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8 ways your patients can fool you

Thinkstock | Creatas
Thinkstock | Creatas

Patients can pull the wool over your eyes over and over again, and you’ll never even know it…or so they hope. Cue the Bassoons of Doom, people: Here are some ways your patients will try to fool you, thinking you’ll fall for it.

 

8 ways your patients can fool you

1. “I’m not a junkie!”
This is number one for a reason. If you have a patient who is allergic to NSAIDs and morphine, who can sing and dance through a 10 out of 10 pain level, and who asks that you put that hydromorphone down at the lowest point in their IV, chances are they’ll tell you that they could take or leave that pain medicine (and the Phenergan that goes with it) any old time.

2. “I swear I didn’t get up on my own!”
Usually said from the floor, where the patient is lying in a heap, with the bed alarm screaming.

3. “I have no idea how that bag of donuts got in there.”
That one I heard once (though it was a half a bag of donuts by that point) from a guy who was hooked up to an insulin drip with q 30-minute blood sugar checks.

4. “That’s my cousin.”
This one usually comes out when the third of three attractive young women has shown up at the bedside, each demanding some say in the patient’s care. Bigamy is more common than the general public thinks.

5. “I have restless-leg syndrome.”
This one came right before I twitched the blankets back to reveal a sad-eyed, absolutely adorable long-haired Dachshund at the patient’s feet. No matter how cute your dog is, she cannot spend the night with you in the hospital.

6. “I faint at the sight of blood/I punch when people stick me/I vomit when confronted with syringes.”
Usually said by really big, tough military guys or people of either sex with gauged-out earlobes and multiple tattoos. It doesn’t matter; you’re gonna get stuck.

7. “I’m a doctor/nurse.”
“I took six weeks of online classes in homeopathy from Fred Friendly University back in 1979.”

8. “I just love all you guys.”
Translated, this means “Get the discharge paperwork ready before I lower myself from the window on a rope made of sheets.” (Note: This might also come from the mouth of a colleague who’s hospitalized, in which case you should get the discharge paperwork ready that much faster.)

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Agatha Lellis

Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at askauntieaggie@gmail.com.
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31 Responses to 8 ways your patients can fool you

  1. Big Sky

    I’m not a junkie says it all. I wonder if people in the medical profession are just trained in school to Assume that. My family’s bodies can’t take NSAIDS and have violent reactions, and you think you were pushing Phenergan before, it won’t seem like so much when you can’t stop the reaction. so sure of yourself, that even though I have paperwork 2 inches thick showing what happens (doctor and hospital records) you know to instantly label people Junkies. Perhaps the problem is that you don’t just be quiet and listen. Sorry, not every body is the same, and your labeling people is not the cure, the answer is not in any text book.
    Perhaps there are people seeking narcotics, but instantly labeling people goes against your “do no harm” Of course, the patient is the one who pays for the bill and the damage done to the body. Damage that can’t be undone, with your pitiful “sorry”.

    • emartin0713

      Ok I get that you are allergic to NSAIDS and If you have all that paperwork then bring it with you. Are you in the medical field I am and I am sorry that you feel slighted but until you deal with 10 out of 10 people drug seeking in the ER or the Dr. office then you can say we are doing no harm. I think not prescribing narcotics at a whim is doing no harm. If you are in your dr office then they should know what you are allergic too. Until you have seen people say there pain is at a 10 and calmly talking on the phone or playing a game on there phone. Please don’t assume that we always label people. We have to protect people and not handing out narcotics to every Tom Dick and HArry so until you are put in that position don’t judge

      • Dawn Wolte Ezell RN

        I am and I have seen that many times. I have also seen old ladies ask for their pain meds and fall asleep waiting for them… and you know what? The right thing to do is wake them up and ask if they still want them! Not assume they aren’t in pain. Pain is dealt with in many different ways and as you know from “way back” in nursing school it is subjective… But I understand about drug seekers and how they have irritated you or have sickened you… but that’s a personal problem. You need to get back to compassion. I agree with not handing out narcs like candy believe me.. but some people actually need them and should have them. Those that “play on their phones” or in other ways that convince you they are faking, should be evaluated by the doctor (not you) and sent to a pain management clinic.

        • Dawn Wolte Ezell RN

          Oh oops I’m sorry I assumed you are/were a Registered Nurse because you said you were in the medical field.. I’m sorry if you are not.

    • Dawn Wolte Ezell RN

      Amen and well said.

  2. Res_Ipsa_RN

    And the ER nurses favorite is, “I only had 2 beers!” We always assume it was 2 40 oz…

  3. over30yearRN

    When I went to nursing school circa 1980, we were taught not to be judgmental. This piece reeks of judgement. I realize it is tongue-in-cheek and I do have a sense of humor but this bothers me. A lot. What upsets me most is that patients will see this and believe we all feel this way (mass-labeling us the way “we” have labeled them. Has nursing changed so much that it’s just easier to place a label on patients before we care for them…or have we stopped caring?

