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Unless you are either female, a minority, young, or have chronic pain in which case any mention of pain you have, no matter how extreme, is considered a drug seeking attempt.
The ER will diagnose people based on their race, sex, gender, and age before they'll diagnose you based on your symptoms. It doesn't matter how much you are suffering, how much pain you are in, or how close you are to killing yourself because you can't take it anymore. ER doctors have no empathy unless you fit a certain demographic.
I hurt my back during training and since it really started hurting after-hours I went to the local ER. The same ER all of the serious training incidents go to.
The ER doc eventually said "this seems like drug seeking behavior".
To which I responded. "No shit. I didn't come in here for a hug. I need muscle relaxers and pain meds so I can fake it through PT in the morning."
Which hilariously worked? He gave me what I needed and I left.
As a former heroin addict (clean for a decade at least) I am terrified to be treated that way.
I’ve made it clear to anyone with any decision making ability in my life that unless they say, “he’s dying, there’s no hope.” they are to refuse opioids even if I’m begging and pleading.
Doctors don’t know I feel that strongly about it, but they can pull up my chart and see that I’ve been a junkie in my life. I hate that.
My son wears a medical bracelet that says no opioids except for end of life palliative care.
He fought too long and too hard to get sucked back into addiction.
I'm happy for you; you have beaten addiction into the past and that's where it's going to stay.
Thank you, I really appreciate the comment.
I’m glad your son is doing well.
The biggest thing I took away from recovery is when they said, “people, places, and things”. That was everything and it didn’t sink in until I spent time going to groups.
I always knew when someone was going to make it. They had support. You are everything in your son’s world and recovery whether you know it or not.
The people who couldn’t get away, the ones who died, their whole family was infested and plagued with addiction.
I heard someone in his early 20s, “I got out of jail two months ago. I did good until last week. I was helping my mom move and she crushed up a pill on the counter. I asked her nicely to please keep it away from me. “Oh, you done forgot where you came from. Mr. High and mighty don’t want me doing what he did for the last 5 years in front him.” I fucked up. I made a call later that day. I’m going to rehab next week.”
We had a moment of silence for him when he overdosed a few months down the road.
I have a friend who just fucked up a decade sober. He has a pace maker from his addiction and he’s only 42. He made it sober longer than anyone else I knew who kept company who still used. He couldn’t leave friends hanging and now he’s paying for it. I have hope that he’ll pull it off because he made it so long before. He’s been to rehab recently and they had to ship him to a hospital because of his heart. He’s heading to a rehab that is better equipped to deal with his health issues soon. He’s in love with a junkie though, and she’s beautiful, so I hope she gets clean or he gets away from her.
I am so lucky. My mother doesn’t even drink. She’s a damn good part of my support system. My uncle kept me employed and looked out for me while I got it together. It has been a huge privilege in my life to have him. The woman I’m with has no interest in drugs. She can’t even imagine me how I used to be.
It hurt walking away from people who had been so kind to me and kept me from being sick so many times, but I had to do it. I ignore them when they message me. Everyone in my life is sober. It’s literally the only way.
One of my closest friends, someone I spent every day with, I walked away from him. I told him, “When the dope is gone I’ll be around, I promise.” He cussed me, told me I was making an excuse so I didn’t have to deal with him. 5 years into my sobriety he called me and asked me if I meant it and if I’d help him. He actually got clean after 30 years on it. I got to sit with him and take care of him at the end of his life and that means the world to me, but if he hadn’t gotten away from it, I would be regretting not being there for him, but I’d know that I couldn’t have been.
I know you’re probably an expert looking out for your son at this point, but if he can stay away from users he won’t use again.
The groups seem like little cults to me, but for the people who make their life about the group, they usually don’t have anyone sober they can turn to outside of it. It isn’t for me because I have real support. They can make it with the support they find there.
Your son has real support in you, and that’s amazing. That’s everything.
I hope you never have to worry about him again. Take care.
I'm confused. You are terrified they will give you opioids, and want them to refuse it... But you also hate that your chart would give them that info and have them block opioids?
