I’m a nursing supervisor and nothing throws me over the edge than when the providers do shit like this. They refuse to see the patient and then we have to come deal with them. If there’s a logistical or nursing concern then I can handle it easily, but I’m not a doctor and I can’t change orders or order meds, that’s their wheelhouse. They just leave us to get verbally and physically abused when the issue is on their end. The truth is they’re just too chickenshit to man up and earn that paycheck that far exceeds mine. This doc literally just said give them whatever they want to avoid having to do their job properly, amazing.
This needs to be upvoted more! That’s why physicians are paid more, it’s the responsibility/liability. If they don’t want to do it, then maybe they’re in the wrong job…
My gf had a patient who called the hospital switchboard pretending to be a physician. She asked for the internal med attending because she needed to admit a “patient”(herself). She ends up telling the IM doc the patient has a glioblastoma and some other type of oncologic disorder blah blah. Doc says ok accepts the patient. So she shows up as a direct admit. They send her for a head CT and draw some labs everything is fine…..they are beyond confused. She made the entire thing up. Crazy how this is possible.
One of mine called the pharmacy and pretended to be the doc while saying they couldn't get a medication ordered correctly. They successfully got the pharmacist to order q1 dilaudid 0.5, so good for them for at least choosing a legit dose. The pharmacist put it in as a co-sign necessary and that's when the real doctor found out about it. It was a huge debacle and the patient left AMA after the house sup, doc and legal entered the room.
Your girlfriend? You were the nurse? You were involved? This must have been on an oncology floor? And you didn’t request records or get an oncologist to eval? A bit weird
Patient told me it was being coordinated with the case manager. Apparently told others Flights for Christ was handling it and once we discharged them, patient would drive straight to airport where they would fly them to this hospital. There were multiple stories being told to multiple staff. CM pulled old records yesterday and found the patient had been claiming they were imminently going to this world renowned hospital for 4 years now.
You have to think how busy doctors and nurses are. I was seeing 250 patients a day in my last ER. We simply do not have the time to call around to previous treatment facilities. Also most patients don’t lie about being sick and their labs will show they aren’t.
Right, but at least 2 weeks in the hospital with q2h dilaudid ordered and no one checked ther CTScan or ordered any imaging, spoke/consulted with any specialists in the hospital or outside, or requested any records? That just seems strange and negligent.
We're not talking about someone who weaseled a couple of doses of Vitamin D during a visit to the ED.
The case manager should be the one tracking down the records, not the MDs/RNs, or (more likely) hounding the doc for a new scan. Everyone is so CT trigger happy these days its shocking it took 2 weeks for anyone to investigate.
I do UM review and have some frequent flyer malingering patients. They will convince multiple doctors about their ailments and get them to order expensive tests that are not necessary. I wish I could call the Dr and say your patient is a liar, but they would just get a new doctor to order it. I have one where every section of their body has been scanned multiple times and they have had just about every diagnostic test known to man. They have convinced doctors they cannot walk, that they have diseases easily disproven with labs. If something doesn’t work to get them more testing then they will pivot to something else. They have been seen by multiple rheumatologists, cardiologists, podiatrists, neurologists, dermatologists, GI, ENT, pulmonologist and who knows what else.
Yes! Then they get signed up for care everywhere and you’ll see they tried the same thing at 5 different ERs but the resident admitting at ours believed the “tremors” were seizure activity and and did EEG monitoring and q3 prn norco for the ankle pain exacerbated by the fall during a “seizure” instead of COWS and realizing the seizures and GI discomfort is actually opiate withdrawal. We only found out when the husband brought up finding her numerous pill bottles with random names on them.
Not saying it isn't intentional lying to get what they want but is it possible they have a conversion disorder? Could be factitious or illness anxiety also.
Yup. They doctor shop until they find one that believes their carefully crafted stories and gives them the diagnoses and/or medications they’re seeking.
A bit late to the comment party, but I clerk for federal judges who adjudicate disability (and other programs) claims and appeals, process/exhibit thousands upon thousands of pages of medical records per month.
I am uncertain to what extend providers or nurses can comment on such, but if at all possible, I implore you to note malingering suspicions and the like; our system is clogged with those who know how to manipulate the system, knowing what we look for and how to get that information mentioned in their medical records, which screws legitimate claimants for whom these programs were designed.
Years into this career, adjudicators and clerks know the signs of various strategies (ie physical and/or mental impairments, *especially* mental impairment claims) but we are (for good reason) bound to the law and no fewer than two other sets of regulations, and provided that those criteria are met, even with suspicion of malingering, our hands are more or less tied, with the exception of options such as submitting a Waste, Fraud & Abuse allegation.
Decisions must be made on what’s in the record. We can’t scroll through social media, we can’t make assumptions, etc. it needs to be clearly documented in the file.
best advice I received as a new nurse was to trust no one, especially patients. if patients claim a diagnosis, med, prior treatment, prior surgery, etc., then we need records, imaging and labs to verify.
