09 May 2007

A Variation on the Theme...

Of the "Advice to Interns" series. I didn't write it and don't know who did (though I kind of wish I had written it). A snippet:

Advice from an ER doctor to drug seekers

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 bastard 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.
Full text here. Obligatory disclaimer, in response to some of the more, um, passionate comments: I do not necessarily endorse the above in any respect. I just think it's hysterical.


  1. Uh - what part of portraying nurses as unethical, negligent practitioners do you find so thrilling?

    Any nurse who "squirts" any portion of an ordered dose of medication on the floor and intentionally underdoses in retaliation to a patient is guilty of malpractice.

    I don't care how repulsive the patient appears to the nurse - or to the physician.

    Patients who attempt to manipulate clinicians need to be dealt with in a firm, clear and ETHICAL manner by physicians - and nurses. Not with threats, retaliation and open contempt. No one says you have to like them or accede to their demands when they conflict with sound medical and nursing practice, but neither can they be "used" for your entertainment and to prove to yourself your superiority of power and control.

  2. N=1, it is painfully obvious that you don't work in health-care.

  3. n=1,

    True. Likewise, servers don't really spit in your food. (Well, that often.) And most judges will give you a fair trial even if you are disrespectful.

    I think the non-Shadowfax author of this piece is probably resorting to the "practical" reason to be nice to nurses because it is hard to tell people to be nice to each other just because it makes us better humans. Which is too bad, because that really is the reason to be respectful to nurses, servers, and judges.

    Re: "prov[ing] to yourself your superiority of power and control" Well, aren't doctors superior to and in control of everyone? I would not think that was limited to nurses.

  4. Not true, oh brave anonymous - I've been on the front lines a long time - but painfully obvious that too many unethical creeps DO work in healthcare, and that licensure doesn't screen them out from inflicting themselves on others.

  5. Not to make a drawn out thing out of this, but I said "don't work" not "have never." As you note on your blog, you were "unceremoniously booted out of health-care."

    I'm sure being self-righteous had nothing to do with that either. (As if N=1 is less anonymous than anonymous).


  6. n=1

    Notwithstanding the personal comments made by other commenters (be nice, people!), I really think you should view this with a sense of humor. Seriously, this post refers to the "Clinical transaction" of "you make it easy for me and I will give you drugs," and implies that a doctor might "make it my mission that night to torment you," if you don't. Never mind the whole non-PC labeling of people as drug-seekers. It's so obviously tongue in cheek that trying to take it at face value makes all of us look silly.

  7. shadowfax:

    I leave you to your junkyard humor and your junkyard salivating, misogynistic dog followers. You can all sniff each others' rears, as is your wont.

    But it's not funny. You're either burned out or you're not honest to admit that this is repugnant. Consider that you don't restrict your blog readership to providers and that patients are reading.

    How much damage does crap like this to physician-patient relationships? While you blog under anonymity, patients will use posts and comments such as this to determine how much to trust unknown physicians.

    You betcha that I'm unemployed - I was a whistleblower who uncoverd lotsa crap and who went to bat for more than one ED physician director, a multitude of ED nurses and of course, ED patients. So those of you who can only insult me really are the most cowardly of all.

    I paid - and continue to pay - for speaking truth to power. SO yes, I am no longer in healthcare - I'm barely able to keep a roof over my head as I sell off the remaining bits of personal belongings. But the day that I stoop to believing the crap that shadowfax posted today is the last day I'll spend in this world.

    Happy now? Do you want to stick the knife in further? Twist it some more?

    Sick souls - I feel real pity for you - and for your patients.

  8. Gee, I can't imagine why nobody would want to employ you. You seem to be friendly, reasonable, well-balanced, and always right about everything. What's not to like?

    The medical establishment must be chock full of incompetent jerks to not appreciate such a gem as yourself.

  9. I wouldn't consider 'squirting medicine on the floor but I do know that when I'm told to "hurry up, bitch." I'm inclined to move as slow as possible.

  10. Actually, I'm not a health care practitioner; my contact with drug-seekers was through the criminal justice system. I thought the post was funny.

    And hey, drugseekers make it rough on those of us who ever have to go to the ER for something legitimate. Someone with a kidney stone and someone who says he has a kidney stone but is really a junkie looking for a shot of Dilaudid both look the same and fall in the same place on the triage list, yes?

  11. Oh my, this is funny. Cynical, but I understand exactly where the author is coming from.

    Fortunately, it is less common for the drug-seeking population to make its way to the cath lab, but occasionally it happens.

  12. "Douchetard" is my new favorite word and I will use it as much as possible. I love whoever wrote this post. I love the language, the hate, and the anger. I also love that this Dr. semi-stood up for ED nurses! Hooray for whoever wrote this-they are not a douchetard.

  13. Whenever I hear the phrase, "Speaking truth to power," I hear "I was a self-righteous jerk." FFS, ER docs have just slightly more of a doctor-patient relationship with their patients as I do. And I get them after the drug seeking stops.


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