The person writing the pain medication prescription IS responsible for considering the patient's drug history, which is part of the medical record for a reason.
The purpose is not to call a person a junkie, or a whiner, but to protect them from possible overdose, addiction, and/or other unfortunate consequences.

It's relatively easy to unintentionally create a drug dependent patient. Refill the Ativan without asking questions.

Addicts do exist. Drug dependence does exist. Medication overuse/overprescribing does exist.
Having said that, you are correct. Pain is pain. 100% agree.

I think in this forum some discernment is due to claims of emotional pain. It can't just be believed to exist whenever someone says so. Waywards in particular are adept at exploiting "pain is whatever the experiencing person says it is" to their advantage.

Classic examples...

1. "Exposure hurt me" - really? Your BS is reaching out for help from others due to the REAL pain you caused them and you've got the gall to complain about YOUR pain regarding exposure of YOUR freely chosen actions. You and your "pain" aren't the center of the universe...the BS and his/her real pain matter too. All to often this "pain claim" is nothing more than manipulation to get the BS to stop interfering with the affair. Besides...waywards are pretty much empty vessels (at the time) and devoid of true feelings so any claim of pain is nothing more than the Herion addict lying in a dumpster lined alley complaining about the itchy scabs on their arms.

2. I am in pain because you attacked me. Used as a complete distraction to avoid addressing anything being legitimately confronted about. Draw the attention away from you and on to "your pain" and, if successful, punish those confronting you by seeking allies to support and comfort your supposed pain. There is no shortage of other wayward sympathizers who want nothing more than to see you remain stuck in your waywardness, like them.

3. I am in pain because you exposed my lies. That's not "pain" that's just anger at getting caught and/or anger that they can't continue on using such lie to protect their duplicity. Liars will often try to fall back on some rationalization like..."well, I didn't feel safe enough here to tell the truth". What the heck....you lie and it's OUR FAULT.

The most pathological people in the world are the most adept at using "claims of pain" to exploit and abuse people. Their "targets" are fuzzy thinkers and people that live in the gray areas of morals, values and beliefs. It's how evil persons communicate with one another...."I'll legitimize your pain if you legitimize mine". As a medical professional you may be being taught how to separate your black and white thinking PROFESSIONALLY as you dole out professional medical services but that does not make it the right way to live your personal life.

People are wrong sometimes.
People are bad sometimes.
Some people are wrong a lot
Some people are just bad.

People need friends that will utilize their abilities of discernment to make such judgments and TELL THEM when they think they are doing wrong, behaving badly, etc. The person being so helped...needs discernment to figure out that they are being helped, perhaps through confrontation, and not "attacked".

In real life...your friends should call you on your chit, even if it may cause you or them pain to hear it and your friends should trust your judgment and discuss it further rationally and HONESTLY to see what can be done about it OR they are not your true friends.

TRYING to lead people out of the pits of darkness into repentance is a noble and often thankless undertaking.

Mr. Wondering

p.s. - I capitalized "TRYING" because I am human and make mistakes too.

Mr W,

One of my top criteria for deciding a (pain clinic) patient was probably "drug seeking" was ....

take a guess ....



Did you guess correctly?
I bet you did !

Example:
(one of my favorites)

Both fine examples. Can't argue with that.


So, as a medical professional who had the responsibility to both diagnose and prescribe medication (professional hero, BTW, overused and underpayed), how often did you see a label follow a patient from care provider to care provider?

Not exactly understanding what you mean by "label" ... because some labels are life-savers.
Every diagnosis is a label, is it not?
Patient is a diabetic. It follows them.
Patient has a psych diagnosis. It follows them.
You should probably re-write your question so I can both understand and answer it.
I THINK you mean a derogatory opinion of the patient, but, I am not sure.

I am 61 years old, by the way.
Just so you know, I worked most of my 30 professional years as an RNP, with just a few years as a BSN prior to that.

I encourage you to GO FOR IT.
Go for the highest level of education your circumstances will permit.
You're in an RN program now?
Get a BSN. Then, get a masters.
I used to mentor UCLA students in the masters RNP program. I mentored them, but never got a masters degree. I was "grand-mothered-in", in just about every way possible. LOL.

When I have needed care my own self, I have always welcomed the RN student nurses as my caregivers.
Student nurses are fun, curious, attentive, and scared as hell to make a big error. So, they pay attention.
I've always said "OK" when asked it I wouldn't mind having a student take care of me.