Happened to me when I was 18. I had severe Sun Poisoning (extreme allergic reaction to moderate sunburn) and not only was I inconceivably itchy, the pain I experienced was indescribable. Waves of pain so bad THROUGH MY ENTIRE BODY I could only scream and cry. I was shaking and incoherent. My mom was with me the whole day, and was the one who brought me to the hospital. Of course, with my behavior as extreme as it was, the hospital staff let me suffer very loudly in the emergency waiting room because they thought I was a drug addict. My mom, who has worked as a nurse, spent about an hour chewing people out left and right about the situation. I eventually got treated but that was probably the most traumatic experience I've gone through my whole life
Is that EPP? My partner's childhood best friend has one of the worst EPP reactions known to medical literature. I can't imagine anything that sounds half as bad.
I have this and this is maybe the first time I’ve heard of someone else with epp. I think mine is pretty mild, but it really sucks! I hate the sun!
Edit since I guess this is kinda relevant to discussion: I never had visible symptoms, just pain and extreme sensitivity to temperature /sun when it flares up, so until I was ~16 people told me I was making it up. Finally got a rash at one point and was able to get tests done and was diagnosed.
Our friend had a similar story to yours, they were told they were making it up despite the fact they were starting to die anytime they went out in the sun, it took multiple near death experiences for them to get diagnosed as a child. I've never run into anyone else with it in the UK but there is a community of expats with it in Rotterdam the Netherlands as they have one of the best Porphyria treatment and research centers in the world. Our friend emigration their a while ago for it and has been using the new implant that's been developed and they've said it's completely life changing - it doubles their exposure time and allows them to live a much more normal life. If you'd like to make contact with other people with it, feel free to DM me your email and I can pass it along.
Unless you are either female, a minority, young, or have chronic pain in which case any mention of pain you have, no matter how extreme, is considered a drug seeking attempt.
It happens to everyone, even white men. We should be advocating for everyone to have healthcare, not looking for another way to divide people.
Please don't pull an 'all lives matter' here. Women and minorities are systemically discriminated by the medical system as a whole. Patient outcomes are statistically better if you fit the correct demographic.
https://www.medicalnewstoday.com/articles/racism-in-healthcare
None of those show evidence that women or minorities are treated as drug seeking more than white men.
Progress is made when people fight for rights for everyone, turning this into an identity politics issue won't hasten anything it will just get in the way.
Dismissal of pain and drug seeking accusations are two sides of the same coin.
No one is 'turning' anything into an identity issue. You don't get to say 'I don't see color' and then pretend that systemic discrimination doesn't exist.
Your lack of understanding of a real world problem doesn't make it any less real for the rest of us. Please think about the relevance of your own experiences before invalidating others'.
I never invalidated anyone's experience, I pointed out you were wrong to dismiss the same struggles other go through.
Everyone deals with this, despite you pretending whiteness or a penis magically makes it go away.
My mother in her last months was in terrible pain. She, an elderly white woman in Appalachia could not have her pain properly addressed. I had to threaten her care providers in order for her to have barely adequate pain management. "If you don't see to this right now, I'm going to video her screaming in pain, put your name on it on YouTube and point every media outlet in the tri-state there." It was literally the only thing that worked.
Permanently Deleted
It's not a pact to discriminate, it's that they're a high traffic area that tries to quickly treat people through the path of least resistance.
That's great if you have visible, obvious issues like a missing limb. If you have anything internal though, forget it. The bevy of tests they'll need to determine anything will take multiple days, so as long as you can still walk with assistance they'll do their best to shove you out the door and tell you to schedule an appointment with your doc, regardless of how much pain you're in.
I hurt my knee and I couldn't walk easily even with assistance. They did x-rays and determined it wasn't broken and said I probably (and that word is important) just sprained it and I would be fine in a couple weeks. The hospital refused to sell me crutches, and when I said I needed them to walk, they told me I could walk just fine because it wasn't broken. Several months later and I'm still not better and I've been told I probably tore a ligament and I might need surgery. Gee, maybe I wasn't being a dramatic cry baby after all???