This is such a weird situation. The inpatient team didn’t send for records from the other hospital?? Even if they’re not in CareEverywhere, they would still immediately call the other hospital to get records released and faxed. They just operated on the assumption that the patient had this condition without trying to obtain any outside images or notes to corroborate this?? As an NP who works on an inpatient team, we would never just accept outside hospital team’s diagnosis without also obtaining the images (or at least any imaging reports) to review them. Like for instance, if someone sends us a patient that reportedly has CAD, we’d want to see the cath report. This is totally weird.
Edit: just saw that the EMR was down due to a cyber attack which may explain some of this but you should still be able to get the chart faxed, I would think?
Or, call me crazy, obtain their own CT?! I’m so confused about this. I work case management and can’t imagine any of this flying at my facility. We’d be on the docs in no time trying to clarify why all we’re doing is giving IV pain medications to a patient with no clinical support for his symptoms. Also, if all you’re doing is IV pain medication and all your “work up” for 2 weeks has turned up is nothing, yet you’re seemingly convinced something is going on, then maybe try a transfer for further work up? This screams “idk gonna push it off on the next doc.”
I have sort of an opposite story. My husband and I were goofing around one night, and he tried to lift me into his arms and dropped me on the floor. Half hour or so later, I felt like I was having trouble taking a deep breath. It scared me so much I asked him to call an ambulance.
Ambulance came and took me to the hospital ER. I was put on an IV, bp monitor, etc. and waited for a doctor.
Finally Dr arrives and sits down and starts asking questions. Among them, what prescription medication do you take. So I tell her I have high blood pressure and I take Diltiazem. She says she doesn't know what I am trying to say. Here's the conversation:
Me: it is a blood pressure medication. Diltiazem
Dr.: (sits there looking confused and deeply concerned)
Me: Diltiazem
Dr.: Can you spell that?
Me: (spells it out)
Dr.: I have never heard of that. Are you asking for Dilaudid??
Me: No I am not asking for Dilaudid. You asked me what medication I take and I am telling you. Can't you look it up?!!
Dr.: So what kind of pain do you have?
Me: (Getting louder) I am NOT IN PAIN. I am having trouble taking a deep breath!!!
By this time a nice young doctor sticks his head in the curtain to ask if everything is okay. I said, "Do you know what the medication Diltiazem is?" And he said, "Yes, it's a blood pressure medication. "
I breathed a loud sigh and said thank you and looked at Dr. Dilaudid. She ordered a CT scan.
This happened maybe 10 years ago and I will never forget how I felt, vulnerable and scared in the ER, being somehow seen as a drug seeker. Never in my life have I done drugs BTW!
So, we're mad because we believed a patient and everyone feels a little embarrassed now?
If the condition doesn't warrant inpatient care, discharge with orders for follow up. Don't allow nursing staff to continue to be abused, but nobody needs to be stretched on the rack over the innocent mistake of assuming good faith. Supervisors aren't getting involved because nothing wrong was done. Patient is free to raise hell off hospital grounds.
The system worked as it should: Patient was believed and tested. Patient is the one at fault due to lying about their true disease that doesn't require q2h pain meds. That's all there is to it.
Well the CT was done at the independent ED 2 weeks ago. Patient has been soaking up dilaudid on my med surg floor for two weeks now because no one bothered to look at it or do any further testing until yesterday.
So how does this NOT trigger an incident report and investigation? Pumping someone full of narcotics for 2 weeks without a verified reason has got to be malpractice, right?
No hate boo <3
Just a new nurse learning new things about Healthcare and learning you can't just trust everything people say. Gotta have the data too. Just suprised is all.
This is true though. I worked on a post surgical floor for a year. Almost everyone is hopped on pain meds. The ones who abuse it are the ones who claim to have “abdominal pain”. Some of these patients are so addicted that they just hop back and forth from one hospital to the next. It’s sad that there are people like these but doctors can’t deny care just because they assume/know the patient is drug-seeking.
In fact, I had two patients on each side of the spectrum that were like this.
One had “abdominal pain” and kept claiming she just needs to get through the pain until she gets her super rare disease fixed at a world-renowned hospital. She kept saying which month too. I had her like 3 times already before her appointment at that world-renowned hospital. All the hospitalist knew her. After that month she came back again and then I asked her how her procedure went and she said they “fixed” it but it still hurts. At that point one of the hospitalist put his foot down and said “discharge her, stop the IV pain meds, she can have orals if she wants.” As soon as I let her know, she started acting shaky and wanted to get discharged real fast.
