WhiteCoat

We’ve Been Facebooked — Part 1

4-6-2014 2-50-29 PMI’m developing an increasing dislike for certain forms of social media.

Fortunately, this first incident didn’t happen to me, but the nurses who endured the onslaught were still twitching the following day when I came into work.

The day before started out as a pleasant day, or so they said. Even pace. Good flow of patients. No holding patients in the emergency department. Waiting room nearly empty. Nurses got to take their lunch breaks. One of those days that you leave feeling refreshed. But those days are subject to change without notice.  And change, it did.

Lumbago Joe hobbled in the front door.

Lumbago Joe was a well built guy in his forties. Rough around the edges. Always walked with a limp on hospital grounds. It was almost pathetic to watch him come in the door. Chronic back pain. Surgeries didn’t help. He refused further surgeries because they only made his back worse. He had seen so many doctors who told him they couldn’t help that he kept a copy of his latest lumbar spine MRI on his iPhone. That damndable iPhone. He’d even show you pictures of his bodybuilding days many years ago. He used to be in great shape. The thing about Lumbago Joe was that when he was off hospital grounds, he was different. See him in the store and he was lifting cases of beer with no problem. In the bars he would dance the cha-cha – unless he saw someone he knew from the emergency department … and he knew EVERYONE from the emergency department. Knew their names, knew their significant others. Sometimes even knew their work schedules. So when Lumbago Joe knew he had been sighted, suddenly he’d catch himself, grab his back and put on a show, pretending he didn’t see the hospital personnel. Or sometimes he’d come up to say hello, mentioning how well his pain was in control after getting those 8mg of Dilaudid in the emergency department the other day. Yeah, Lumbago Joe was like a modern day medical Verbal Kint (by the way, if you’ve never seen the movie the Usual Suspects, don’t click the link, stop reading this right now, go rent the movie or pull it up on NetFlix, and thank me later).

So Lumbago Joe slowly limped back to his assigned room. As luck would have it, Lumbago Joe’s favorite doctor was working that day. Yes, Dr. Feelgood was in the house.

Dr. Feelgood works a few days a month at several different hospitals. He doesn’t like to spend all his time at one place and likes the “freedom” of working at several hospitals. Nice guy. Fairly good clinician. Gets great patient satisfaction scores. And boy does he write. You come in with pain, you get Dilaudid. If you even may have pain when you leave, you get Percocets for home use. Finger sprain? Dilaudid. Ankle sprain? Dilaudid. Toothache? Dilaudid. Have Narcan on standby if your back is bothering you or if you have a migraine. Yes, despite being only a part-time physician, Dr. Feelgood is at the top of the leaderboard for both Dilaudid prescriptions and for Narcan use. Little old ladies probably don’t need 4mg of Dilaudid for back pain … but they get it.

Lumbago Joe got a spring in his step … er, um … in his hobble when he caught a glimpse of Dr. Feelgood’s combover while Dr. Feelgood sat at the desk charting. The triage nurse would even recount how it initially appeared like Lumbago Joe was going to stand upright and say “Hi” to Dr. Feelgood, but caught himself and began to limp even worse.

Dr. Feelgood didn’t disappoint.
“I’ve got this,” he told the other doctor on duty.
He went into Lumbago Joe’s room and a few minutes later he came out and started pecking away at the computer.
New orders up. Start an IV line. Dilaudid 4mg IV push. Valium 10mg IV push.
To put that into perspective, 1mg of Dilaudid is the analgesic equivalent to between 6mg and 8mg of morphine.
While most people would have suffered a respiratory arrest shortly after receiving the medications, Lumbago Joe was up and walking around, back straight with perfect posture. He smiled and shook Dr. Feelgood’s hand, thanking Dr. Feelgood profusely for his kindness.
Lumbago Joe was discharged home a half hour later with a prescription for thirty Norco tablets.

