I have another one: How about Mr./Mrs. Blase -- Someone with something seriously emergently wrong with them who refuses to go to the ER (because they might admit him) and refuses to take his medication that might prevent said episode from happening in the first place.
I remember one patient who refused to take any BP meds (ever -- because she was convinced they made her hair fall out) who came in for a headache. Her BP was 290/160 or something outrageous like that.
It's funny because it's true. Some of these patient subtypes (e.g., Mr. Ice Finger and Mr. MC) are THE reasons I firmly decided against going into primary care.
As a future physiatrist, I think I'm pretty well stuck with the flagrant disregard for the pain scale, but I can't win them all and at least some patients are more thoughtful in their pain estimation!
HAHAAAH! I love the 'flagrant disregard' for 10 point scale.
Indeed.
I mean really, if your pain was truly 2 points over the maximum that it could possibly be would you still be eating doritos and texting while I triage you??
Drug seekers are usually allergic to codeine-but somehow morphine is just fine. Oh, and of COURSE-IV dilaudid is the only thing that takes away the pain completely.
One more thing-I never fail to be amazed by the consult patient with 10 out of 10 pain who is either sleeping requiring shouting/sternal rub to awaken , eating , or chatting amiably with family at the bedside.
Erm. Only 40% of the people allergic to codeine are allergic to morphine. Codeine gives me the flying barfs, oxycodone and hydrocodone make me barf AND don't touch the pain. Morphine can infrequently make me queasy for a short while but it doesn't make me vomit. Dilaudid, however, does nothing. No nausea, no pain relief. Nothing.
Apparently this is a genetic defect. I've met two other people (besides my sister) with the same issue. And, no, we're not drug seekers or people who regularly take narcotics.
The problem is that the drug seekers make it hard to get this understood. Saying that morphine is one of the few drugs that works on you is painting the drug-seeker target on your back. So in the few cases you need it, you wind up with continued pain + throwing up because doctors and nurses jaded by dealing with druggies don't believe you for a minute.
My blood pressure was 150/90 but then 15 seconds later it was 153/91 and 10 seconds after that it was 155/89 and I came in right away because gosh that is just so high! There must be something wrong!
As an ER doctor I dream of a world without home BP monitors...
Is having your nose and mouth swell and itch like hell, because that's what codeine does to me. Morphine doesn't cause this affect, but it does make me nauseous and constipated.
Let us not forget the "WebMD/Google patient" who excessively researches EVERYTHING health, medication, and disease related. May bring stacks of printouts of said research into office. May refuse to take medications or have certain tests done after performing research. May make attempts to self-diagnose. Amen.
Very Nice....I found this post when I was searching annoying patient types, after I wrote a post on my blog about them. However my artistic skills are not as good as yours so just drew a little and wrote the rest in text... Great work.
You can see my post at http://crankyshanky.blogspot.com/2011/05/types-of-annoying-patients.html
Hell, you nailed it for EVERY specialty.
ReplyDeleteAnd you just know Mr. IceFinger will get sent to me.
I have another one: How about Mr./Mrs. Blase -- Someone with something seriously emergently wrong with them who refuses to go to the ER (because they might admit him) and refuses to take his medication that might prevent said episode from happening in the first place.
ReplyDeleteI remember one patient who refused to take any BP meds (ever -- because she was convinced they made her hair fall out) who came in for a headache. Her BP was 290/160 or something outrageous like that.
It's funny because it's true. Some of these patient subtypes (e.g., Mr. Ice Finger and Mr. MC) are THE reasons I firmly decided against going into primary care.
ReplyDeleteAs a future physiatrist, I think I'm pretty well stuck with the flagrant disregard for the pain scale, but I can't win them all and at least some patients are more thoughtful in their pain estimation!
HAHAAAH! I love the 'flagrant disregard' for 10 point scale.
ReplyDeleteIndeed.
I mean really, if your pain was truly 2 points over the maximum that it could possibly be would you still be eating doritos and texting while I triage you??
Drug seekers are usually allergic to codeine-but somehow morphine is just fine. Oh, and of COURSE-IV dilaudid is the only thing that takes away the pain completely.
ReplyDeleteOne more thing-I never fail to be amazed by the consult patient with 10 out of 10 pain who is either sleeping requiring shouting/sternal rub to awaken , eating , or chatting amiably with family at the bedside.
ReplyDeleteErm. Only 40% of the people allergic to codeine are allergic to morphine. Codeine gives me the flying barfs, oxycodone and hydrocodone make me barf AND don't touch the pain. Morphine can infrequently make me queasy for a short while but it doesn't make me vomit. Dilaudid, however, does nothing. No nausea, no pain relief. Nothing.
ReplyDeleteApparently this is a genetic defect. I've met two other people (besides my sister) with the same issue. And, no, we're not drug seekers or people who regularly take narcotics.
The problem is that the drug seekers make it hard to get this understood. Saying that morphine is one of the few drugs that works on you is painting the drug-seeker target on your back. So in the few cases you need it, you wind up with continued pain + throwing up because doctors and nurses jaded by dealing with druggies don't believe you for a minute.
It sucks for everyone.
Nausea isn't an allergy.
ReplyDeleteThe overly zealous home blood pressure checker
ReplyDeleteMy blood pressure was 150/90 but then 15 seconds later it was 153/91 and 10 seconds after that it was 155/89 and I came in right away because gosh that is just so high! There must be something wrong!
As an ER doctor I dream of a world without home BP monitors...
This reminds me of the stupid Step 2 CS cases too.
ReplyDeletei LOVE the mom cartoon. :) its sooooooooooooo true! u left out the patient who is a doctor himself !
ReplyDeleteIs having your nose and mouth swell and itch like hell, because that's what codeine does to me. Morphine doesn't cause this affect, but it does make me nauseous and constipated.
ReplyDeleteLet us not forget the "WebMD/Google patient" who excessively researches EVERYTHING health, medication, and disease related. May bring stacks of printouts of said research into office. May refuse to take medications or have certain tests done after performing research. May make attempts to self-diagnose. Amen.
ReplyDeleteVery Nice....I found this post when I was searching annoying patient types, after I wrote a post on my blog about them. However my artistic skills are not as good as yours so just drew a little and wrote the rest in text...
ReplyDeleteGreat work.
You can see my post at http://crankyshanky.blogspot.com/2011/05/types-of-annoying-patients.html
Cheers