I was listening to the recent EMS Garage podcast on pain management, and several things came to mind. One was in regards to “drug seeking behavior”. Many EMS professionals, from medics to nurses to doctors, choose not to treat the pain complaints of patients on occasion.
Sometimes people feels as though they have a personal duty to try to fix the problems of our EMS system by denying drug seekers their “fix”.
A friend of mine who is a physician at a local trauma center once told me, “I’m not going to make an addict, and I’m not going to cure an addict.” When you think about it this way, it makes sense. Your actions on a single day are not going to undo the years of damage to someone’s life that have led them to become a drug addict. You can surely give them all the resources at your disposal to be well, but anyone who has ever studied addiction knows that it takes an enourmous and unwavering desire on the part of the patient to treat an addiction. Our job is to treat their pain, but sometimes we may be too skeptical of their complaints. We may not believe an addict, or believe that we can see right through their theatrics or even lazy attempts at such. Would you believe that they do actually hurt?
It’s known that opioid addicts actually have a downregulation of opiate receptors, and thus are actually in pain longer and more severely than the normal person. This is why they will actually scream and squirm under your IV needle. It’s probably not theatrics. They are actually in pain. Their body feels pain different than yours. It is not our job to judge. It is our job to treat. Maybe they are abusing the system to get their fix. So what? You’re not going to fix it by being a jerk to them. Practice being an excellent caregiver ALWAYS.
Help. Be a patient advocate. Know all that you can about pain clinics in the area and help your patients get in touch with them. Follow up on patients (and subsequently educate your local ER staff that have probably never read HIPAA that it allows for patient follow-up). You know that many of these chronic pain patients become “frequent flyers”. Know what the doc did last time so that you can bring it up, know about a patient’s background and needs, and maintain a continuity of care with the hospital. These are all vital aspects of true “patient care”. There is a difference between caring for a patient and treating a complaint. The difference is caring.
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Jake I agree with you in the fact that we are not the ones to judge, are job is to treat. But I also feel that we need to teach the people in chronic pain, with symptoms like migrains, chronic pancreatitis, or whatever they may have. I feel this is like a parent continuing to give their obease child unhealthy foods. Should they keep feeding their child unhealthy food and continue down the wrong path just because they are required as a parent to feed? Or should they be more involved and and feed them just maybe feed them with something healthier for them. People in chronic pain quite often have legitimate pain but that also doesn't mean we have to continue to give them narcotics. More and more ER docs are looking up CURES reports on pts, that way they can see how many times they have gotten narcotics rx's in a given time. If all the docs did this we would minimize the pt.s with drug seeking behavior.
ReplyDeleteThanks so much for your comment! I didn't know about the CURES program until researching it just now. What a perfect example of how we need to humble ourselves and learn all we can to help our patients. What a helpful program this would be to have everywhere and available to EMS in the field.
ReplyDeletehttp://ag.ca.gov/bne/cures.php
I completely agree that we need to treat the patient as a whole and not just a complaint, considering their chronic problem and their medical history, and considering the possiblity that patient education may be a more appropriate treatment than narcotics.