Friday, June 04, 2010

An Open Letter to Emergency Department Physicians and Nurses

Dear Cynics,

I get it -- you’re burnt out from dealing with the seemingly endless parade of drug-seekers and addicts who march through the exam rooms in your Emergency Department. I really don’t blame you. I’m certain I’d struggle with keeping the more acerbic side of my personality in check if I was forced to listen to a relentless barrage of demands for narcotic pain medication from people too stupid or too stoned to realize how absurd their stories sound. It must be hard to not get cynical after seeing the same faces give the same thinly-veiled reasons for why they need opioids week in and week out.

But even if 95 percent of the people who come to you with complaints of severe pain are just hoping to score their next fix, that doesn’t give you the right to treat the five percent of us who really are dealing with unrelenting pain like shit.

Yes, Virginia, there really is such a thing a chronic pain. Although that description has become so associated with drug-seekers that most ER staff can’t say it without rolling their eyes, some forms of pain -- most notably central pain -- truly are relentless. And if you bothered to spend a few minutes talking to me about my medical history and what I’m going through instead of writing me off as soon as you see “pain” listed as one of my chief complaints, you might be able to understand that.

No matter how bad I‘m hurting, I make every effort to be a patient patient and to treat you with respect when I have no choice but to visit your ER. Is it really asking too much to expect you to extend that same courtesy to me?

The last thing in the world I want to do -- except keep enduring the agony I’m in -- is to ask for your help in getting the pain back down to a level where I can hang on for a little while longer. Coming to the ER means investing hours of time, risking ridicule and scorn because you prejudicially decide that I’m either faking or a junkie, and, after all that, getting sent home in as much pain as I started with but even more frustrated and desperate because you‘ve denied me treatment and taken away my only hope for relief.

Although you may not believe it, I hate the drug-seekers as much or more than you do. Prescription drug addicts are the reason I have such a hard time finding doctors willing to treat me, and am forced to sign 15 page contracts that leave me with no rights at all but allow the doctor to terminate treatment at any time for any reason. The junkies are the reason that even after five years of total compliance (i.e. no early refill requests, no “lost” prescriptions, and no filling prescriptions anywhere else), my pharmacist still treats me with suspicion. And as I’ve explained here, they’re the reason why you’ll only see me when I am at rock-bottom and utterly desperate.

So the next time your triage nurse hands you a chart for someone in chronic pain, try to put your addict burnout aside -- or at least on hold. There’s a chance that your next patient may be someone like me whose pain is physical, real, and overwhelming, and who legitimately needs something more than "Tylenol…Number Three.” If you treat me with respect, and listen to what I have to say with an open mind instead of through a filter of inherent distrust, I promise I’ll do the same.

1 comment:

Blogauthor said...

http://www.nytimes.com/2010/06/08/health/08mind.html

I think you'll find this interesting.