We’ve all had those patients that have pushed us to our limits and made us reconsider our career paths. These patients are usually frequent flyers. It almost seems like certain conditions can cause certain patient characteristics.
Some of you know as soon as you hear a certain diagnoses, you by instinct know that your day/night is going to consist of you passing multiple pain meds, waiting on them hand and foot, all while trying to keep them hemodynamically stable.
One begins to wonder if there is a secret meeting of these patients where they actually discuss the different medications they are getting from the nurse, just imagine it, a fictional post from this over the top patient:
- “The nurse was just here and only gave me my IV dilaudid, she actually wants me to wait a “safe” amount of time before she will give me the IV Phenergan and benadryl, seriously I guess I will wait because in 30 minutes my oxycodone will be due and I made sure to set the timer on my phone so she won’t “forget” to bring them on time.”
- “Ugh I am so hungry let me call for some ice cream, graham crackers and peanut butter. Oh good the tech is here with my snacks, now she can help me reposition several times.”
- “She just left and now I need to pee so badly, better call her back. Yay, my timer went off it’s time for meds better call the nurse. OK it’s been at least 5 minutes since I called, where is she, better call again. It’s about time, 10 minutes really….my pain is a 10 and I feel so nauseous. Oh yes there is the relief from Phenergan, benadryl, oxycodone mix. Nurse please bring me a ginger ale and sandwhich I am starving. The doctor is here, we need to talk about my pain medications I need to be getting the dilaudid more frequently or he needs to increase it. I wonder who the next nurse is, I hope it’s not the one that won’t wake me up for pain meds.”
This is sadly not an over exaggeration, this is the way it appears at times with some patients. They seem to always be in pain and need other medications to provide nausea relief and itching associated with some pain medications.
So how do we handle these patients?
Well, once upon a time doctors would limit the medications given and people would have to use more alternative methods such as ice, heat, relaxation, massage, and distraction.
Now with one of the main questions asked to patients on surveys being how well their pain was controlled, more and more patients are being prescribed medications they want over medications they need.
I do agree that pain is subjective and some people live in chronic pain, leading to a need for higher pain medication doses; however, there is a fine line between patient satisfaction and safety.
Here is a simple fact, if you are hospitalized for surgery or an injury having no pain at all is not a realistic expectation.
Honestly, we will not be able to attain a pain scale of 0 without having you intubated and sedated the entire time. Surgery is painful, we can give different medications to help alleviate the pain and make you feel less pain, but to be pain free is going to be near impossible.
So although to the untrained eye it would appear that we are not doing everything to control your pain, we are in fact doing everything we can to control it without causing you harm.
The government has made some efforts to reduce complications from pain medications, including strict laws when prescribing pain medications in an outpatient setting, however while hospitalized those regulations don’t have any precedent over the treatment you receive.
That means that doctors are almost being bullied into prescribing pain regimens that patients are requesting. The nurse then is dispensing these medications to the patients in the safest way possible.
So have we done everything to control your pain? Well in your eyes no because you still have pain, but truthfully yes we have. There are some questions that are sadly not cut and dry.