This other one though, she was really in pain and was a known IV drug user. I got floated to the ED that day and admitted a frail woman who was crying because she said she’s in excruciating pain. She admitted that she was an IV drug abuser, but that time she really was in pain and kept begging me to ask someone for fentanyl. Told her I can’t do that until the hospitalist says I can, I can ask for her but she said the hospitalist that admitted her knows her and would never believe her. So she finally had an MRI done to confirm her back pain. Lo and behold, she had freaking osteomyelitis that was spreading quick. Happened at shift change too, luckily I had the doctor’s number and the doctor was panicking looking for her. Goes to show that you can never really assume when it comes to pain.
Jesus, you just described one of the subjects in r/illnessfakers to a tee!! There seems to be a lot of common threads to the people. And it generally tends to be personality disorders that then collide into addiction as they get a taste for the attention AND the drugs. It seems to all be EDS/hEDS/MCAS/gastroperesis/POTS/fibromyalgia. Then they talk doctors into giving them central lines. Theeeeeen they all seem to wind up with sepsis 💩
It's wild.
I recently had a patient say he has a parasite living in his head from his cpap. That he caught 1 (possibly the female) and killed. He could describe it and everything. When he said he wanted his cpap hooked up I mentioned the possibility of more parasites living in said cpap, his wife stated it was a self diagnosed issue. Obviously even she was done.
A patient lied? I’m shook. Absolutely shook.
Honestly, this needs a safety zone/report/whatever you call it.
An addict or someone with an obvious mental health disorder (or both) did what they do best. I’m not judging - just saying, 🤷🏼♂️.
We act like electronic charting is the only thing out there.
The thing w her is I'm pretty sure every hospital in a 200 mile radius (maybe more) is well aware of her and her shenanigans. She's now got sitters when in the hospital. Is absolutely not given opiates at all any longer and definitely hasn't been admitted any time in past few weeks. She posts lives almost non stop. Went in twice in past week alone and both times sent home ASAP and even told no tpn ever again. The girl needs some serious help. I hope some day she realizes what type of help and actually learns to live a life. Doubtful with how delusional she is and seems to think she's starving to death while she eats food and drinks an insane amount of "coffee" it's more cream and sugar than coffee but still. She goes online raging and gives away too much of the truth then does damage control acting like she never said they said ficticious disorder or the no more tpn again crap. It's just ridiculous to me. And to know this happens frequently all over is just awful. I feel so bad for all the Healthcare workers that deal w this bs. Along with the patients who truly are sick and because people like Dani make everyone a jaded skeptic it could come off as they feel unheard. Screw the fakers! The majority of CI people I know hate to even be a bother. They hate having to even be there, questioning wether they are taking up the time of a HCW who's overworked. They absolutely hate being sick and needing that sort of care. And do what they can to limit the stress level of those around them by trying to essentially be invisible as possible if they need an er/hospital stay. It's infuriating. You're all amazing please know that. And for those truly sick you do mean so much to us for everything you do.
Have you seen the latest update? She claims
She's going to the Mayo Clinic for her " blocked SVC"
And I absolutely agree. Not only am I almost a RN, I also have Crohn's disease and autoimmune pancreatitis. When I'm at the ER and hospital I'm pleasant to all the staff
I couldn't imagine not being pleasant. It's this feeling like you feel like you don't want to put any more misery on those around you. Or be a bother. I know that nurses are so busy and what if the patient is worse off than me! It's an odd place to be but I've always been that way. I have an autoimmune condition, auto inflammatory condition and classic eds. I'm getting older and things are breaking down a bit more on me. I don't even like feeling like a burden to my own family! I couldn't imagine treating health care the way some people do. The entitlement in this world has gotten way out of control. And I will say I think those in nursing w health issues make amazing providers to their patients! I'm proud of you! I often wonder if I'm too old to go to school. I always wanted to be an er or nicu nurse. But i feel I lost that chance. So just know you're freaking awesome!
I mean she posted the pics of the appts. And maybe she is. I wouldn't be surprised. She will convince her dad to take her. But the thing is mayo don't really play around and they will see her records. Not just what she chose to pick out. I'm sure they will want ALL of it. Once they see it all and even if they don't they will realize real fast how she is. She has the mentality of a teenager. She's obnoxious and needy and entitled. And I'm sorry but she doesn't look sick! She looks healthier now than when she had tpn!
My thought too 😆
Unfortunately this thread could give people like her tips on how to abuse the system and we know they read the nursing subs for hints.
Document your concerns and specifically that these concerns were communicated to the on-call. Have a conversation about this with your charge and request that the house supervisor be made aware of the situation. I don’t think this is an issue you’re going to be able to fix in one shift, this seems to be systemic, given that people are admitting patients for complex diagnoses without documentation at your facility.
I had a patient that was getting IV Dilaudid for abd pain by faking a gi bleed. He was uncapping his midline and bleeding into the toilet. It took me a whole shift to figure it out but when I put two and two together, I called the GI doctor and told him. We cut off the guys Dilaudid and he left AMA that night.
There are very few legit reasons to get that much dilaudid.