Lol, maybe your hospital is staffed purely by orthopedic doctors.
If you have anything internal though, forget it.
Sure thing. Just spent a 12h shift treating 'internal' stuff at the ER. But I guess we both rely on anecdotal evidence.
https://www.sciencedirect.com/science/article/abs/pii/S0196064423002676
https://www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/
Individuals who are intersectional in groups that are under prioritized for health care have it the absolute worst.
https://www.tandfonline.com/doi/abs/10.1080/13557858.2021.1899138
Interestingly I saw one study while pulling this up from 2009 that came to the conclusion that there isn't a major disparity in pain treatment between races and genders, but I think we've learned a great deal about the social determinants of health since then, and these more recent studies and articles show the opposite.
It's less to do with a pact, and more to do with ignorance. Most clinical signs are taught in north America on caucasian skin (though there's a really neat clinical guide put out I think by St George's university in the UK that I highly recommend to all health care providers- it's called mind the gap and it's free afaik). Additionally, cultural and language differences change how people raised in different cultures express pain. Finally, women's health is probably 50 years behind where it should be because any pain to do with female reproductive organs (and by extension abdominal pain) is often written off even when it's debilitating.
Add in those natural unconscious biases we carry as humans and no universal pact needed, discrimination happens anyway even with people who don't realize they are doing it.
For anyone doubting these experiences, I am a US medical student, and implicit biases and racism are big topics we are taught and made aware of due to physicians profiling their patient whether intentionally or not.
This is especially common in the ER where many people without PCPs come in for issues that are generally handled by a PCP. One of the more difficult things that physicians struggle with is balancing time with the quality of care they provide to their patients. Profiling makes the "time" component easy, but obviously that results in very poor quality healthcare.
No one should be doubting people's experiences of racism and discrimination in the ER and beyond. Doctors are people too, and the bigoted behavior you see in other professions are just as likely to appear with your doctor.
It's nice to see that someone is going to be one of the good doctors.
I appreciate that, and I want to offer hopefully a more positive outlook. These topics are becoming standard courses in the US medical school curriculum, as in they have to be taught to medical students.
It won't solve every problem, of course, but the curriculum is way more patient-oriented than it used to be instead of being a simple "solve disease" kind of curriculum, which is what most of the doctors you see today are taught with.
I rarely comment on lemmy, but I had to say something against the few people who were saying these experiences aren't valid.
Discrimination is real, and don't assume Doctors are perfect because they're not. Of course be open-minded and don't be antagonistic to the ones who are legitimately trying to help you, but if you feel your care wasn't great, then that's very likely a failure on the physician's part.
That is really good news that it's becoming standard. I sincerely hope the grueling hours don't take its toll on you and that they're working on that as well. Burnt out doctors shouldn't be a thing.
I'm a medical student that is aiming for emergency medicine, and threads like these are a special kind of demoralizing. When I was working as an ER tech, there were a fair few times where aggressive or combative patients would only let me get anywhere near them for anything because I never showed any judgement or disdain. Not that I blame my coworkers. It's hard to treat someone nicely after they fake having an overdose in the lobby and then assault one of the nurses after they "wake up" from the narcan.
I honestly think that most medical workers are a victim of the healthcare system and pharma drug pushing as much as the patients. If there was affordable healthcare and a focus on helping people live healthy lives, there wouldn't be so much drama and life threatening decisions.
I know that the general public's idea of what ERs are for doesn't help. EMTALA doesn't mean that everyone who comes into an ER will get treated for anything regardless of ability to pay. It's that they'll be treated and stabilized for any emergent medical condition, illness, or injury... And many people seem to have interesting ideas about what constitutes an "emergency".
The presumption that every patient is someone who fakes an overdose until proven otherwise is precisely why so many people in this threat is suffering. We aren't asking you to serve narcan on a silver platter to people who fakes an overdose. We're just asking to be treated as humans, with empathy, without preconceptions about who we are or why we are at the ER based on our skin color, sex, age, and chronic medical conditions.
