accident where documentation of a visit is important — and always holler for a diagnosis rather than pain treatment (which, to be clear, you have every right to expect).
Your insurer’s nurse line is always going to err on the side of sending you there because they can’t do much else. It isn’t right, but part of the *personal* workaround here is finding a primary care doc who can get on the phone to advise more realistically in these situations and schedule you promptly to be seen in their office to avoid the ED — there are much other, larger problems in your post, but having to wait a week for a visit with your primary after pain that was bad enough for you to go to there in the first instance is too darned long.
posted by LadyInWaiting at 5:52 AM on July 15, 2018 [4 favorites]
Your insurer’s nurse line is always going to err on the side of sending you there because they can’t do much else. It isn’t right, but part of the *personal* workaround here is finding a primary care doc who can get on the phone to advise more realistically in these situations and schedule you promptly to be seen in their office to avoid the ED — there are much other, larger problems in your post, but having to wait a week for a visit with your primary after pain that was bad enough for you to go to there in the first instance is too darned long.
posted by LadyInWaiting at 5:52 AM on July 15, 2018 [4 favorites]
Mod note: Comment removed. Asker, totally understandable that this is a frustrating situation for you, but please take what you can from the answers you've found useful and don't get into point-by-point rebukes of the ones you haven't.
posted by cortex (staff) at 9:12 AM on July 15, 2018
posted by cortex (staff) at 9:12 AM on July 15, 2018
I've been to the ER 10 times for anxiety/psychiatric issues.
You have to act. You're in pain and afraid but the EMTs/nurses/doctors really don't care. They're trained to blunt their emotional reaction and treat you like a machine with a problem to be fixed.
You know what you need: pain medication. Asking for pain medication is a huge mistake and will instantly get you red flagged. Instead you have to play the tech support game. You have to let them figure out and come to conclusions you already know. They're the professionals and this is their job and they're proud of their skills; they'll be damned if some raving lunatic on a stretcher has the answer.
You have to almost act like a child in terms of your ignorance of your body. Don't reference technical medical knowledge. Act grateful and surprised when the nurse finally says something that will guide them toward giving you pain medication. When they are finally about to give you the medication feign ignorance about the prescription and ask them what it's for or how it's going to help like you never heard of klonopin or xanax or oxycontin or morphine.
I'm sorry it has to be this way but unless you get very lucky this is my lived experience in the ER. I made the mistake of not acting my first couple of times to the ER and was also treated like a drug seeker. After that I learned to act and was treated every time with dignity.
posted by laptolain at 11:00 AM on July 15, 2018 [10 favorites]
You have to act. You're in pain and afraid but the EMTs/nurses/doctors really don't care. They're trained to blunt their emotional reaction and treat you like a machine with a problem to be fixed.
You know what you need: pain medication. Asking for pain medication is a huge mistake and will instantly get you red flagged. Instead you have to play the tech support game. You have to let them figure out and come to conclusions you already know. They're the professionals and this is their job and they're proud of their skills; they'll be damned if some raving lunatic on a stretcher has the answer.
You have to almost act like a child in terms of your ignorance of your body. Don't reference technical medical knowledge. Act grateful and surprised when the nurse finally says something that will guide them toward giving you pain medication. When they are finally about to give you the medication feign ignorance about the prescription and ask them what it's for or how it's going to help like you never heard of klonopin or xanax or oxycontin or morphine.
I'm sorry it has to be this way but unless you get very lucky this is my lived experience in the ER. I made the mistake of not acting my first couple of times to the ER and was also treated like a drug seeker. After that I learned to act and was treated every time with dignity.
posted by laptolain at 11:00 AM on July 15, 2018 [10 favorites]
Have you discussed with your PCP establishing a "pain contract" and/or considered a pain clinic to deal with your chronic pain?
Someone very close to me was diagnosed last August with Ankylosing Spondylitis after years of pain and discomfort. They need pain medicine for relief, not because they're trying to get high. After years of uncontrolled pain very recently were they able to find a doctor who would listen and believe the pain was very real. Now they are on a pain contract and subject to monthly UAs and pill counts, but she gets her script for pain every month.
My friend is now researching CBD Oil in an effort to find an alternative to pharmaceuticals. Have you had a chance to look into that??
posted by AnneBoleyn at 12:58 PM on July 15, 2018 [1 favorite]
Someone very close to me was diagnosed last August with Ankylosing Spondylitis after years of pain and discomfort. They need pain medicine for relief, not because they're trying to get high. After years of uncontrolled pain very recently were they able to find a doctor who would listen and believe the pain was very real. Now they are on a pain contract and subject to monthly UAs and pill counts, but she gets her script for pain every month.