My 24 year old son would like to go to nursing school one day.
However, he recently enlisted in the ARMY and will be going to boot camp and then combat medic training in 2011.
I'm terrified, but don't tell anyone. Shhhhhhheeeeet!

Ack, I have a disdain for military and their "promises" to our young men and women. Keep on his behind to use the resources available to him to further his education at every opportunity. I work with a former combat medic... which translates to NAC and/or Medical Assistant and I have been encouraged to my schooling by a former army RN, which translates to LPN.

I do want to go as far as I can, so long as the cost isn't my M along the way. School has been part of the damage done.

61... nurse... retired? I didn't think teachers and nurses ever retired? Lol.

Yes, the negative labels. Have you ever had a patient switch, or be referred, and carry a negative label into your assessment? You provided excellent concretely evident situations, how about the seemingly less obvious? Has there ever been, to your knowledge, a misjudgment?

I think you paint a fine picture with students. There was a study a few years ago in which a simulation was set up, and veteran nurses were tested against new nurses.

I can't remember the specifics of the scenario - but it was a difficult nursing judgment situation. Bot groups ended up killing the "patient," but the experienced nurses did it faster!

O_o

Difficult situation; sometimes knowledge and experience leads us to the wrong conclusion. It's something I try to constantly keep in mind.

Humility. I R not so smart...

I love this !



So true.



OK.
I can see where we (you and I) went astray. I think your use of the word label is misleading. So, I am going to substitute derogatory opinions. Ok with you?

Yes, is the short answer.

Here is an example from ambulatory care, which is where most of my career took place.
"Non-compliant"
That one is common.
A noncompliant diabetic who does not take their meds properly , no one wants to tackle that.
Can that be a misjudgment?
Yes, again.
The patient might be noncompliant for a variety of reasons.
They might not be able to afford the medication.
They might not have literacy skills to follow the complicated instructions.
They might have a co-diagnosis of depression, or something else that interferes with their follow-through.

A personal example of a difficult patient: (You'll enjoy this one)

My former employer provided a retired MD/JD who was available to answer our medical/legal/ethics dilemmas. I remember emailing him a question about how to enter something in the medical records in a way that protected myself and the patient.

Here is what happened.
She was young. Early 20's.
She had been seeing me yearly since her teens for her GYN exams.
She had always acted overly friendly with me.
I entered the room, she was lying completely naked on the exam table (had been given a gown and a sheet by the MA) with her feet already in the stirrups.
She starts her usual chattiness and what she considers to be friendly (nosy) questions about my personal business.
I go to the "business end" of the exam table to find that she had taken a sticky note and placed it over her labia. On the sticky note, she wrote, "Have a nice day" and drew a smiley face.


So, I knew I was in trouble.
I WANTED to write "inappropriate nudity and sexually suggestive behavior" in my note.
But, THANKs to the MD/JD resource, I did not.
He told me to write a complete description of the event and leave out the words "inappropriate" and "sexually suggestive".

BUT, I'm sure that anyone reading the description would come to the same conclusion.
That providers needs to be vigilant and self-protective when seeing this young woman.

Found this thread interesting as I like rants.

Pepperband,

The advice you were given sounds similar with how I had to testify regarding child custody. Was not to give an opinion, just the facts.

So, the sink was full of dishes, there were animal feces in several places in the carpet and the garbage cans were overflowing.

Not....the house was a total disaster.

I wouldn't even comment on an odor as that is purely subjective.

Same can be said about these posts. Words like inappropriate, disrespectful and the like are really way to vague.

Odors are indeed subjective.
In medicine, we sometimes might use our sense of smell to help suggest a diagnosis (not make a diagnosis).
There is a "strep throat" odor that no amount of mouthwash or toothpaste can eliminate.
I remember many times when my sense of smell "suggested" a diagnosis immediately upon entering a room.


And, of course, the infamous "whiff test" ... look it up.

Oh, my!

And I think your explanation and example furthers the conversation here; best intentions. (get "word choice" beat into my head a lot when it comes to notes)

I remember reading some abbreviations that used to sneak into charts... none of them come to mind at the moment. Just simple two or three letter "codes" describing patient behavior or attitude.