Trust us, we know what it's like to feel demoralized at the ER. I've had enough close calls of neglecting life threatening conditions, enough of ER staff laughing off my pain, enough ER staff deliberately manhandling me and hurting my tender points to prove I'm 'overreacting', enough of waiting 6 hours only to be sent home with nothing and in more pain than I was to begin with, enough of being left to cry in pain for hours at the ER and being ridiculed for it. Many of us are demoralized to the point of fearing the ER and avoiding it even under life threatening circumstances, because going through another ER experience might be the tipping point to actually kill ourselves.
There is only so much suffering, pain, and psychological torture the human mind can endure. Most people in the ER have no idea how much chronic pain sufferers have at stake when going to the ER. I have had ER visits that left me more broken than being sexually assaulted as a teen. I trusted doctors, I trusted the hospital, and I trusted that I was in a safe space. Being painfully jabbed, mocked, laughed at, and told im lying and drug seeking were the last things I was expecting. Nothing will repair this breach of trust, because the stakes are too high. I cannot gamble away my physical and mental health for the sake of improving moral in ER staff. For you, at worse you become disillusioned with your career. For me, it's my life that I'm risking.
He came in for an entirely unrelated complaint and faked the overdose to get taken back immediately. The only drug in his system at the time was meth. Literally every room was full except for the resuscitation bay where we took him, and we had to keep him there for almost 2 hours until we had somewhere to move him to. It was the biggest of the resuscitation bays we had, so if we had someone coming in that needed ECMO, we'd have been kind of fucked.
I wish we hadn't had to deal with that guy. Every nurse in the department had minimum 5 patients, mostly high acuity, and his stunt backed up the department for an extra couple hours by pulling unnecessary attention. I much rather would have been helping the nice gentleman in the lobby who had been waiting 5 hours with chest pain and a cardiac history, or the sickle cell patient in pain crisis.
I don't have a problem with drug seeking. Pain is horrible and substance use disorders are diseases, not moral failings. I do have a problem with attention seeking, malingering, and abuse or assault of staff. As a physician, I plan to treat pain appropriately with the necessary medications or therapies, and to treat abuse of my staff with extreme prejudice.
And an edit to add: a drug overdose is treated as the same level of emergency as a cardiac arrest. We don't serve Narcan on a silver platter, we serve it via wide bore IV while getting set up for intubation and resuscitation if it fails because we mean to move heaven and earth to keep the patient alive. An OD gets you to the front of the line, almost no questions asked besides "what substance?" so we know what antidote to give.
I'm terribly sorry that you have had that experience, and I'm disgusted with people who have treated you that way. However, you are making similar assumptions about me that other people have made about you. Working as an ER tech, I've literally had mental health patients try to strangle me, then given 10 minutes or so to shake it off, and then run straight into another code on a 16 hour shift that did not include any other breaks besides that 10 minutes... and then I came back 8 hours later for another 16 hour shift because the department was so understaffed that it would have been disastrous if I called out sick.
I've come into work, wholly unrecovered from a kidney infection and my own trip to the ER as a patient, and never let a whisper of it show on my face so that I could provide the best care possible for my patients. I've been the patient in the waiting room with 9 out of 10 pain for 6 hours, and I know how much it sucks. That's part of why I do everything I can to give every patient the time, attention, and care that they need to heal them as much as I can.
I'm sorry you had to deal with that awful guy. Abuse of staff isn't something that you should tolerate, nor am I asking you to. All I ask is that patients are not profiled as this guy until they have proven otherwise.
This is a systemic issue, not something that you're expected to fix alone. I'm not blaming you for all the failings of a medical system that is understaffed, underpaid, and overcharged by insurance companies. I'm just asking that people who have suffered at the ER before be heard and believed. I have tried countless times explaining the extent of this systemic issue to medical professionals, and was met with skepticism and outright disbelief about the magnitude of this issue. The many anecdotal experiences from ER visit should give an idea of how common this is among ER visitors.
