The Customer is NEVER Right - A Nurse Practitioner's Perspective
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I saw a patient who I declined to give “something stronger” to and the patient said to me, “I will check in again to be seen in the main ER. I always have to do it that way to get a pain shot.” A “pain shot” or “something stronger”, terms created by drug seeking patients in their quest for prescription medicines used for recreation.
The mentioned patient had chronic shoulder pain and was scheduled to see a pain specialist, all irrelevant to me as neither was an indication for narcotics, but the patient shared the story with me as I was the one seeing her and the one who denied her a "pain shot" or "something stronger".
Regardless, the patient checked in again and was seen in the main area of the emergency department where she was given a “pain shot” just like she said and the cycle continues as the patient had said, “I always have to do it that way to get a pain shot.” Incidentally, the patient was allergic to Toradol, Ibuprofen, and all the NSAIDs. I always thought allergies meant having an allergic reaction to an antigen but somehow it has evolved to “That just doesn’t work for me.”
A few days earlier, a friend forwarded me an email he was sent about a letter written to the Emergency Medicine News, a healthcare journal. The letter, written by an Emergency Medicine physician, was titled A letter to the country. Interesting enough, the subject title of the original email was, Nothing we don’t already know. Between the two titles, the latter speaking volumes alone, as the letter to the journal was written to the choir, the Emergency Medicine community.
In my book, I talk about a number of interventions used to curtail drug seeking behavior and that I do not get caught up with either the drug seeking behavior or those impotent interventions as I do not prescribe narcotics indiscriminately, and for no reason other than I do not accommodate exaggerated unrealistic emotional expectations, regardless if the patient is a drug seeker or not.
That is not to say that I do not prescribe narcotics, however my decision to prescribe narcotics is my decision and based solely on my clinical findings, not some arbitrary number on some pain scale or because I think the patient may complain if I do not.
Many healthcare workers point to drug seeking patients as the underpinning of poor customer satisfaction scores and they may be correct, however I say they are channeling their frustration in the wrong direction and here is why.
Drug seeking patients are not healthcare’s problem, healthcare’s problem are administrators who insist healthcare is a customer-driven industry and expect patients be catered to.
Drug seeking patients may give hospitals bad scores but so do patients without drug seeking behavior because their exaggerated unrealistic emotional expectations were not met, and my experience has been the latter complain the most.
Drug seeking patients may rant and rave and be melodramatic, but drug seeking patients, like their polar opposites with life, limb, or eyesight emergencies rarely complain formally.
With regard to A letter to the country, the following are some recommendations to healthcare workers about patients who complain, drug seekers or not:
As healthcare workers, we need not pin patients against one another, instead we need to point at administrators who want healthcare workers to cater to patients. Because those accommodations and the message they send have given patients an unprecedented amount of influence over those trusted to care for others. As patients now hold healthcare workers hostage with threats they will rate the healthcare worker or the healthcare system, “A one, at most a two,” if their exaggerated unrealistic emotional expectations are not met.
It is likely drug seekers, and complaining patients alike, will self-deport from our emergency departments if healthcare administrators surrendered the ideology that customer satisfaction comes before medical care, freeing healthcare workers from having to cater to patient’s, drug seekers or not, delusions they are the center of the universe or what I have coined, exaggerated unrealistic emotional expectations, entitlements, and the so-called VIP.
I would discourage healthcare workers from using “real or true emergency” to justify such and as an effort to discount patients with “non-real, unreal, untrue, not true emergency”. When I see the latter patient I tell them, "I know. To you this is an emergency but in the bigger picture of Emergency Medicine it is not an emergency." Likely a definite complaint but regardless a fact. Healthcare workers know an emergency is an emergency and those things that are not an emergency are not. We should not have to champion for those with emergencies as "real or true", instead, we need to deflate those that are not, even if it generates a complain, as the fact remains.
As healthcare workers, let’s not compare our history to patients. Even if similar, as they will complain, “I [patient] knew more about [healthcare worker] than she knew about me.” Or others will tell you, since you got yours the hell with the rest, a common argument if you mention, “I was worse off than you and look at me now.” Because their expectation is you, not themselves, should pull them up along with your success.

Finally, as healthcare workers lets see patients as patients, drug seekers or not, complainers or not, frequent flyers or not, the Pope, the child molester, the celebrity, or  the homeless, emergencies or not, and let administrators face the social disfunction they created by demanding healthcare workers accommodate exaggerated unrealistic emotional expectations.


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