For those who suffer from chronic pain, fibro, IBS, etc…who seem so upset by the observations of ED physicians and nurses posting here, I have this to say:

Realize this ain’t about you. You are taking the stated observations of people who work with hundreds of patients per week too personally. Each person is an individual, however, these smart people who have medical degrees and nursing licenses are sharp enough to be able to synthesize the trends they see week to week. As another nurse described earlier, crazy is as crazy does. Not all chronic paineurs are lying sacks with somatoform d/o’s. That is evident by the way they behave (subjective) and data like vital signs, lab results, and physical exams (objective). I believe the term is “down the hall diagnosis.” Most of the time, the combination of behavior, allergies, PMH, and currents meds is enough to see these people coming from a mile away. Does that mean that staff do not make the effort to rule out emergent problems that could still be legitimately occurring? Of course not. But it doesn’t mean that staff should be kissing their asses and putting on their kid gloves to pass out the vitamin D.

Since I’m willing to give *most* doctors the benefit of the doubt, maybe you should understand that when doctors generalize about a certain subset of patients, it ain’t about you. It’s a generalization based upon the thousands of patients these people have treated through the course of their careers.

http://www.wikihow.com/Overcome-Martyr-Syndrome

I call BS on that. Almost everyone with abd pain gets a work up with lab tests and imaging that usually is not needed. You would have to look exceptionally well if that is all you got.

I haved been diagnosed w/2 out 3 of those. I have never asked anyone for a pain shot or anything more powerful that some Gabapentin and once some Imatrex. I fought hard against getting the label “fibromyalgia” because I knew how that would be perceived. Seems I was right.

Last night I went to the ER with the worst stabbing stomach pains of my life. After looking over my chart and taking my temp, I was sent home with a bottle of Mylanta. Obviously that has not helped. THe thing is, doctors like you are the reason why I avoid ERs like the plague that they are and I’d rather writhe in pain than encounter your type again.

in my experience there are certain diagnoses which seem to coincide with psych problems, or at least with difficult personalities. crohn’s disease, multiple sclerosis, and diabetic gastroparesis for example.

then there are some diagnoses that seem to span a wide spectrum from clear-cut disease with objective physical findings to very questionable patients that claim to carry the diagnosis but who knows. migraines, reflex sympathetic dystrophy, cyclic vomiting syndrome.

finally there are diagnoses that completely mystify me, in that as far as i can tell there’s no way to prove conclusively that you have it or you don’t. fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome. i mean not even an elevated esr? of course one of my mentors used to say every patient needs an esr or a doctor but never both… but i digress.

in our line of work, this is complicated by the fact that chances are we’ve never seen you before, and never will again. now i believe that anyone who feels they are in pain or suffering, regardless of the underlying cause (psychiatric or otherwise), are actually suffering and deserve the appropriate compassion and treatment. but you have to realize that you are mixed in with a steady stream of people who are just trying to scam us for narcotics, work notes, what have you. if you have some chronic condition that is debilitating and constantly impacts your life, it is imperative to be locked into a pcp or chronic pain doc or whatever that helps you manage your condition without going to the ed where you’ll be seen by a doc who doesn’t know you and just saw a scam artist with the same complaints and the same paucity of objective findings.

i like to think i’m experienced enough to have a decent bs radar but it can be difficult, especially when the volume is high and some of the other patients have more pressing emergencies (in the sense that they’ll die without immediate attention). very easy for people not in the trenches to claim the docs on this thread are lacking in compassion or “have no brain cells” but when the shit hits the fan i would choose the jaded ed doc who manages my emergency competently over the touchy feely doc that treats fibromyalgeurs with respect. (of course, the ideal doc can do both…)