Yes, it's true that both sides are making assumptions here. However, patient assumptions that ER staff are capable of causing harm are there to keep themselves safe, and don't turn them into abusive patients. Discriminatory assumptions made by ER staff can turn them into abusive staff.
What I have been trying to say is that we didn't make any assumptions about that guy. We treated him with the same standard of care and urgency that any emergent medical condition would warrant until we had proof that he was faking it and after he grabbed a nurse's breast so violently and so hard that the entire right side of her chest was bruised for a couple of weeks. We made no assumptions and only acted on his behaviors and proven medical condition.
The experiences you have had are horrible, but they are not universal. Unfortunately, the way the emergency medical system has been stretched to its limit lately means that the best the ER can do is to keep people from dying, and diagnose and treat the more straightforward conditions. For most of the more complicated and chronic stuff, there's very strict laws about how much medication for what duration can be prescribed by an emergency physician, and a significant amount of the time, the best we can do is make sure you're not actively dying and put in a referral to the specialists with a note that you should be bumped up the waiting list a bit depending on severity. Hell, even trying to admit people to the hospital isn't a sure bet these days because the inpatient departments are allowed to enforce their staffing-to-patient ratios, so the ER gets stuck trying to take care of inpatient and even ICU patients with ER resources for up to days at a time.
My somewhat glib comment about people not being aware of what counts as an "emergency" is very literal when it comes to triage. We do our best to treat everything that comes through our doors, but if there's not an immediate threat to life, limb, or permanent disability, there's pretty distinct limits on what we're able to do on a short timeline and what the hospital allows us to do for free. EMTALA stands for "Emergency Medical Treatment And Labor Act" and it dictates that anyone who turns up to an ER with an emergent medical condition that poses immediate threat to life, limb, or permanent disability will be treated and stabilized to the accepted level of care regardless of ability to pay, and a mother presenting in active labor will be provided with delivery care or appropriate timely transfer to a labor and delivery department if appropriate regardless of ability to pay. There's very strict rules about the level of treatment to be provided and when or if transfer to another facility or provider is warranted and permitted, but past the stipulations of that law, it comes under the hospital administration's rules and regulations about what level of care can be provided by the emergency department.
I've seen quite a few physicians defy the hospital rules by ordering some of the special labs and tests that the specialist would order so that the results are already available in the system for when (if) the patient gets seen by the specialist, but they can get in quite a bit of trouble for it, and if it's not documented just right the patient's insurance might not pay for it. That's one of the other delightful limitations on what the ER can do...we have to toe the line on what needs to or should be done versus what the patient's insurance will pay for, because believe it or not, we really don't want to stick you with a bill for thousands of dollars of tests that your insurance denied coverage for.
Due to overwork, understaffing, antiquated training, and burnout, a lot of physicians' and nurses' bedside manner could use a fair bit of work, but in terms of the care provided, 99+ percent of the time, it really is the best we can do under the restraints created by laws, rules, resources, and insurance.
Permanently disability is exactly what happened to me and so many others when the ER refused to do anything because our pain is not taken seriously. The crux of the issue here is that you cannot 'see' how much pain someone is in and come to a conclusion how pressing their need for medical attention is without further investigation. I'm not asking ER staff to provide treatment beyond what they are supposed to, I'm asking ER staff to provide treatment of what they are supposed to.
The problem is that what constitutes as a medical emergency isn't dictated by patient's pain or symptoms, it's dictated by the medically unsubstantiated biases and preconceptions of medical professionals because patients are presumed drug seeking to be and unreliable witnesses to their own bodies even with clear documentation of prior medical conditions.
Your comment was removed, I wonder why.
I think the person I was replying to deleted their comment.
You don't think age and sex are medically relevant? A 5 year old will scream about a scratch on their knee, but I'll walk several miles home after making a meat crayon out of myself with my electric longboard and patch myself up.
You speak like someone with no conception of what pain is like outside of your own narrow experiences.
Trust me, lots of us out there would trade being meat crayoned 10 times over to get rid of our painful conditions. You can't compare other people's pain to your own if you haven't experienced what they have. Even then, that's not an excuse to deny people human pain treatment.