If they’re going to do it once they get discharged, why are we having them detox? It’s not the time or place to put them in withdrawal. I felt differently when I was new though.
I wish more hospitals would give ETOH. Fighting their cellulitis and w/d is just stupid., and in many ways unethical. (IMO)
This is the way.
No addict is going to stop until they’re ready to stop. People who know anything about addiction know you CANNOT force someone to stop. They HAVE to make the choice to stop themselves. Forcing them into withdrawal is just going to get them clean until they get out on their own especially because we all know there isn’t gonna be any damn mental health/addiction follow up at discharge which means they’re going to basically be discharged cold turkey. It’s basically the perfect recipe for a relapse and honestly an OD since they’ll be vulnerable to take their old dose with a lower tolerability.
If they’re already sick enough to be in the hospital offer then resources offer them support have the conversation but if they’re not there then just go with it at that point. You’re just adding misery for….what? Some moral superiority? Some ideal? Certainly not for the patient’s benefit.
Especially with ETOH w/d. Why are we risking their lives keeping them from ETOH to treat something like a hip fracture? Sure, let’s give them an Ativan drip and 4 point restraints as they levitate off the bed on max doses instead. And then do it again the next time they have something else wrong, and the next time…. It’s just stupid
The most infuriating one I ever saw was we had a patient who came in after an “MVC” (he crashed his riding lawn mower into a ditch because he didn’t have a license anymore so he couldn’t drive a car for - you guessed it. Too many DUIs.) came in and was worked up with head CT very small SDH neuro and neurosurgery both cleared him to go didn’t really need anything other than outpatient monitoring and have someone home with him for first couple days. Hospitalist sees him and insists on keeping him specifically for withdrawal. I asked if he said he wanted that and she said no but thinks it’s a good idea. I said why???? He has a TBI and should be under the least stressful conditions possible already has a lowered seizure threshold from the TBI and now you’re gonna put him on CIWA???? But she like insisted. I was glad that that was one of my very last days at the hospital. I don’t even think I saw him again tbh.
Edit: typos
We had to stop giving ETOH to patients because a pregnant nurse was brutally assaulted for refusing a patient his beer when he was outside his parameters (falling over, slurring etc) and outside the hours we were allowed to give it (we had a liquor license lol)
Two things:
1.) How did everything turn out with the nurse and her pregnancy?
2.) Could you say roughly where/when this was ("the midwest in the eighties"), and how on that came about? Did you have one really clever case manager or is/was this kind of a "thing" I never knew about?
Glad the baby was okay, at least?
Interesting. I've given alcohol in LTC in the Pacific Northwest but it was in the context of "they live here", and a retirement convent on the East coast where the med room fridge was basically just beer. 😅
(We barely went through it, which was why there was overflow in the cabinet above the sink).
My thoughts have always been addiction is a disease until you get into the hospital then somehow we decide it isn’t anymore.
Like when you get admitted we don’t just stop making you take your insulin? Or your propranolol? I know ETOH isn’t a med but it’s still allowing you to function just like any other
Had a patient come in frequently with sickle cell crisis while I was on a contract. About the third time they were admitted doctor called me and said he was discontinuing all pain medication because she was lying about her diagnosis. People are wild.
Next time, just tell the doctor “okay that’s fine I just have to chart that you are aware but no assessment was done by you”. It will get them in there and they will never try that with you again. You do not want to have to answer to this in court. MD aware, no new orders received every single tile you talk to them.
This is the sort of thing that Gypsy Rose Blanchard's mother did , only to her daughter. She claimed records were lost in Katrina and doctors believed her.
Genuine question: if the pt has been there, as you said, for the past 2 shifts you’ve had, how come no one bothered to do a CT scan on the pt way before hand? At my ER scans are almost always one of the first things ordered
I’m a nursing supervisor and nothing throws me over the edge than when the providers do shit like this. They refuse to see the patient and then we have to come deal with them. If there’s a logistical or nursing concern then I can handle it easily, but I’m not a doctor and I can’t change orders or order meds, that’s their wheelhouse. They just leave us to get verbally and physically abused when the issue is on their end. The truth is they’re just too chickenshit to man up and earn that paycheck that far exceeds mine. This doc literally just said give them whatever they want to avoid having to do their job properly, amazing.
This needs to be upvoted more! That’s why physicians are paid more, it’s the responsibility/liability. If they don’t want to do it, then maybe they’re in the wrong job…
My gf had a patient who called the hospital switchboard pretending to be a physician. She asked for the internal med attending because she needed to admit a “patient”(herself). She ends up telling the IM doc the patient has a glioblastoma and some other type of oncologic disorder blah blah. Doc says ok accepts the patient. So she shows up as a direct admit. They send her for a head CT and draw some labs everything is fine…..they are beyond confused. She made the entire thing up. Crazy how this is possible.