    • bassnurse13

      I agree with you 100%. I actually think this site is ‘anti-patient’ for a profession that is supposed to be the patient advocate. If the patient is ‘fooling’ me, so be it. I’m there for THEM not to sit in judgement and try to analyze each and every concern the patient brings to my attention. I am pro patient and will do everything in y power, within reason and in accordance to state and facility laws and rules to make my patient comfortable and their stay at the hospital a positive one even though they are going through a rough tie in their lives. The last thing they need is a nurse who looks at every patient in pain or discomfort as a ‘junkie’ or a ‘seeker’ and shame on any nurse who would ever look at their patient in that way, maybe you need to re-evaluate your reasons for becoming a nurse.

    • Dawn Wolte Ezell RN

      I agree!! I have only been a nurse since 1998 but the same for me.

  4. heather.m.meeks

    I agree with you BigSky! The true junkies ruin it for the patients and the practitioners. So many of us assume things like being allergic to NSAIDS means they are just trying to get buzzed or that when they tell us they’re scared of having blood drawn we react coldly due to the fact that they have a tattoo. We must learn to be kinder to patients! My wake up call happened when I was out of town and had to visit an ER and was treated EXACTLY how I have treated others in the past. I was in the most terrible pain of my life and was turned away with a lecture of “if you’re looking for pain meds you can just move right along.” I have never felt so helpless…and being a healthcare professional I KNEW something was wrong. I was literally in the floor crying and nurses thought I was drug seeking BC they’ve seen it so much. A week later I had to be rushed in for emergency gall bladder removal. So yeah I hate #1 too. Really bad mindset to practice in!

  5. Granny RN RN

    It is interesting how the Fates can rearrange your thinking when you have logged more years on Duty in ICUs than the number of years that the ‘mind-readers’ have been alive.
    Regarding pain and appropriate medication: For those who do not believe that a ’10 out of 10′ can exist I ask this question: What quantitative test or radiologic procedure do you use to objectively judge how ‘correct’ a patients’ pain level may or may not be?
    That’s right boys and girls-pain can only be measured Subjectively by the patient. If you suspect that the patient is simply ‘drug-seeking’ you have more work to do. Have you done a thorough examination? Checked the medical/surgical history? Perhaps they have had 4 knee surgeries because the first two were botched by a surgeon whose group just got fined 5 million dollars for insurance fraud and malpractice? Maybe there is an undiagnosed condition causing that neck to hurt (perhaps an abscess from a bad manicure?). All of these I have treated (and given depositions later).
    If you are so certain that your judgement of the patient is correct then you do have options. You can allow him or her to leave and potentially return or go to a different facility with a life-threatening condition only to survive and sue you 2 years later; you can consult with the attending MD and have the order changed to suit YOUR notion of what is appropriate; you can give adequate medication to relieve the pain and nausea/anxiety which all potentiate each other; you can relieve the immediate pain and send the patient home with enough medication to last for 3-4 days until he or she can see their regular doctor.
    Remember that we are in the business of making things Better, not sitting as judge and jury over whatever a patient’s lifestyle happens to be. Neither are we Law Enforcement. An addict can only be successfully rehabilitated when he or she decides to do so.
    Most ‘drug-seekers’ are well known to local EDs and everyone’s prescription history can be pulled up on the computer by a pharmacist.
    Remember that some day it could be YOU whose pain is a ’10’!

    • bassnurse13

      I agree Granny and thank God there are still nurses like you in practice! :)

  6. ldrnc

    I’m an L&D nurse. It’s been a while, but patients used to push on their tocos (contraction monitors) to simulate contractions, saying they were in labor. I would sit with them for a period of time and NO contractions during that time.. I get it. When you’re done, you’re done.

  7. Abby McCommas

    I live in a small town with a small family medical practice. al lot of the people here DO drugs, so I’m already treated like I do them when I go in for treatment. My shoulder hurt so I went in to ask this family practice if they could look at it. I wasn’t asking for narcotics, I just wanted the pain to stop being so annoying that it was waking me up in the middle of the night. Give someone a urinalysis if you’re worried about them being a junkie, don’t treat them like they already are one when they come in.