The problem here is that doctors would rather let 9 innocent people suffer to punish 1 drug seeker. You can't judge how much pain is in by how someone 'looks'. There is no 'look' to pain, especially in people chronic pain sufferers who have mastered the art of suffering unendingly without writhing on the floor because that's not an option while going out in public.
I have been permanently in pain for 4 years, to the point where I have forgotten what painlessness feels like. Everyday, I wake up to a body that felt like it was sunburned for hours, fell down 3 flights of stairs, and ran 10 miles after. Everything fucking hurts and the smallest bump onto furniture feels like being stabbed with a knife. And yet, I go to the grocery store holding every whimper and tear in because I can't shop if I'm busy writhing in pain. People see me and think I 'look fine' and have no idea the suicidal levels of suffering that come with invisible disabilities. Please don't be one of them.
I'm really sorry to hear about you dealing with this. I have trigeminal neuralgia, which is an extremely painful nerve condition in the face. Thankfully, I finally found a medication regimen to keep the pain to a minimum where (supplemented with cannabis) I can handle things. But recently, I've been going through a mystery health issue and one possible cause is a reaction to one of my medications. It's unlikely, because I've been stable on them for so long, but the only way to find out for sure would be to stop taking both of them and then only take one to see if the symptoms go away. And I don't know if I can handle that because I was at your level a few years ago and I don't think I can go back there.
I don't wish my pain on anyone. Not my worst enemy. And I had to deal with it, like you, all day every day. Excruciating pain. For years. I was even on disability for it because you can't have a job when you have pain flare-ups that make you scream.
And, also like you, I "looked fine" most of the time. Only my wife learned the signs of when I was in lots of pain in public and got me out of there. Because you can't function at all if you can't "pass" as being healthy.
So, again, I am really sorry you have to deal with it. I sympathize 100%. I hope you find a solution. It took me years, but I finally found one.
I was once in the emergency room for hyponatremia and you know how in triage, All the patients are in one huge room But no one can see each other because all the beds are partitioned off with curtains So we have some illusion of privacy in there.
anyway I overheard this twenties-something well-composed polite Caucasian male trying to explain to the doctors that he's in pain and he needs medication and it was fascinating to listen to because I could tell the doctors had to use all their analytical judgment to determine whether or not he was really in pain or if he was just seeking the good stuff like benzodiazepines for the high (or whatever drug or effect theyre seeking, I dunno) Ultimately the doctors sent him away with Tylenol.
I experience pain on a scale of seven sometimes it wakes me up in the middle of the night It hurts so bad, and all the doctors give me is Tylenol and I can tell you it does nothing to numb the pain, but I have no desire to seek anything stronger than Tylenol because yeah reasons because I don't want to become addicted to the good stuff I guess. I've heard and read and seen too many stories of people caught in that spiral and life is hard enough already and I don't want to deal with benzodiazepine addiction on top of all the other shit life throws at me.
It's recently been proven that NSAIDs are entirely useless too.
All I remember about NSAIDs is that they're bad for your liver or kidneys or something like that, But in general they are designated for treating inflammation and pain and fever. Are NSAIDs still useful for treating those three things? or are they going to be banned by the FDA?
There's a very free select types of inflammation they're useful for, and not common types.
I completely agree with you. None of that really has much to do with my point though.
Weird. When I was 5/6 I split my head open and didn't make a sound while got stitches done on my fucking forehead.
Good for you. When I had migraines, I was in so much pain I repeatedly banged my head onto the wall until it was bleeding and then kept going until I was too tired. Then I would sit there and cry silently because my vocal cords were spent and breathing made my head hurt, until I reached postdrome.
I don't know what point you're trying to make. If you think this is a pain tolerance issue, I don't think you know how pain works. Consider this, people experience pain subjectively and you can't 'see' how much pain they are in because it's not measureable by any metric, let alone facial expression. The 1-10 pain assessment chart is the biggest joke in the chronic pain community.
I had something similar. It's also pretty clear that no small children are out to sell pain meds on the street.