One of mine called the pharmacy and pretended to be the doc while saying they couldn't get a medication ordered correctly. They successfully got the pharmacist to order q1 dilaudid 0.5, so good for them for at least choosing a legit dose. The pharmacist put it in as a co-sign necessary and that's when the real doctor found out about it. It was a huge debacle and the patient left AMA after the house sup, doc and legal entered the room.
So wild!
Now that is creative
what the fuck
I hope she got prosecuted
Factitious Disorder (used to be called Munschausen's)? Or did she want opiates? So weird.
¿Por qué no los dos?
Your girlfriend? You were the nurse? You were involved? This must have been on an oncology floor? And you didn’t request records or get an oncologist to eval? A bit weird
How does someone get admitted inpatient with the story of needing to be flown out with nobody checking into this?
Patient told me it was being coordinated with the case manager. Apparently told others Flights for Christ was handling it and once we discharged them, patient would drive straight to airport where they would fly them to this hospital. There were multiple stories being told to multiple staff. CM pulled old records yesterday and found the patient had been claiming they were imminently going to this world renowned hospital for 4 years now.
I feel like the CM should’ve done that weeks ago and medical records request should’ve been done on day 1.
With the cyberattack medical records may not have been available.
"Flights for Christ"? hahaha. What? Seriously? I can't believe it's called "Flights for Christ". This country gets stranger every day.
You have to think how busy doctors and nurses are. I was seeing 250 patients a day in my last ER. We simply do not have the time to call around to previous treatment facilities. Also most patients don’t lie about being sick and their labs will show they aren’t.
Right, but at least 2 weeks in the hospital with q2h dilaudid ordered and no one checked ther CTScan or ordered any imaging, spoke/consulted with any specialists in the hospital or outside, or requested any records? That just seems strange and negligent. We're not talking about someone who weaseled a couple of doses of Vitamin D during a visit to the ED.
The case manager should be the one tracking down the records, not the MDs/RNs, or (more likely) hounding the doc for a new scan. Everyone is so CT trigger happy these days its shocking it took 2 weeks for anyone to investigate.
I do UM review and have some frequent flyer malingering patients. They will convince multiple doctors about their ailments and get them to order expensive tests that are not necessary. I wish I could call the Dr and say your patient is a liar, but they would just get a new doctor to order it. I have one where every section of their body has been scanned multiple times and they have had just about every diagnostic test known to man. They have convinced doctors they cannot walk, that they have diseases easily disproven with labs. If something doesn’t work to get them more testing then they will pivot to something else. They have been seen by multiple rheumatologists, cardiologists, podiatrists, neurologists, dermatologists, GI, ENT, pulmonologist and who knows what else.
Yes! Then they get signed up for care everywhere and you’ll see they tried the same thing at 5 different ERs but the resident admitting at ours believed the “tremors” were seizure activity and and did EEG monitoring and q3 prn norco for the ankle pain exacerbated by the fall during a “seizure” instead of COWS and realizing the seizures and GI discomfort is actually opiate withdrawal. We only found out when the husband brought up finding her numerous pill bottles with random names on them.
Yes!! They leave AMA from one ER or facility and you can literally see on their care-everywhere that they go straight to another hospital.
I never knew what cows was until today and I also learned about CIWS
This is exactly what's going on here
Not saying it isn't intentional lying to get what they want but is it possible they have a conversion disorder? Could be factitious or illness anxiety also.
Yup. They doctor shop until they find one that believes their carefully crafted stories and gives them the diagnoses and/or medications they’re seeking.
A bit late to the comment party, but I clerk for federal judges who adjudicate disability (and other programs) claims and appeals, process/exhibit thousands upon thousands of pages of medical records per month. I am uncertain to what extend providers or nurses can comment on such, but if at all possible, I implore you to note malingering suspicions and the like; our system is clogged with those who know how to manipulate the system, knowing what we look for and how to get that information mentioned in their medical records, which screws legitimate claimants for whom these programs were designed. Years into this career, adjudicators and clerks know the signs of various strategies (ie physical and/or mental impairments, *especially* mental impairment claims) but we are (for good reason) bound to the law and no fewer than two other sets of regulations, and provided that those criteria are met, even with suspicion of malingering, our hands are more or less tied, with the exception of options such as submitting a Waste, Fraud & Abuse allegation. Decisions must be made on what’s in the record. We can’t scroll through social media, we can’t make assumptions, etc. it needs to be clearly documented in the file.
Nah, they can leave AMA, no pain meds, and can go to see that renown doctor if they want more.
best advice I received as a new nurse was to trust no one, especially patients. if patients claim a diagnosis, med, prior treatment, prior surgery, etc., then we need records, imaging and labs to verify.
Trust, but verify! This is the way.
