Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
It might be better for me to wait to start this topic. I have been so exhausted lately I can't tell if I am making sense in emails, etc. But this topic has come up quite a bit recently so I'd like to try to help.
By no means am I judging anyone. And I'm not excusing ER people. I'd like to give insight into the why... Why ER people act as they do and what you can do.
Healthcare work is exhausting. People lie to your face everyday, for a number of reasons. "He didn't hit me... I fell." or "I'm in pain, 10 of 10." But they're smiling. Compassion gets killed off pretty fast.
It's about assumptions... stereotyping... to avoid being "burned" by people who want the drugs not for pain relief, but because of addiction. No one wants to enable an addiction.
ER "people" (doctors, nurses, PAs, NPs, etc.) get cranky when people with "chronic conditions" come to the ER for management. The assumption, right or wrong, but right sometimes (at least once, not with you), is that you are not getting pain control from your relevant doctor, because he won't give it to you. You are "drug seeking" not for pain control but addiction. OR the other possibility is that YOU are not managing your condition well, not being responsible, and have to "use" the ER inappropriately. That is when you hear, "Oh you just want a med refill." Read, stop wasting my time.
It's funny how they get bent out of shape, right? They're thinking why can't people come in with real emergencies... but 90% of the time we see truly non-emergency stuff. Diaper rash, colds, ear aches. In their mind it's abusing the ER. It gums up a system meant to respond to life and death emergencies.
The ER is not the best place to manage chronic conditions. Yes... we know. But for uncontrolled 10 out of 10 pain, or anything new or unusual, go right ahead to the ER. That's darn well what it is there for.
Make it very clear this is above and beyond your normal, and normal is pretty crappy... Is NOT normal at all, and we live with pain every day... Make sure they know you follow up regularly with your rheumy (or whomever) and he will hear about it ASAP, but you need help Right. Now. Please. Here are the meds I take. I take them as prescribed. But this is something special. You might even have pain control that works most days but not this day.
So, be honest. Be nice if you can. Don't be overly dramatic. Make it very clear you are not an addict. (Don't be an addict, please.) And clear you're responsible with your condition. If an RA patient said to me "I can take a lot, but I can't take what is going on today." That would make my ears perk up.
I hope this helps you guys.
By no means am I judging anyone. And I'm not excusing ER people. I'd like to give insight into the why... Why ER people act as they do and what you can do.
Healthcare work is exhausting. People lie to your face everyday, for a number of reasons. "He didn't hit me... I fell." or "I'm in pain, 10 of 10." But they're smiling. Compassion gets killed off pretty fast.
It's about assumptions... stereotyping... to avoid being "burned" by people who want the drugs not for pain relief, but because of addiction. No one wants to enable an addiction.
ER "people" (doctors, nurses, PAs, NPs, etc.) get cranky when people with "chronic conditions" come to the ER for management. The assumption, right or wrong, but right sometimes (at least once, not with you), is that you are not getting pain control from your relevant doctor, because he won't give it to you. You are "drug seeking" not for pain control but addiction. OR the other possibility is that YOU are not managing your condition well, not being responsible, and have to "use" the ER inappropriately. That is when you hear, "Oh you just want a med refill." Read, stop wasting my time.
It's funny how they get bent out of shape, right? They're thinking why can't people come in with real emergencies... but 90% of the time we see truly non-emergency stuff. Diaper rash, colds, ear aches. In their mind it's abusing the ER. It gums up a system meant to respond to life and death emergencies.
The ER is not the best place to manage chronic conditions. Yes... we know. But for uncontrolled 10 out of 10 pain, or anything new or unusual, go right ahead to the ER. That's darn well what it is there for.
Make it very clear this is above and beyond your normal, and normal is pretty crappy... Is NOT normal at all, and we live with pain every day... Make sure they know you follow up regularly with your rheumy (or whomever) and he will hear about it ASAP, but you need help Right. Now. Please. Here are the meds I take. I take them as prescribed. But this is something special. You might even have pain control that works most days but not this day.
So, be honest. Be nice if you can. Don't be overly dramatic. Make it very clear you are not an addict. (Don't be an addict, please.) And clear you're responsible with your condition. If an RA patient said to me "I can take a lot, but I can't take what is going on today." That would make my ears perk up.
I hope this helps you guys.
Yes, we always know how people arrive.
People abuse the ambulance too, thinking it will put them in a room immediately, or at the front of the line. You get triaged like everyone else, though, and still might end up in the waiting room. In some people it actually increases the suspicion if they come from home/work/gas station/walmart, but from a doctor's office, it should be quite low.
Definitely good uses of your urgent care centers. Aortic dissection?! Yeah, that's legit. You're not gonna walk that off. Get thee to an ER. Stat. (No one ever says stat. It's a joke.)
Ah yes, some people are the Candyman. And you never seem to get the Candyman when you need him the most. You get the bloody Scrooge.
You grab onto any example of humanity that you can.
Ahhh, the dreaded 10 scale. So very subjective.
A 10 should be reserved for I CAN'T TAKE THIS ANYMORE, I'D RATHER BE KNOCKED OUT THAN TAKE THIS! It's funny when people are barfing and crying in pain, and very meekly tell you it's an 8. No honey, you're a 10. An earned 10. On the opposite, you want to roll your eyes when they're texting and lauging, and report a "10." Even when you have explanied what a 10 REALLY is.
But it's always variable. Some people have their pain level recalibrated when they have a new pain experience. Kidney stones almost always rate a "10" and we believe it.
