Tuesday, January 27, 2015

Injecting a Little Humor, with just a little seriousness

I'm sorry to be so sporadic in posting, but here at Bagram Air Field, there is always something to occupy my time.  My wife ran across a funny video and sent the link to me. I enjoyed it and found a second.  Both are posted for your review, and both reflect some of the frustrations we have as practitioners of emergency medicine.

Patient satisfaction.  I like people and I like practicing medicine.  However, part of the job is often to tell people things that they don't want to hear, and of course, even under the best of circumstances, you will not be able to please everyone.  Finally, doing whatever is takes to please someone, may result in a bad outcome.  Basic psychology shows us that when people are under stress, are unhappy, etc. they will often project those negative feelings towards those around them.  Our job, is not to make people happy, but to practice good medicine.  If we can make them happy at the same time, that's good, but at the core...providing good medical care always take precedence.  Administrative types and former health care personnel-turned-"suits" don't seem to get this concept.  Probably because their are dollar signs attached, which often impairs both ethics and common sense. Then again, they either never provided care, or took a desk job because they were never very good at it.

In any case, please enjoy the video (Credited of course to KevinMD...be sure to visit the site):

My boss is CEO

Drug-seeking...have I said enough on this subject.  Probably, but these guys actually sing about it...something I would not subject you to myself.  Mo tune would be something more like, "NO!" then "I don't know how many times I can tell you No!" generally followed by a discharge, or in the case of the blatant drug-seeker for resale purposes, an introduction to a nice police officer is my approach.

Once...a patient came in with a dicey pain complaint...of course it was 10/10, but he sat cool as a cucumber requesting "PERCs" (ask for them by name), and of course an injection of dilaudid.  We wasn't from the area, but rather was staying some friends in SC (very far South of my ER) and when asked what he was doing up here, he said that he had gone up to VA to visit some other friends and his back started hurting on the way back.  He apparently was driving himself.  Oh...and of course, he listed allergies to every medication that he didn't want or couldn't sell.  Sound familiar?  I looked him up on the controlled substances registry...this was for my state only, but is showed that over the past 3-4 days, he had been visiting various facilities within a 20-30 minute drive of my ER and had received multiple prescriptions for opiates.  I guess he was taking the long way back to SC.  I placed a phone call.

About 20 minutes later, I went back to the patient's room.  I told him what I had found out, told him I wasn't going to give him any medication, either in the ER or by prescription.  I then introduced him to some nice officers, who arrested him and carried him from the ER in handcuffs right through the waiting room.  I'm sure my customer feedback would have been less than ideal.

The reality today is that more Americans die now from prescription pain medicine abuse than from heroin and cocaine combined.  Many that aren't just abusing their medications and diverting it for sale on the illegal market, and much of ER prescriptions for opiates is helping fuel these deaths and illegal diversions.  So much for serious talk...enjoy the video.  This was also on KevinMD, but I snagged it from a repost.

We are never, never, ever...

Like Reagan said...just say "NO!" to drugs.