I wish there were more docs like you in the world. Sometimes (as a patient with chronic pain), flareups send even the best coping mechanisms out the window, and a few days of pain meds literally will make the difference between feeling absolutely miserable/potential SI without a serious plan, but a desire to end it all, and being able to ride out the flare in more comfort until you can get to your specialist- especially if the specialist is hundreds of miles away.

I’ve had docs who cut to the chase, didn’t think I was drug seeking as an addict, and treated me like a person with a SERIOUS emergency- and yes, Migraines that go over 72 hrs without a 4 hr break in pain while awake IS a medical emergency… especially for those with other potential stroke risks… But, even the regular Migraineur in Status Migrainousus is at risk of a TIA…. and needs it broken, either via Mag Sulfate, a drug cocktail, or whatever has a hx of working for the patient previously. When a doctor asks me what has worked previously, and doesn’t dope me up on narcs when I don’t want them- just Mag Sulfate and Dexamethasone and Zofran- I feel like I’ve hit the lottery.

For my neck, however, sometimes I DO need the narcs for a few days with muscle relaxants to get me through and to keep my head from getting involved in the pain cycle. And then- the 2 times I’ve HAD to go the the ER, it was even worse than being a Migraine Patient- which I thought was the “low of the low” on the totem pole of ER physicians’ emnity… I was wrong, apparently. Chronic pain patients in crisis really need more doctors like you, who treat them like human beings, and ask what brought the patient there today. Sometimes, it’s ’cause you can’t take it anymore and can’t get to your specialist immediately, or your PCP won’t prescribe Narcs ’cause of FDA scares, and it’s literally the last hope you have. And other times, it’s for the flares that last longer than you have rescue meds for, and can’t get them called in over a weekend… We, the patients, are totally in your hands. It hurts even more than the physical pain when I’m mistreated by someone who swore to “due no harm” and makes the patient even more desperate, and SI may increase.

Thank you for caring, and treating us like any other patient that you may see during your day. You are a gem, and I just wanted to let you know how much people like me appreciate people like you.

Best,

J

Then I cut to the chase by directly asking what exactly they want from me today.

Often with these patients, what they want is not purely “medical” (i.e. a diagnosis or cure). There is a hidden agenda – fear, isolation, stress, strained coping mechanisms, breakthrough pain, grief, being at the end of one’s tether, etc. Sometimes the patients themselves haven’t thought about exactly what led them to present to the ED that day! This sort of direct questionning certainly helps to crystalise in their minds what their expectations for the consultation are.

By identifying this hidden agenda early in the consultation the Emergency Physician can focus the consultation on delivering precisely what the patient needs at that crisis point in their chronic illness, rather than offering what he assumes is needed.

I do know that in my neck of the woods there is a dearth of walk-in clinics for those who are without regular doctors and become sick. Now in certain circumstances, taking a complete history makes sense. But, it seems to me this is a contributing to the costs of the ER.

Pax,

MLO

My tests were so perfect it was disgusting. When I saw my regular docs the tests continued to be impressively normal, which makes putting up with my personal health situation a bit of a PITA, but at least the ER was able to tell me, when I was scared nerveless, that not only was I not going to die but that I was revoltingly healthy.

Eh, it can be a double-edged sword. Plus side? I get to nag my family for a long, LONG time ;)

About those who are chronically ill but the doctors can’t seem to find out what’s wrong with them, it’s hard having to explain to these patients that there’s nothing that I can do for them in the ER. But in situations like that, I try to tell them that all the tests have been done for them as ordered by the specialists they have seen, but the problem is, although modern medicine has improved very significantly in the last few decades, still it has limitations.

“often the best we can do here in the emergency department is to tell you what you don’t have. sometimes we can’t tell you what is causing your problem, but we can make sure it’s not an emergency.”

super, huh?