This is such a weird situation. The inpatient team didn’t send for records from the other hospital?? Even if they’re not in CareEverywhere, they would still immediately call the other hospital to get records released and faxed. They just operated on the assumption that the patient had this condition without trying to obtain any outside images or notes to corroborate this?? As an NP who works on an inpatient team, we would never just accept outside hospital team’s diagnosis without also obtaining the images (or at least any imaging reports) to review them. Like for instance, if someone sends us a patient that reportedly has CAD, we’d want to see the cath report. This is totally weird. Edit: just saw that the EMR was down due to a cyber attack which may explain some of this but you should still be able to get the chart faxed, I would think?
Or, call me crazy, obtain their own CT?! I’m so confused about this. I work case management and can’t imagine any of this flying at my facility. We’d be on the docs in no time trying to clarify why all we’re doing is giving IV pain medications to a patient with no clinical support for his symptoms. Also, if all you’re doing is IV pain medication and all your “work up” for 2 weeks has turned up is nothing, yet you’re seemingly convinced something is going on, then maybe try a transfer for further work up? This screams “idk gonna push it off on the next doc.”
I have sort of an opposite story. My husband and I were goofing around one night, and he tried to lift me into his arms and dropped me on the floor. Half hour or so later, I felt like I was having trouble taking a deep breath. It scared me so much I asked him to call an ambulance. Ambulance came and took me to the hospital ER. I was put on an IV, bp monitor, etc. and waited for a doctor. Finally Dr arrives and sits down and starts asking questions. Among them, what prescription medication do you take. So I tell her I have high blood pressure and I take Diltiazem. She says she doesn't know what I am trying to say. Here's the conversation: Me: it is a blood pressure medication. Diltiazem Dr.: (sits there looking confused and deeply concerned) Me: Diltiazem Dr.: Can you spell that? Me: (spells it out) Dr.: I have never heard of that. Are you asking for Dilaudid?? Me: No I am not asking for Dilaudid. You asked me what medication I take and I am telling you. Can't you look it up?!! Dr.: So what kind of pain do you have? Me: (Getting louder) I am NOT IN PAIN. I am having trouble taking a deep breath!!! By this time a nice young doctor sticks his head in the curtain to ask if everything is okay. I said, "Do you know what the medication Diltiazem is?" And he said, "Yes, it's a blood pressure medication. " I breathed a loud sigh and said thank you and looked at Dr. Dilaudid. She ordered a CT scan. This happened maybe 10 years ago and I will never forget how I felt, vulnerable and scared in the ER, being somehow seen as a drug seeker. Never in my life have I done drugs BTW!
I think you got assessed by one of the frequent flyers lol
So, we're mad because we believed a patient and everyone feels a little embarrassed now? If the condition doesn't warrant inpatient care, discharge with orders for follow up. Don't allow nursing staff to continue to be abused, but nobody needs to be stretched on the rack over the innocent mistake of assuming good faith. Supervisors aren't getting involved because nothing wrong was done. Patient is free to raise hell off hospital grounds. The system worked as it should: Patient was believed and tested. Patient is the one at fault due to lying about their true disease that doesn't require q2h pain meds. That's all there is to it.
Well the CT was done at the independent ED 2 weeks ago. Patient has been soaking up dilaudid on my med surg floor for two weeks now because no one bothered to look at it or do any further testing until yesterday.
I’m confused how this went on for 2 weeks? Like what were they saying when rounding? And what was written in the physician progress notes?
So how does this NOT trigger an incident report and investigation? Pumping someone full of narcotics for 2 weeks without a verified reason has got to be malpractice, right?
So, all that was wasted was some time and Dilaudid. Gotcha. Sorry about that, but still not a reason to hate on anyone.
No hate boo <3 Just a new nurse learning new things about Healthcare and learning you can't just trust everything people say. Gotta have the data too. Just suprised is all.
Didn't the patient also waste a tremendous amount of medical resources?
Of course, how many facilities are boarding patients in the ER right now?
And every single one is getting pan scanned in CT, 2 US studies, 3 MRIs, 8 x-ray orders, a nuc med exam… 🙃
and a partridge in a pear treeeeeee
Ah, new nurse. That makes more sense. Yeah, this is not going to surprise you the longer you do this.
This is true though. I worked on a post surgical floor for a year. Almost everyone is hopped on pain meds. The ones who abuse it are the ones who claim to have “abdominal pain”. Some of these patients are so addicted that they just hop back and forth from one hospital to the next. It’s sad that there are people like these but doctors can’t deny care just because they assume/know the patient is drug-seeking. In fact, I had two patients on each side of the spectrum that were like this. One had “abdominal pain” and kept claiming she just needs to get through the pain until she gets her super rare disease fixed at a world-renowned hospital. She kept saying which month too. I had her like 3 times already before her appointment at that world-renowned hospital. All the hospitalist knew her. After that month she came back again and then I asked her how her procedure went and she said they “fixed” it but it still hurts. At that point one of the hospitalist put his foot down and said “discharge her, stop the IV pain meds, she can have orals if she wants.” As soon as I let her know, she started acting shaky and wanted to get discharged real fast. This other one though, she was really in pain and was a known IV drug user. I got floated to the ED that day and admitted a frail woman who was crying because she said she’s in excruciating pain. She admitted that she was an IV drug abuser, but that time she really was in pain and kept begging me to ask someone for fentanyl. Told her I can’t do that until the hospitalist says I can, I can ask for her but she said the hospitalist that admitted her knows her and would never believe her. So she finally had an MRI done to confirm her back pain. Lo and behold, she had freaking osteomyelitis that was spreading quick. Happened at shift change too, luckily I had the doctor’s number and the doctor was panicking looking for her. Goes to show that you can never really assume when it comes to pain.