  8. nateohio

    You guys need to settle down… that first point isn’t saying a 10/10 doesn’t exist… it’s saying that when a pt says they are 10/10 and acting as though nothing is wrong, when they have “allergies” to everything but iv dilaudid, etc… there is cause to raise an eyebrow or two…I have drug seekers that I deal with on a regular basis…telling me 10/10 pain in both legs while they are propeling themselves down the hallway in a wheelchair using their legs to go outside and smoke…so you mean to tell me that you’re experiencing the worst pain imaginable in your legs and you’re worried about going outside to smoke? Let alone using your legs to propel yourself when that’s the part of your body that you’re telling me is hurting so much

  9. hotrod41

    The nurse took my methadone herself. I NEED MY DOSE1

  10. eamelt123

    I had a patient tell me they were allergic to Tylenol, and could only take Norco and Percocet… ummm, ok.

  11. chloemarie

    As an ER nurse, I must add my input to this. If someone has allergies to NSAIDS it does not make one judge a person who is in pain. It is when they are allergic to any pain medication other than dilaudid, and they will not even try anything else for their pain unless it is a narcotic. Some patients will even request certain physicians because they know that they will give them narcotics. These patients are typically frequent flyers, some in their 20s with no medical problems, with several visits every month consistently, with multiple areas of pain complaints, and every study done has come back negative. Many have a history of coming in for overdose or detox in their chart. Many have had multiple CT scans which can be dangerous. There are some great non-narcotic pain medications out there and some patients are offended when those medications are offered.
    Most health care providers where I work will usually look at the whole picture, not just anyone who comes in the door c/o pain.
    The fact of the matter is, drug seeking is a real problem in this day and age, and it is causing physicians to have to use more caution when using narcotics. I have had patients even tell me that they were doing it, after recovery from narcotics and they told me that they partly blame the medical system because narcotics were so easily accessible.
    With that being said, I understand that there are patients with chronic pain conditions, and they do require narcotics to help their pain. I do not treat anyone disrespectfully when I am caring for them. I honestly don’t care what they are there for, whether or not they are there for narcotics, it is not my call. I leave it up to the doctor, if they want to give multiple doses of dilaudid or just give motrin, I do what the doctor orders. As long as the patient is respectful to me, I am respectful back. Some patients have been so rude and belligerant, even threatening nurses. As an advocate for patients, there are times that the doctors were reluctant to give pain medications and if I felt that they really needed something I would tell the doctor that I felt something was really wrong. I do realize that there are many health care providers who do judge people based on their appearance or jump to conclusions when they encounter patients. I am not saying that this is not a problem, or that it is acceptable in health care.
    The main thing is to provide the best care that you can, and follow the proper nursing practice. I am certainly one who stands behind not judging people by their appearance. I treat all of my patients with empathy and concern for their needs. I am pretty sure that the things listed above are indicated toward those who are abusing the system like that, not people who are really in pain. I just felt that I had to put my point of view out there.

  12. rnurse

    Being someone who has suffered chronic pain for many yrs, I disagree w/how some health care workers treat those in pain. I am constantly treated like a drug seeker, because I have a high tolerance for pain meds. I also can be in extreme pain, but I don’t like others seeing me cry, so I will try to act tough and “normal”. Yes, I know there are drug seekers out there; however, you can’t truly know what a person’s pain lvl is -it is their pain. Also, those with chronic pain knows what meds work for them and which don’t even begin to touch it. Trust me I hate being on pain meds, the side effects are terrible (thank God it doesn’t effect me mentally, my mind is as clear and sharp as ever, even more so since pain isn’t bad enough to distract me), but I also want to have a life and be able to work in a field that I love (but can be very physically demanding) and have fun without being in constant pain. I am lucky to find a dr who doesn’t treat me like an addict, and will prescribe me what I need to get through my day. My employers have also been great and understanding, and allowed me to continue working, since I proved to them I was still safe and capable of rational and sound judgement. I guess it is good that I had this experience, otherwise, maybe I too, would judge others as being drug seekers.

    • Dawn Wolte Ezell RN

      Aw sweetie thanks for sharing your story! I agree. My daughter has very bad pain in her knees and so far they can’t find the cause.. They seem to be affected by weather and are more painful in cold/rain.. kind of like Arthritis… She takes a HALF of Vicoden and it relieves her pain. She has tried many things including OTC knee pain patches, Aspircream, Motrin, etc…Nothing helps. She wants to take her HALF of Vicoden only when they hurt and was labeled a drug seeker because she asks for Vicoden because she knows it helps. She tells them she only takes a half but no one believes her. It is frustrating and sad that my daughter has to endure pain and so far they can’t put a finger on why she gets her knee pain, which does not help her.

  13. smiletoday

    I’m afraid of needle and the patient is covered with tattoos. Also, I overheard a nurse ask a chronic alcoholic, have you been drinking. The patient sat up, looked at the nurse, responded no and layed back down. We all laughed.

