Thursday, October 4, 2007

Finally, Some Enlightened Attitudes!

While this site was set up to challenge the ignorant, hostile and judgemental attitudes so many in the medical profession have towards people in pain, and to document just how destructive these attitudes really are, it is very refreshing to note that there are at least some doctors and nurses out there who "get it" and take a logical, ethical and humane approach to people claiming pain, even when they suspect those people may be "drug-seekers."

In this thread on allnurses.com, a new nurse asks the question "drug-seeking or real pain? How do you tell?" and while some of the answers display the usual hostile attitudes, many of the others are very enlightened and show that there are at least some people in the medical system who think critically and take their ethical obligation to relieve pain seriously. You might particularly note the responses by "Dave ARNP," "Fgr8out," and "cmo421." Here are some highlights from this thread:

Now, as far as being able to tell if someone is in pain, or seeking. It is almost impossible. Have I medicated a seeker? I'm sure. I think anyone who has been a nurse, or MD/NP more than an hour has. It is very hard to make that call. Even if you DO decide they are seeking. Do you really KNOW? I don't think so. I've had my doubts about a few patients in my time, but when I begin to venture down that road, I remember how long my mother suffered before finding someone who would adquately treat her pain. Several docs she saw, just labled her as a seeker. Would I want to chance labling somone just like her? Nope. Every patient that I see is treated to the best of my ability. If nothing we can do will get their pain under control, then I will find someone who I think can.

Someday, Nursing will accept that pain is whatever the individual experiencing pain says it is. Why do we persist in this need to control an issue that is out of our hands, namely a patient's report of pain? There is no way to measure pain through biomechanical means, no magic machine that pinpoints the exact site or severity of pain. Pain is completely subjective, yet there are those in Nursing who simply can't or won't accept the fact that we don't have the ability to say "Yes, here is proof you have or haven't pain" with any reliability.

People in pain may or may not display behaviors that we consider indicative of "being in pain." Coping mechanisms such as distraction or avoidance, may often mask a person's true pain level. I believe that if health care professionals expect someone in pain to act a certain way, some patient's learn to adopt those very behaviors. They become concerned that if they don't "look" as if they are having pain, their report of pain won't be believed and they won't receive the proper pain management. What exactly does that say about our practice?

If a patient says they are having pain...they are having pain. It doesn't matter if they are 'drug seeking' or not. My belief is they are in pain because if they weren't they would not be seeking drugs to "numb the pain" they feel whether that pain be physical or emotional pain. Pain is more than physical. It's emotional, mental...unseen physical findings....so treat the person and leave the judgement to God.

Ok, I have to weigh in here. You are walking a fine line when you start to label pts as "drug seekers" Granted, they are out there. Because a person asks what medication they will be receiving does not imply they are a drug seeker. Some pts know what works for their pain. Moreover, some people are allergic to NSAIDs or they are intolerant of these meds. They may be allergic to sulfa nad were told to avoid NSAIDs because of possible cross allergy.

Well, like so many have already written here, we are certainly taught that if the patient says they are in pain, they are in pain. Personally, I like that idea for a number of reasons. If they are, and I "guess" wrong, I will have been instrumental in continuing someone's discomfort. I don't like that.

Very interesting topic. As someone who lives in chronic pain and happens to be a nurse and a student, I find it educational to hear what others have to say about whether or not they think somebody is in real pain or drug seeking. Unfortunately, I have dealt with many physicians and nurses who have made it very difficult for me. When somebody puts down in ones chart, "drug-seeking".........."drug-seeking behavior" etc.......I wonder if they know what they are doing to that patient.

I have been in both positions I have pancreatitis which causes me a great deal of pain and I am also Dr Rx addicted to oxycontin. So when I have had an attack I never got the pain relief I needed because I was labled "Drug Seeking" When you go to an ER and a Doctor tells you he will not medicate you because everytime I was seen in his ER it was for a painful condition and he also said I had used two different names with my correct info. One why would I go to an ER unless I was in pain. Two I had gotten married hence the two names. To top it off one year later I had a attack the Same ER different doctor said the same exact thing word for word. Now I am on MMT I could not get pain medication if I was dying. It is wrong but I am glad to see that many of you opt for treating anyones pain. Because people do not always Dr shop because they are addicted sometimes because of idiots like the ER doc that will not medicate or under medicate.
It is good to see that there are at least a few medical professionals out there with intelligent, thoughtful and humane attitudes towards people in pain, as opposed to the usual malignant herd-think that is so prevalent in medicine today. If I were a doctor or nurse, I would like to think I would have the moral courage and integrity that these nurses display, and would always err on the side of treating pain. Since it is the ethical duty of a physician to relieve suffering, I would prefer to always believe any patient's report of pain, including his subjective report of its severity, even if that meant I would occasionally give a drug addict a free high. After all, the drug addict is also suffering, and by supplying him with a narcotic drug, I have relieved his suffering for that night, so from an ethical standpoint, there is nothing wrong with this. The alternative is to risk denying treatment to someone in pain who desperately needs it, and that possibility is so barbaric I could never bring myself to go that route unless I was utterly convinced it was in the best interest of my patient to do so. But be sure to assemble your team of angels first if you wish to convince me of that.

1 comment:

Nancy said...

I'm so sorry some of you have had the displeasure of reading posts by Fgr8out. She is a very negative peron that is on probation by the hospital she works at in Reno, Nv. She has a very bad attitude and treats her patients like she is superior to everyone. nothing could be further from the truth! With any luck, her lisence should be revoked sometime soon.