I don't want to misrepresent myself here. For instance; DD12 had a problem with bleeding with BM's when she was little. We talked about it with our OD several times - it was intermittent and was never a large amount. He concluded, at the time, that this was probably due to constipation, or maybe a slightly small rectal tract. We tried several things; increasing fluid intake, increasing fiber intake (including sprinkling bran on top of foods) and nothing really seemed to work permanently. Yet, we weren't really vigilant about the interventions we were trying, and the bleeding wasn't a constant issue.

Well, when she was 3, she was sitting on the pot, straining to go, and she complained to W that "the poop is stuck." W inspected, and noticed something "poking out." It turned out to be a rectal polyp. Not an entirely common thing in a 3 year old.

W was incensed. "Why didn't he SEE that? Why didn't he CHECK?"

Well, he was simply dealing with the information he was given, and working through interventions to eliminate variables. I know this, and this was when I was a night manager at the grocery store... 22, 23 years old or so.

I'm a science nerd, I understand the research and discovery process, and try to give the benefit of the doubt.

The bodily process just happen to beat the diagnosis process here. It's going to happen. It ended up not being life-threatening, and corrected surgically, and no problems have arisen since.


What does this have to do with derogatory opinions?

I don't have my "own" example, I just have this one from the aforementioned pain management presentation, and a stinging realization towards my own tendencies and errors in judgment.

The presenter had an anecdote specifically prepared for the danger of labeling, her own sister.

Her sister was experiencing chronic pain, and just couldn't seem to get anything done to relieve it. There were tests and prescriptions, but when those interventions did not alleviate the issue, she seemed to hit a brick wall with her providers. She went through SEVEN "second opinions" and that brick wall remained. Acquisition of her records evidenced that a "med seeker" stigma had been applied and carried through every alternate opinion.

It was only when she found a provider that would take her WITHOUT her medical records, that she was finally taken seriously. WITHOUT HER MEDICAL RECORDS. Those records created and maintained this negative stigma and impeded her ability to receive proper treatment!

It was an OB/GYN that took her w/o records (we were told this is actually common for OB/GYNs - so ladies, there is hope!) and took her seriously.

Long story short, the woman was riddled with small, cancerous nodules. By this time, the cancer had spread throughout her entire body, and there was no hope for treatment.

All because people with knowledge and experience allowed themselves to continually apply a label and care for her improperly. They did so with the information available, believing they were doing the "right thing" and DID NOT LISTEN TO THEIR PATIENT.

Seven different people. SEVEN. Experts, professionals.

I had that painfully fresh in my mind.

THAT is the danger of applying labels.

"Cake-eater." "Freeloader."

BAM!

Label applied, job done?

No.

The cake eater and freeloader are descriptive labels of BEHAVIOR patterns. They do not describe a person.

I think you are over reaching.
But, I could be wrong.

On a thread in "Recovery" you described your own vulnerability.

So, you self-labeled "vulnerable".
That does not mean you will be vulnerable tomorrow.

A "freeloader" is a person who might also be capable of self-correction and becoming a really solid spouse with "buyer" written all over him/her.. (Like my beloved husband, the Sweetest Babboo ever).

A "cake-eater" is descriptive of behavior where a wandering spouse (AKA infidel) is accepting/getting love deposits from more than one source. It's not a permanent label of a person.

However, there are some MBers with less (ahem) sophisticated discernment skills who might not realize that "cake-eater" is a behavior set, and not a person.

Don't get your knickers in a knot.
It's bad for your laundress.

Lol.

Thanks, Lucy.



I get what you are saying, however, "vulnerable" is more specific of a descriptor, whereas "freeloader" and "cake-eater" refer to behavioral sets.

Ack. <---- right there realized we are on the same page. Actually, I think we have hit complete understanding here...

Thanks, boss.

Oh... and nevermind the Lucy... Sally...

Look, is this Peanuts, or Cathy?

Someone learned how to post photos.
In Facebook lingo:
like

Lol.

Knew how, don't even have to use the neat little "dummy buttons."

Just didn't see a ton of them, so was trying to follow etiquette.

Talking like robot, or Rorschach from The Watchmen....

I am closer to a Sally, most days.
Especially recently.

But, I do confess some rather alarming Lucy tendencies when push comes to shove. I try to keep her subdued if she gets too loud.
Lucy does have a strong & hearty point of view.

Never afraid to scream "BLOCKHEAD!!!!"