Labeling Patients
When I lecture on pain management I often discuss the critical issue of labeling patients. Although it is something all practitioners do at some time during their career, it really can have a negative impact on patient care and also affect patients in ways that they may never realize--unless told.
Here is my story...Being a nurse who has also been a patient more times than I would like to remember, I am all too aware of the impact labeling can have on patients.
Roughly 13 years ago, I was a patient in a small town hospital where I lived and worked. I had a reaction to medications prescribed for cluster headaches. Well, one thing headache sufferers often realize is the need to take medication at the first sign of a pending headache in order to gain the most benefit from the medication. And one thing about clusters is the fact they often come on like clockwork with clusters running over a period of days, weeks, and even months. Well this particular time was 9:50 a.m. on a Friday while I was a patient in room 218. (Notice the fact I can remember the exact day/time and location of this incident.)
Having recognized the aura I was all too familiar with at this particular time, I called for medication. The nurse on duty answered the call light at the station and yells over the intercom asking me if I really needed the med or was I just "thinking" I was going to get a headache. Her attitude was sarcastic and her tone of voice condescending. I was devastated.
I realized this nurse doubted my need for medication which when translated indicates her belief I would ask for pain meds for reasons other than pain. Whether she realized it or not, she had labeled me as a drug seeker. Being a nurse who worked beside this nurse on a regular basis, I was devastated to think she might think of me this way--and for no reason.
I still remember how it made me feel then because it brings back many of those same emotions as I think about it now. The point of my sharing such a scenario is in hopes that nurses and other caregivers will take heed about how their attitude and demeanor can affect their patients. Now this nurse may not even have realized how she came across to me.
The way I have managed to get past the incident is to identify this as an example of a professional who needs to learn more about pain and its management. She also needs to understand the differences between tolerance, dependence and addiction. And she also needs to realize her own biases and what things trigger her to respond in such ways that can impact her patients so profoundly.
This incident occurred over 13 years ago... Can you remember where you were at 9:50 a.m. last Friday and what your conversation might have been about?
Related Topics: Treating Chronic Pain, Managing Migraines, Migraine Triggers
Abstract: NIH: The practice of pain management and why treatment has been proven to be inadequate. One of the three reasons is the underprescription of analgesics.
Here is my story...Being a nurse who has also been a patient more times than I would like to remember, I am all too aware of the impact labeling can have on patients.
Roughly 13 years ago, I was a patient in a small town hospital where I lived and worked. I had a reaction to medications prescribed for cluster headaches. Well, one thing headache sufferers often realize is the need to take medication at the first sign of a pending headache in order to gain the most benefit from the medication. And one thing about clusters is the fact they often come on like clockwork with clusters running over a period of days, weeks, and even months. Well this particular time was 9:50 a.m. on a Friday while I was a patient in room 218. (Notice the fact I can remember the exact day/time and location of this incident.)
Having recognized the aura I was all too familiar with at this particular time, I called for medication. The nurse on duty answered the call light at the station and yells over the intercom asking me if I really needed the med or was I just "thinking" I was going to get a headache. Her attitude was sarcastic and her tone of voice condescending. I was devastated.
I realized this nurse doubted my need for medication which when translated indicates her belief I would ask for pain meds for reasons other than pain. Whether she realized it or not, she had labeled me as a drug seeker. Being a nurse who worked beside this nurse on a regular basis, I was devastated to think she might think of me this way--and for no reason.
I still remember how it made me feel then because it brings back many of those same emotions as I think about it now. The point of my sharing such a scenario is in hopes that nurses and other caregivers will take heed about how their attitude and demeanor can affect their patients. Now this nurse may not even have realized how she came across to me.
The way I have managed to get past the incident is to identify this as an example of a professional who needs to learn more about pain and its management. She also needs to understand the differences between tolerance, dependence and addiction. And she also needs to realize her own biases and what things trigger her to respond in such ways that can impact her patients so profoundly.
This incident occurred over 13 years ago... Can you remember where you were at 9:50 a.m. last Friday and what your conversation might have been about?
Related Topics: Treating Chronic Pain, Managing Migraines, Migraine Triggers
Abstract: NIH: The practice of pain management and why treatment has been proven to be inadequate. One of the three reasons is the underprescription of analgesics.
3 Comments:
Indie,
I have recently had a similar experience with a chronic pain doctor. One of Kaisers downfalls is that their chronic pain doctors are also their drug and substance abuse doctors. I feel this is a bad idea because the way they seem to approach treatment is this -- "my patients are either drug addicts or potential addicts, so that's how I will treat their pain". In other words, they seem to treat the possibility of an addiction first and the pain second. Since I started with this guy, the only time my pain has been under control is when I've been in the hospital and not under his care.
For the record, I have chronic nerve pain secondary to Guillain Barre Syndrome, as well as chronic muscle/joint pain in my low back, hips and legs. I've been told that the reason for the joint/muscle pain is because of weak core muscles that are doing all of the work for leg muscles that have permanent nerve damage.
Anyway, I agree. Chronic pain is treated poorly in this country. I wouldn't be with the doctor I had right now if I had any other choices. Due to pre-existing conditions, I am un-insurable anywhere else, and Kaiser isn't going to change their practices for me
I can relate to most people with cronic pain as I have had 7 low back operations with 10 disc removed and plates, rods and screws put in. My pain level was a 10 all the time and even drove me to trying to take my own life.
