Critical Care Medicine - List
http://www.pitt.edu/~crippen/

Another tale of the Emergency Department and drug seekers

Remember our previous discussion of drug seekers in the ED? Last night I was moonlighting in the ED. A well dressed "Mr. Businessman"-type entered complaining of neck and back pain. Here is the story and how it unfolded.

He had suffered a motor vehicle accident several months before and had continuous neck pain. Neurologist and neurosurgeon recommended symptomatic treatment and rehab therapy. Orthopods ditto. Was undergoing the usual rehab at another hospital and ultimately was referred to the "Pain Clinic" (run by the Physical Rehab Medicine service here). Showed up for his first appointment and it turns out that there was no clinic that day. Secretarial foulup. He complained of pain and was immediately tubed to the ED.

Signed in, went to his area and announced to the nurse that he didn't want to see the doctor, didn't want to get examined, only wanted his prescription for Percocet (shudder) refilled. (For you out-of-towners, that's oxycodone and acetaminophen). At this point, the experienced ED nurse directed me to a neutral corner and called for the other ED attending to deal with this.....a more accommodating person. Didn't matter, the other guy went in there and the screaming soon began. Finally the Doc exited white faced with rage and refused to see him again. The patient called for the administrator on call.

Here's where it gets interesting.

As a practical matter, there are two species of Hospital Administrators on Call for Trouble. "Flak Catchers" and "Feather Smoothers". This guy clearly had mucho flack to throw, and so, accordingly, a Flak Catcher from the pool was dispatched to the ED. It is the Flak Catchers job to absorb slings and arrows of pissed off patients, give them the impression that someone, somewhere really cares about their complaint, and something will be done about it. After absorbing a sound scolding, the Flak Catcher advanced to the nurses station (supervised at a respectable distance by a glowering patient). "Perhaps the best way out of this uncomfortable situation is to have the other doctor (me) see the patient and perhaps make some effort to defuse this situation (give him what he wants so he'll go away)".

I'm hopping up and down in place, fangs bared and claws extended waiting for the word to pounce......"Uhhhh....I don't think Dr. Crippen would be the right person to deal with this gentleman's unique problem (shred him like a Waring blender)". "Perhaps we might continue to discuss what we have available for him in a positive manner (send in the Feather Smoother)". At this point the Flak Catcher hands the baton to the Feather Smoother, who proceeds to the patient and begins to stroke him. Every diabetic in a 50 yard radius goes into shock. Other patients shriek piteously and attempt to escape. Finally, the patient begins to soften under the merciless barrage...... "We are just oh-so concerned about you problem (and any potential liability for the hospital)". "We intend to hold at least twenty meetings to discuss how to effectively deal with your particular problem (we'll shoehorn them into the other 200 meetings we have daily)".

Waves of nausea envelop the ED staff. "Of course we will launch a full scale investigation into this issue (someday) and we will, of course, meet with the physician involved (Death-of-a-thousand-meetings) to discuss their interpersonal skills (get them to do whatever it takes to make you happy)". Finally he agrees to call his personal physician on the phone (from somewhere else), following which he is gently wafted out the door (Cheshire Cat Smiles all around) and into a waiting cab, graciously called by the ED nurse (gratis, of course).

And so the sum total of this encounter: The patient didn't exactly get what he wanted, but he felt a lot better about the experience. Another satisfied customer here at the Mecca. (Your hospital administrators at work)