One of my attendings in residency taught me a great lesson which I faithfully try to apply to all my patients – well with the exception of really aggravating drunks that piss on the floor, people who choose to vomit on the floor even though the trash bin in 3 feet away and parents who let their kids kick me in the groin when I’m trying to evaluate them. So, ok maybe I don’t apply it as faithfully as I should, but you get the idea. One group that really challenges our reservoir of compassion and empathy though are drug seekers. For those readers who are unfamiliar with what a drug seeker is, an explanation is in order.
Everyone gets pain from time to time. Some unlucky people though have to suffer with pain on a daily basis. These two groups of people are legit, and it provides me great immediate gratification in my work to help relieve their pain when they come to me. Yet there is another group of people out there which totally obscures the pain picture and makes this task very challenging. This pathetic group of losers has lovingly been dubbed “drug seekers” by virtually all ER’s around this great nation.
Drug Seekers are people who typically fake pain in order to get pain medications that provide a euphoric feeling (in other words, they get high with them). Such drugs are usually narcotics that act like heroin, benzodiazepines that mimic alcohol in many ways and then some other really crazy FUBAR stuff that I won’t get into now. Here is a typical drug seeker encounter:
Doctor walks into patient room to see drug seeker (DS) sitting calmly on the stretcher. More often then not, they are munching on some chips and drinking a soda (in other words, they look totally healthy without the slightest indication of any sort of suffering). He introduces himself and asks the patient what brings them into the ER today.
DS (the drama begins): “Oh Doctor, I have been having a horrible _____ (fill in the blank – headache, stomach ache, back pain, etc. – for extra points can use more than one area of pain to complicate the picture) for the past 2 days!”
Doc: “I’m sorry to hear that DS. Have you ever had pain like this before?”
DS (ratcheting up the drama): “Yes doctor, it happens a few times a year. My doctor has put me through all the tests before – a CT, an MRI, blood tests and even a specialist saw me, but they can’t seem to pinpoint the problem.”
Commentary – As Whitecoat has mentioned on his blog, there appears to be a Drug Seeker handbook or Standard Operating Procedure (The DSSOP) out there. They often give the line about getting tested or evaluated, but strangely it is usually in another city/state and in almost 100% of cases they report “normal” findings. Of course they never have any written documentation of these evaluations and asking them what doctor they treated is useless as they never remember of give some generic name like Dr. Smith. Truly fascinating.
Doc: “I can imagine that it must be very frustrating to not get any answers, even from a specialist.”
DS (thinking she’s got this doc in the bag): “Oh yes doctor, soooo frustrating. It just seems that no one understands what I’m going through, but I can see that you do. I can’t even begin to tell you how comforting that is.”
Doc: “So how have you been able to control the pain in the past?”
DS (nearly salivating now): “Well, in the beginning I used to get by on Tylenol. I even tried aspirin and ibuprofen, but I had some reactions and my doctor explained to me that I am allergic to NSAID’s. So the only thing that worked after that were medicines like Vicodin or Percocet … except when it flares up and I need to come in like now.”
Doc: “Yes, it seems that you really have had a tough time. When you do get these ‘flares’, what seems to help then?”
DS (faking an inability to accurately remember): “Oh, its a medicine that starts with a D … deme … dama …. Oh, I can’t remember exactly. Do you know which one I’m referring to?”
Commentary – From an underground version of the DSSOP: “It is imperative to demonstrate that you have tried over-the-counter medicines and that they have not helped, and even better, to say that you are allergic to them. That way they won’t try to prescribe you any crap like Naprosyn or that Toradol BS they try to inject you with in the ER. Then you need to feign unfamiliarity with what you really want so that a naive sucker (the doc) will imagine that you get this medicine so rarely that you can’t even remember the name.” Those of you in the ER will agree that it is amazing how textbook this act is pulled off. Worthy of an Emmy, or a “Narky” as I like to call this award.
Check back tomorrow for the exciting conclusion and to read about my personal approach to dealing with these fine, veteran actors.