My friend is now researching CBD Oil in an effort to find an alternative to pharmaceuticals. Have you had a chance to look into that??
posted by AnneBoleyn at 12:58 PM on July 15, 2018 [1 favorite]
Also - it’s ok to straight up ask for pain medication in the ER. Jeezum crow, it’s not some delicate dance where you tip toe around the fragile egos of the doctors and nurses. (Frankly, their egos are most definitely NOT tied to how they are treated by patients, or no one could work there).
Be honest with the staff. If you are in excruciating pain then tell them. You will do yourself a disservice by trying to play mind games with people who actually DO want to help you.
And acute pain is a totally valid reason to go the ER.
posted by pintapicasso at 2:01 PM on July 15, 2018 [2 favorites]
Be honest with the staff. If you are in excruciating pain then tell them. You will do yourself a disservice by trying to play mind games with people who actually DO want to help you.
And acute pain is a totally valid reason to go the ER.
posted by pintapicasso at 2:01 PM on July 15, 2018 [2 favorites]
It has less to do with the egos of the medical staff and more to do with their biases, which other people here have attested to. It's really just a matter of hedging your bets. You can ask for pain meds and risk being seen as "drug seeking" or you can tell painless white lies to get medication in any scenario. Being in terrible pain and not only *not* getting relief but being treated like a criminal is not an experience I would want anyone here to experience. The sad truth is it happens more often than you seem to know or want to believe.
More pragmatic advice: depending on the immediacy of your medical issue try to go to the ER dressed professionally and with good hygiene. Yes it's the *emergency* room and it's for acute pain and you shouldn't delay going there in case it's something immediately life threatening. That said, many times going to the emergency room is more of a "it's 3am and doctors offices are closed, I think I should go to the ER" decision. In that situation consider it.
posted by laptolain at 2:53 PM on July 15, 2018 [1 favorite]
More pragmatic advice: depending on the immediacy of your medical issue try to go to the ER dressed professionally and with good hygiene. Yes it's the *emergency* room and it's for acute pain and you shouldn't delay going there in case it's something immediately life threatening. That said, many times going to the emergency room is more of a "it's 3am and doctors offices are closed, I think I should go to the ER" decision. In that situation consider it.
posted by laptolain at 2:53 PM on July 15, 2018 [1 favorite]
Nurse here. Some thoughts in no particular order:
- I understand your anger and desperation to get the care you need. I say with complete respect, but also with honesty, you are unlikely to have the outcome you desire if you are walking back into that ER with the framing you have in this question. I'm saying, I hear you, but if you want advice on this, take a listen to how the ER might be framing this.
- ER providers work quickly to stabilize people and them send them back to primary care, an appropriate specialist, or a hospital bed. That's their job: quickly solve a problem or refer to someone else. They don't generally call people's primary care doctors (although they sometimes do). They aren't set up to come up with long term solutions to medical problems, but to come up with short term solutions. If you have an ongoing pain problem, you need follow up from a primary care provider, or your PCP should refer you to an appropriate specialist to address the cause of your extreme pain. You finally got to an orthopedist. That's great! This is the right person to address your misery.
- ER providers and staff are also people. Stressed, busy people, who are dealing with life and death problems every day. ER providers should treat everyone completely equally, but if you walk into the ER angry, accusing people, threatening law suits, etc, you are likely to have a negative response. However justified you may feel or may be in your anger, the nature of humans is, we don't like being yelled at.
- It would be very surprising to me if an EMT stated directly to you that they are providing a pain medication and then not providing it. I think this is unlikely and impossible to prove at this point either way.
- You should know that there has been a shift in prescribing practices because of the rise of opiate addiction. Prescribers are much more reticent to prescribe opiates than they were 5 years ago. Why? People are dying of opiate overdoses in enormous numbers. In my opinion, opiates were prescribed too easily in the past. In my opinion, their are instances now when they are under-prescribred. This is a challenging issue for providers as they want, no, they are ethically bound, to try to do the safest thing they can while reducing suffering. There is subjective and difficult judgement involved.
- There may well be a note in your chart stating they believe you are drug seeking. You can actually find out for sure simply by ordering a copy of your medical records from the hospital. It is available for a nominal fee or free.
In conclusion, my advice:
- Follow up with your orthopedist. This is the best person to address the causes of your severe pain.
- If you are in a crisis of pain, yes, go to the ER. Consider going to a different ER than this one. Then do your best to assume the best of these busy people who have a lot of other patients in crisis as well. Clearly and specifically state your problem: "I am in 10 out of 10 pain." or "I am in the worst pain of my life" or "I haven't been able to stand up for 3 days because of pain". Know that pain management is a very challenging area of medicine. Often we can only reduce but not totally eliminate the pain. In the ER, their job is to get you stable, so someone in the outpatient setting, like an orthopedist, can help address the underlying problem.
posted by latkes at 3:18 PM on July 15, 2018 [7 favorites]
- I understand your anger and desperation to get the care you need. I say with complete respect, but also with honesty, you are unlikely to have the outcome you desire if you are walking back into that ER with the framing you have in this question. I'm saying, I hear you, but if you want advice on this, take a listen to how the ER might be framing this.