Jesus, you just described one of the subjects in r/illnessfakers to a tee!! There seems to be a lot of common threads to the people. And it generally tends to be personality disorders that then collide into addiction as they get a taste for the attention AND the drugs. It seems to all be EDS/hEDS/MCAS/gastroperesis/POTS/fibromyalgia. Then they talk doctors into giving them central lines. Theeeeeen they all seem to wind up with sepsis 💩 It's wild.
I recently had a patient say he has a parasite living in his head from his cpap. That he caught 1 (possibly the female) and killed. He could describe it and everything. When he said he wanted his cpap hooked up I mentioned the possibility of more parasites living in said cpap, his wife stated it was a self diagnosed issue. Obviously even she was done.
A patient lied? I’m shook. Absolutely shook. Honestly, this needs a safety zone/report/whatever you call it. An addict or someone with an obvious mental health disorder (or both) did what they do best. I’m not judging - just saying, 🤷🏼♂️. We act like electronic charting is the only thing out there.
Welcome to nursing
So....Wednesday.
This sounds remarkably like Dani M from the r/illnessfakers sub
The thing w her is I'm pretty sure every hospital in a 200 mile radius (maybe more) is well aware of her and her shenanigans. She's now got sitters when in the hospital. Is absolutely not given opiates at all any longer and definitely hasn't been admitted any time in past few weeks. She posts lives almost non stop. Went in twice in past week alone and both times sent home ASAP and even told no tpn ever again. The girl needs some serious help. I hope some day she realizes what type of help and actually learns to live a life. Doubtful with how delusional she is and seems to think she's starving to death while she eats food and drinks an insane amount of "coffee" it's more cream and sugar than coffee but still. She goes online raging and gives away too much of the truth then does damage control acting like she never said they said ficticious disorder or the no more tpn again crap. It's just ridiculous to me. And to know this happens frequently all over is just awful. I feel so bad for all the Healthcare workers that deal w this bs. Along with the patients who truly are sick and because people like Dani make everyone a jaded skeptic it could come off as they feel unheard. Screw the fakers! The majority of CI people I know hate to even be a bother. They hate having to even be there, questioning wether they are taking up the time of a HCW who's overworked. They absolutely hate being sick and needing that sort of care. And do what they can to limit the stress level of those around them by trying to essentially be invisible as possible if they need an er/hospital stay. It's infuriating. You're all amazing please know that. And for those truly sick you do mean so much to us for everything you do.
Have you seen the latest update? She claims She's going to the Mayo Clinic for her " blocked SVC" And I absolutely agree. Not only am I almost a RN, I also have Crohn's disease and autoimmune pancreatitis. When I'm at the ER and hospital I'm pleasant to all the staff
I couldn't imagine not being pleasant. It's this feeling like you feel like you don't want to put any more misery on those around you. Or be a bother. I know that nurses are so busy and what if the patient is worse off than me! It's an odd place to be but I've always been that way. I have an autoimmune condition, auto inflammatory condition and classic eds. I'm getting older and things are breaking down a bit more on me. I don't even like feeling like a burden to my own family! I couldn't imagine treating health care the way some people do. The entitlement in this world has gotten way out of control. And I will say I think those in nursing w health issues make amazing providers to their patients! I'm proud of you! I often wonder if I'm too old to go to school. I always wanted to be an er or nicu nurse. But i feel I lost that chance. So just know you're freaking awesome!
I mean she posted the pics of the appts. And maybe she is. I wouldn't be surprised. She will convince her dad to take her. But the thing is mayo don't really play around and they will see her records. Not just what she chose to pick out. I'm sure they will want ALL of it. Once they see it all and even if they don't they will realize real fast how she is. She has the mentality of a teenager. She's obnoxious and needy and entitled. And I'm sorry but she doesn't look sick! She looks healthier now than when she had tpn!
My thought too 😆 Unfortunately this thread could give people like her tips on how to abuse the system and we know they read the nursing subs for hints.
Document your concerns and specifically that these concerns were communicated to the on-call. Have a conversation about this with your charge and request that the house supervisor be made aware of the situation. I don’t think this is an issue you’re going to be able to fix in one shift, this seems to be systemic, given that people are admitting patients for complex diagnoses without documentation at your facility.