I went to the Veterans hospital and they gave me 2 percocet 5 every 6 hours. If you are a veteran try the VA hospitals as they are more likely to give you the meds you need. Thank god for the VA because without them I most likely would have taken my life long ago.
I go to the VA now because I have no other insurance sense my Ex wife left me in 1996, I was seen at a pain clinic in NY for several herniated disks with arthritis in my neck and lower back from a car motor cycle accident. I also have Thoracic outlet syndrome that has been operated three times with no success and I have pain in my legs from deep vein thromboses. One of the DVT was not diagnosed for 2 months and ruined most of the vein in my left leg. I also have fibromyalgia. When I went to UT the state to get a new start at my mothers home the state pulled the medication I was on and lowered me to a lesser pain medication that put me back in the house most of the time in bed with bad pain, the pain med I was on was considered for cancer victims only by the state of UT, I went to KY after that and after trying to get a Dr here in time to fill my pain meds I was allowed to run out and get in severe pain and left to detoxify on my own. I tried to go to UK medical center in Lexington KY before I was to run out to get my scrips filled to see a Dr later that month to get a regular pain control again but was told even with my medical records in hand I did not need to be on pain meds by a Dr Kennedy in the ER. I walked out before the other test was finished I also had them check how thin my blood was being I am on a blood thinners and had not been checked in a month by anyone. I finally went to the VA where I found out I was eligible to be seen there and again went to there ER and was sent home the same day in pain and detoxing off years of use of needed pain medication in Lexington's VA ER, I later came in in severe pain 2 days and in danger of serious problems two days later and was treated only when I was only close to a dangerously sudden detox off meds I was told I was never to try and stop all at once by Dr's and pharmacies but the ER Dr's do not care so don't think you will get help at any ER if you move until your blood pressure is of the scale and pain is so bad you can just barely walk. I got my pain meds filled and was given a Dr who does not know anything about pain or pain medication. I told her my story of the pain meds I was on in 1996 by a pain clinic and that I was lowered to another medication that did not work very good and she wrote me the same pain med that is a 12 hour time release medication but she wrote it to take every three hours with a total of three a day, I have spent time trying to get her to see that the pills only work when they over lap each other for a few hours to no use. I was told not to push pain treatment by a worker in the VA because they have dropped many people off pain treatment for just needing something stronger to help them with there chronic pain and seen as drug seekers or people who sell their drugs on the street even if there is no proof you ever tried they will label you anyway, we should be taken one case at a time but we are sen all the same because of other people making it bad on us that need help. As of last 02/07/08 I finally got to see a neurologist and it was the same DR I walked out on at UK medical ER and she said after seeing all my records she was recommending I go off pain meds and be put on anti inflammatory that didn't work on me sense the 90s and go to physical therapy that has been tried on me by the pain center in NY with great distress along with every thing that is tried on most chronic pain patients before pain meds are used to treat pain. This Dr quit listing to me the minute a brought up my pain medication problem , My Fiance was with me and sees me in pain daily and she could not believe what the Dr said to me, I even asked to get pain shots so I could get off pain meds and this Dr said my pain was to wide spread to get the shots? I have a witness to this. Now I am worried I will be pulled off all pain meds and wind back up in bed and I have no money to any other Dr's I believe I am now labeled as a pain pill seeker now even though I was put on SSD for pain and severe headaches and chronic widespread pain in 1990 for thoracic outlet syndrome, This was way before I found out about my neck and back problems or fibromyalgia and before I had 5 blood clots. The VA in my opinion has no experience with pain management and there GPs should not be in charge of pain patients. Th VA has a pain control center but does not use pain meds. I wish I knew how to get legal action going to keep me out of being house bound like I have been a few times during my experience with the pain control center in NY before I final got out of bed after 2.5 years when they changed my pain meds and got me out of bed to the point I lost 100 Lbs I gained because I had to stay in bed most of the time, now I could at least go out side and do somethings with in limits and walk over a 100 ft to more than a mile. Be careful you don't fall into my problems if your pain management care is working do all you can to stay there because if you think anyone cares even with your medical records in hand and you paim meds were carefully given to you so you could be useful and make deep depression better, that if you move that any one will keep your pain under the same treatment you are wrong and could wind up like me ready to lose it completely after a 26 year period of pain management in one state for just moving! Note to all, Get a copy of every Dr visit and test you have had nad keep exrta copies. Some Dr's do not send medical records when you sign a releise to have your old medical records sent to your new Dr.
I lost some of my spelling and use of numbers after my accident I am sorry some spelling is off.
I have extensive medical records to document my pain to be under needed pain management not just a story to tell. If anyone has had the same problems with changing Dr's or the VA please post a comment we ned to speak out and if any one knows how I could take legal action on the VA please post it I do not know what to do and they have had me scared for almost a full year about taking me off pain meds and putting me back into bed useless again and if you have not been put thorough this problem you will not undrstand how bad your nerves get to lose your mobility and get put back into severe pain if you have had this happen I am sorry you already know... Becarful not to get labled even if you have broken no rules in a in a pain contract because I haven't and they never find anyting wrong in a urain test you can still lose your pain meds.. RJ in KY
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