- ER providers work quickly to stabilize people and them send them back to primary care, an appropriate specialist, or a hospital bed. That's their job: quickly solve a problem or refer to someone else. They don't generally call people's primary care doctors (although they sometimes do). They aren't set up to come up with long term solutions to medical problems, but to come up with short term solutions. If you have an ongoing pain problem, you need follow up from a primary care provider, or your PCP should refer you to an appropriate specialist to address the cause of your extreme pain. You finally got to an orthopedist. That's great! This is the right person to address your misery.
- ER providers and staff are also people. Stressed, busy people, who are dealing with life and death problems every day. ER providers should treat everyone completely equally, but if you walk into the ER angry, accusing people, threatening law suits, etc, you are likely to have a negative response. However justified you may feel or may be in your anger, the nature of humans is, we don't like being yelled at.
- It would be very surprising to me if an EMT stated directly to you that they are providing a pain medication and then not providing it. I think this is unlikely and impossible to prove at this point either way.
- You should know that there has been a shift in prescribing practices because of the rise of opiate addiction. Prescribers are much more reticent to prescribe opiates than they were 5 years ago. Why? People are dying of opiate overdoses in enormous numbers. In my opinion, opiates were prescribed too easily in the past. In my opinion, their are instances now when they are under-prescribred. This is a challenging issue for providers as they want, no, they are ethically bound, to try to do the safest thing they can while reducing suffering. There is subjective and difficult judgement involved.
- There may well be a note in your chart stating they believe you are drug seeking. You can actually find out for sure simply by ordering a copy of your medical records from the hospital. It is available for a nominal fee or free.
In conclusion, my advice:
- Follow up with your orthopedist. This is the best person to address the causes of your severe pain.
- If you are in a crisis of pain, yes, go to the ER. Consider going to a different ER than this one. Then do your best to assume the best of these busy people who have a lot of other patients in crisis as well. Clearly and specifically state your problem: "I am in 10 out of 10 pain." or "I am in the worst pain of my life" or "I haven't been able to stand up for 3 days because of pain". Know that pain management is a very challenging area of medicine. Often we can only reduce but not totally eliminate the pain. In the ER, their job is to get you stable, so someone in the outpatient setting, like an orthopedist, can help address the underlying problem.
posted by latkes at 3:18 PM on July 15, 2018 [7 favorites]
I think it's worth bearing in mind that the priorities and framing of the er staff may be different to yours.
In both instances you describe, you've attended the er for an exacerbation of a chronic pain condition. ER staff may feel that this isn't the best use of resources and this could be one of the flags that gets you "profiled" as you describe. Calling an ambulance because you can't get a ride might also be a flag - again as misuse of resources rather than drug seeking per se.
ER staff will be prioritising unwell patients with potentially life threatening injuries /illnesses. They don't want you to be in pain, but it isn't their priority. If you keep demanding they contact your doctor while they are trying to juggle multiple unwell patients they may feel antagonised. In an ideal world this wouldn't happen, but staff are human too.
It's also worth noting that you kind of are drug seeking - "this time, luckily, my doctor prescribed pain meds without seeing me" - just for legitimate reasons. If you are also threatening complaints and making extra demands on people's time that may skew this into looking like illegitimate drug seeking behaviour.
The way you were treated is wrong, fundamentally, but your question was partly about why this might have happened, and some of it may be to do with the above.
posted by bored_now_flay at 4:18 AM on August 11, 2018
In both instances you describe, you've attended the er for an exacerbation of a chronic pain condition. ER staff may feel that this isn't the best use of resources and this could be one of the flags that gets you "profiled" as you describe. Calling an ambulance because you can't get a ride might also be a flag - again as misuse of resources rather than drug seeking per se.
ER staff will be prioritising unwell patients with potentially life threatening injuries /illnesses. They don't want you to be in pain, but it isn't their priority. If you keep demanding they contact your doctor while they are trying to juggle multiple unwell patients they may feel antagonised. In an ideal world this wouldn't happen, but staff are human too.
It's also worth noting that you kind of are drug seeking - "this time, luckily, my doctor prescribed pain meds without seeing me" - just for legitimate reasons. If you are also threatening complaints and making extra demands on people's time that may skew this into looking like illegitimate drug seeking behaviour.
The way you were treated is wrong, fundamentally, but your question was partly about why this might have happened, and some of it may be to do with the above.
posted by bored_now_flay at 4:18 AM on August 11, 2018
This thread is closed to new comments.
posted by Dolley at 5:56 PM on July 14, 2018 [4 favorites]