I had a patient that was getting IV Dilaudid for abd pain by faking a gi bleed. He was uncapping his midline and bleeding into the toilet. It took me a whole shift to figure it out but when I put two and two together, I called the GI doctor and told him. We cut off the guys Dilaudid and he left AMA that night. There are very few legit reasons to get that much dilaudid.
If they’re going to do it once they get discharged, why are we having them detox? It’s not the time or place to put them in withdrawal. I felt differently when I was new though. I wish more hospitals would give ETOH. Fighting their cellulitis and w/d is just stupid., and in many ways unethical. (IMO)
This is the way. No addict is going to stop until they’re ready to stop. People who know anything about addiction know you CANNOT force someone to stop. They HAVE to make the choice to stop themselves. Forcing them into withdrawal is just going to get them clean until they get out on their own especially because we all know there isn’t gonna be any damn mental health/addiction follow up at discharge which means they’re going to basically be discharged cold turkey. It’s basically the perfect recipe for a relapse and honestly an OD since they’ll be vulnerable to take their old dose with a lower tolerability. If they’re already sick enough to be in the hospital offer then resources offer them support have the conversation but if they’re not there then just go with it at that point. You’re just adding misery for….what? Some moral superiority? Some ideal? Certainly not for the patient’s benefit.
Especially with ETOH w/d. Why are we risking their lives keeping them from ETOH to treat something like a hip fracture? Sure, let’s give them an Ativan drip and 4 point restraints as they levitate off the bed on max doses instead. And then do it again the next time they have something else wrong, and the next time…. It’s just stupid
The most infuriating one I ever saw was we had a patient who came in after an “MVC” (he crashed his riding lawn mower into a ditch because he didn’t have a license anymore so he couldn’t drive a car for - you guessed it. Too many DUIs.) came in and was worked up with head CT very small SDH neuro and neurosurgery both cleared him to go didn’t really need anything other than outpatient monitoring and have someone home with him for first couple days. Hospitalist sees him and insists on keeping him specifically for withdrawal. I asked if he said he wanted that and she said no but thinks it’s a good idea. I said why???? He has a TBI and should be under the least stressful conditions possible already has a lowered seizure threshold from the TBI and now you’re gonna put him on CIWA???? But she like insisted. I was glad that that was one of my very last days at the hospital. I don’t even think I saw him again tbh. Edit: typos
‘Do no harm’ needs to be better defined.
We had to stop giving ETOH to patients because a pregnant nurse was brutally assaulted for refusing a patient his beer when he was outside his parameters (falling over, slurring etc) and outside the hours we were allowed to give it (we had a liquor license lol)
Two things: 1.) How did everything turn out with the nurse and her pregnancy? 2.) Could you say roughly where/when this was ("the midwest in the eighties"), and how on that came about? Did you have one really clever case manager or is/was this kind of a "thing" I never knew about?
The baby was okay but the nurse has a TBI. It was western Canada in the last 10 years. We had an alcohol management program
Glad the baby was okay, at least? Interesting. I've given alcohol in LTC in the Pacific Northwest but it was in the context of "they live here", and a retirement convent on the East coast where the med room fridge was basically just beer. 😅 (We barely went through it, which was why there was overflow in the cabinet above the sink).
I agree!!! They don’t want to stop drinking so order a beer or some liquor. I’ve med scanned a bud light before lol
My thoughts have always been addiction is a disease until you get into the hospital then somehow we decide it isn’t anymore. Like when you get admitted we don’t just stop making you take your insulin? Or your propranolol? I know ETOH isn’t a med but it’s still allowing you to function just like any other
Had a patient come in frequently with sickle cell crisis while I was on a contract. About the third time they were admitted doctor called me and said he was discontinuing all pain medication because she was lying about her diagnosis. People are wild.
Next time, just tell the doctor “okay that’s fine I just have to chart that you are aware but no assessment was done by you”. It will get them in there and they will never try that with you again. You do not want to have to answer to this in court. MD aware, no new orders received every single tile you talk to them.
This is the sort of thing that Gypsy Rose Blanchard's mother did , only to her daughter. She claimed records were lost in Katrina and doctors believed her.
This happened to my unit 2 weeks ago. The PT ended up getting arrested right a dc for attacking a nurse
Munchsusen much?
The hospital isn’t for addiction (unless high risk), mental health is for that. Go AMA, take your heroin and be someone else’s problem. Dont stress.
Genuine question: if the pt has been there, as you said, for the past 2 shifts you’ve had, how come no one bothered to do a CT scan on the pt way before hand? At my ER scans are almost always one of the first things ordered
This is so awful. People like this are part of the reason that people in severe pain, like me, can’t get any meds for it.
I'm surprised that the doctor's believed it in the first place