To show his appreciation for the care he received, Lumbago Joe posted a Facebook update.
Apparently a Facebook “friend” of the ED secretary was also friends with Lumbago Joe. The ED secretary was therefore able to see what Lumbago Joe had posted after he left the emergency department. This makes no sense to me, but that’s because I currently do not and never will use Facebook. In fact, I call it Fecesbook. Anyway, suffice it to say that the secretary was able to see Lumbago Joe’s posts.
“Just left Metro General Hospital pain-free for the first time in several weeks. Thanks to Dr. Feelgood for his excellent care.”

About 30 minutes later, the waiting room was filling up. Sixty minutes later, it was full. Fifteen patients registered within the 90 minutes after Lumbago Joe left. Looking through the names of patients, it was like a class reunion for Ridgemont High. The complaints were overwhelmingly pain-related. Headache. Migraine. Toothache. Fell down the stairs – back pain. Low back pain. Abdominal pain. Headache. Back pain. It was a flashmob of misery.
The odd thing was that the waiting room patients in all their misery were laughing and joking … until the doors leading into the emergency department clicked then swung open. Then there was an eerie silence as the next name was called and the next patient was brought back holding a random body part in terrible pain.
The rest of the day and evening were filled with long waits and lots of opiates.

One nurse, still twitching as he recounted the afternoon, simply stated “That Lumbago Joe character facebooked us real good, he did.”

I just smiled and shook my head, being thankful that I wasn’t working that day and thinking how ironic it was that the provision of medical care would even lead to creation of such a term.

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

9 Responses to “We’ve Been Facebooked — Part 1”

  1. Nick Genes says:

    I’m certainly familiar with the theory that drug diverters and malingers share information on emergency departments and even individual practitioners. While I’m sure some sharing of info exists among family/friends and drug users, I’m not really convinced it amounts to measurable changes in volume.

    But you’re suggesting this information is shared digitally, in realtime, over social networks, and leads in short order to a waiting room full of of drug seekers?

    That is really remarkable. I guess I should consider myself lucky to work where I do, where this kind of thing is really only a peripheral, occasional concern.

    • WhiteCoat says:

      The waiting room wasn’t full of solely chronic pain patients, but in looking back through the logs, there was a disproportionate number of “regular” customers. Whether there is a causal relationship based on an anecdote still remains to be seen.
      Will be interesting to see demographics during Dr. Feelgood’s next shift.

  2. markps2 says:

    The solution is for all drugs to be legalized. Then the drug user doesn’t need a doctors prescription to get them.
    Oscar-winning actor, 46 Philip-Seymour-Hoffman died from taking an unsafe dosage of illegal drug. Imagine beer/alcohol not having an alcohol percentage on the label to indicate how strong the drink is.

  3. SeaSpray says:

    Why in the world does Dr Feelgood do this?

    ” the nurses who endured the onslaught were still twitching the following day when I came into work.” – Funny! Your description – not what they endured on their shift. :)

    Great post! :)

  4. TyreeeMD says:

    Oh to have closed circuit cameras of the waiting room. What a great tool to show patients that they had full range-of-motion just 15 minutes before while they were laughing and joking in the waiting room, and now have 20/10 back pain

    • WhiteCoat says:

      Got them. Unfortunately, no way to put them in the patient’s chart and HIPAA keeps them from being published online. But our administrator did get security to make a DVD of one clip and then sent it to the state to have the patient investigated for fraud. Don’t know if it was related, but don’t see that patient around the ED any longer.

  5. Johnny says:

    as the husband of a chronic pain patient it is practitioners belief in and reaction to people such as “lumbago Joe” which causes real chronic pain patients to be terribly under treated for their pain. Give the so and so his dope who cares. Id rather see 50 malingerer dope fiends od than even ONE real pain ridden patient be treated like crap because people have been trained to see those in chronic pain as drug seekers. Its bs.

  6. Edward says:

    Ya but admin loves that PG satisfaction scores!!!

  7. Edward says:

    Chronic pain patients need “Chronic pain management” with an effective plan for break through pain to keep them controlled.

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