  14. Taryn Brenner

    I have Ehlers-Danlos Syndrome and suffer from chronic pain. The problem is my pain is above and beyond what any radiographic tests can show. It’s a hallmark of it, pain beyond what testing shows. I hate being treated as a drug seeker, the only drug I’m seeking is one to relieve my pain. I’ve started to just bring my prescription bottle of whatever narcotic I’m on(first Percocet, which was a joke and now methadone, yes for pain, I’m not a junkie) with me to prove I’m not even close to out of whatever it is. I’m also highly allergic to ibuprofen(it causes severe facial swelling) but I have no problem with other NSAIDs, I’ve never had a problem with aspirin, or naproxen, I had taken both prior to when I took an ibuprofen for a backache and ended up having to call 911 when my face swelled up and my airway started to become compromised. It just so happens that morphine does nothing to relieve my pain and Toradol works better than dilaudid at relieving my pain. You’d be amazed at how quickly people stop being rude to you when you request Toradol for your pain. I’ve had people in the ER just be so rude to me, until they roll their eyes at you then ask what helps my pain and mouth over their shoulders to their coworkers ‘I’ll bet you $100 she says dilaudid’ when I say Toradol. They instantly stop being rude and start being really nice. It upsets me, more for the people in legitimate pain that Toradol doesn’t help than for myself.

    • Dawn Wolte Ezell RN

      I understand and as nurses they should be more concerned with stopping your pain than playing games and trying to bust drug seekers. I remember when as nurses we cared more about relieving their pain. :'(

  15. carolslee1949

    I’m an RN and really try to keep on top of my medication regimen. However, I also have major depressive disorder and am taking 2 antidepressants and Valium. I’ve had the unfortunate experience of being labeled “the psych patient” when I had to be seen in the ER for right upper quadrant pain. Because I have a history of gallstones, I become anxious when I get the RUQ pain. I didn’t appreciate the attitude of the nurse who assessed me and assumed I was having an anxiety attack. She kept asking questions about my psych history, medications, when did I last take my Valium. I kept telling her that I’ve had a sonogram that showed lots of gallstones and that my primary care advised that I go to the ER when I have the RUQ pain, as it could be a stone moving out. I even overheard her giving the ER doctor her “diagnosis” of my condition. Fortunately, the ER doctor was really professional, ordered another sonogram, and a surgical consult. Result…….the stones weren’t moving, but the gallbladder was inflamed. Next day I was scheduled for gallbladder removal. That same nurse couldn’t even look me in the face when she came to ask me if I’d like to have something for pain.

  16. Dawn Wolte Ezell RN

    Sorry but when I say #7 it is true, and a lot of times when patients say they are a doctor or a nurse it would be best to believe them…. I can always show you my license. When I feel the need to inform them of this it means I am watching your arse.

  17. iowarn71

    Just had a patient tell me he couldn’t take Norco because he was worried about how the Tylenol would effect his liver function…he then requested Percocet. 😐

  18. jailhousenurse

    Can nurses not have a sense of humor? I think it’s ridiculous how there is offense taken to comments or subjects on this site. I whole heartedly care about my pt’s! I work where there is no place for judgement! Look at a man that’s murdered his wife or taken the innocence of a child & give them the same medical TX you would for your own family member. I come on here & see/hear things that are funny or odd in relation to pts or being a nurse! I get a chuckle & relief at times that I’m not the only nurse out there dealing with these things.
    If you feel it makes nurses/medical field look bad then maybe find another site.
    I cannot give pain medication where I work. The docs, company & County won’t put narcotics in the jails. SO…I find the whole “I’m allergic to NSAIDS” & other ref frequently…& can only imagine what an ER nurse deals with. It is insane the amount of pain pills that are handed out! And if you haven’t noticed opioid/pain rx is currently a serious problem -not to mention the drastic rise in opiate related OD-in this country! I deal with the end result of this problem. Yep, many bad eggs ruin it for the ones that do need them!
    #unwadyourpanies

    • nrskris10

      I think it’s just so hard for those of us that suffer w chronic pain to find it funny since WE ARE IN PAIN!

  19. mommadisneybrat

    I was recently hospitalized for a week for lower right sided diverticulitis. Believe me I was in a lot of pain. My second day there, the day shift nurse decided that I needed to be on oral pain meds, so I would be able to go home. My night nurse, that had admitted me, came in at the start of her shift. She said, I was there not only for the antibiotics but because I needed pain meds stronger than what I could take at home. She also said IF I had that nurse again, I needed to tell her that. She was telling me this as she was giving me the IV pain meds that I had needed during the day but didn’t stand up for myself. She also brought the pain meds in every 4 hrs without my asking because she knew that I needed them. I later found out that she too had experienced diverticulitis.

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