You want to avoid making the doctor think "Why are you here in the ER right now? (Some actually flat out ask like that!) This is stupid and unecessary." That's what makes me say "be honest." Let them know why... This is worse than ever... My chest hurts...
In the case of pain meds...
You also want to let them know they can trust you, that you aren't going to abuse the meds they trust you with, or sell them, or give them to a friend/family member/other drug abuser.
I have migraines. Loooong ago I went to an urgent care for migraine meds. I didn't have all the issues that I do now, so an urgent care was perfect for me. Nothing narcotic. I was asking for ultram. I told the doctor there my whole story, my history of migraines. I stopped and he looked me right in the eyes and said "Is there anything else you want to tell me?" I said "Noooo.." He stared at me for a full minute, clearly making a decision. He was deciding whether to trust me. He didn't know me from anyone. He had no history with me. He decided to trust me thankfully.
"Are you better than last visit?"
"Yes."
"And what is your pain level."
"A 10."
Look of confusion. "But you said you were better..."
" I am... But this is still not tolerable."
Crickets chirping.
My son had meningitis (viral thank God) when he was 4 - I couldn't feel what he felt, but he was a very stoic little boy and to see the pain on his face - well that was a 10 in my book.
Confoosed - good point about perceived pain. I probably sounded like a jerk with my rating scale comments, sorry - lol. I didn't mean to!
Children to me are a HUGE exception. And I forgot all about kidney stones - never had them, but from what I hear, that's easily a 10.
OH - and I had gallstones for years, the attacks came every few months, I never really knew what it was until one night I had one so bad I could not breathe. It was worse than all my labor pains (I have 3 kids) put together. So for me....a 9?
Gahhh it's all subjective, you're totally right. I just have a family member who does the texting and laughing while saying she's on a pain level of "10" with a straight face (I've taken her to the ER a few times - don't even ask - she's a whole other convo - she likes the "attention").
Anyway, she's made me a bit jaded about the pain scale, lol.
0 - Pain Free
1 - Very minor annoyance - occasional minor twinges. No medication needed.
2 - Minor Annoyance - occasional strong twinges. No medication needed.
3 - Annoying enough to be distracting. Mild painkillers take care of it. (Aspirin, Ibuprofen.)
4 - Can be ignored if you are really involved in your work, but still distracting. Mild painkillers remove pain for 3-4 hours.
5 - Cant be ignored for more than 30 minutes. Mild painkillers ameliorate pain for 3-4 hours.
6 - Cant be ignored for any length of time, but you can still go to work and participate in social activities. Stronger painkillers (Codeine, narcotics) reduce pain for 3-4 hours.
7 - Makes it difficult to concentrate, interferes with sleep. You can still function with effort. Stronger painkillers are only partially effective.
8 - Physical activity severely limited. You can read and converse with effort. Nausea and dizziness set in as factors of pain.
9 - Unable to speak. Crying out or moaning uncontrollably - near delirium.
10 - Unconscious. Pain makes you pass out.
I guess this one isn't like the Richter scale (earthquakes) where eah number higher is a 10-fold increase. Where do other people live on this scale? Do the majority of healthy people really live at 0 or 1? I've had various joint pains for 30 years, and don't really remember a time when nothing hurt. This is really depressing.
I do like the pain scale in this link, though: http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html
I used to use the ER regularly with serious asthma, and dealt with the asthma with my lung specialist and I have not been back in probably 20 years, despite continued lung issues.
A few weeks ago, though, I did use the ER. I had never gone to the ER for RA in 17 years, and never gone in an ambulance. But I had the flare of flares in my left knee, to say nothing of what turned out to be a tear in the knee.
After screaming for several hours at home, despite serious pain meds and prednisone, I could not even bend my knee enough to get in our truck or car and go to the ER. I would rate my pain at 11/10, which means completely incapacitated! So my husband called the ambulance, and I took the trip and accepted the gas they gave me to keep me from screaming.
When I got there, I continued to scream until they were able to give me a morphine shot. It took an hour, and then aspirated the fluid plus a cortisone shot.
I left soon after, and my promise is to never have to go the ER for anything other than accidents, like my broken wrist this summer! (For which I never screamed for a moment!) And hopefully not break anything again, either!
Good post!
I think so many of us have been in pain every day for so long that it's like "pain chart, shmain chart." I just hurt, dang it.
but dang that was funny ("I'm sorry about your cat but can we talk about something else now?" LMAO!!)
Most people are a 0!!!
This is getting bumped up to it's own post. Oh, myface and stomach muscles hurt now.
I would say the past 3-4 months I've been at a "5" with pain meds taken on a regular basis. I know if I miss one during the day or sometimes at night I reach a "7".
A few years back, I had some kind of intestinal kink that was excruciating. I was in so much pain, I was vomiting. One of the staff members at the hospital mentioned something to the effect that I was just there for drugs. I was horrified and greatly insulted. I have never been a drug abuser in my entire life. They ended up keeping me overnight, giving me regular doses of morphine that just made me vomit more and more. I wondered if they put something in the morphine to make me sick (like they really thought I was a drug abuser or something). Horrible experience.
I've said it a million times. We get so very jaded. We see drug abusers every day we work. And they lie so well. But it is always, always, always our responsibility to maintain our humanity.
There's an advocacy for me... Stop abusing/misusing drugs. You are killing off the humanity in healthcare workers (and hurting the people who are truly sick.)