¶ … 40-year male presented to the emergency room at 11 a.m. In the morning with complaint of pain all over his body. On history, he did not state that the pain was localized; rather he complained that his entire body was aching. The man was asked to lie down on the couch in the emergency room, while I started to review his vitals. His blood pressure was within the normal range; however his pulse and respiratory rate were slightly increased. I also noted that he was perspiring heavily. The moment I asked for his consent to do his physical examination, he started screaming with pain. When I asked him to describe his pain in terms of character and intensity, the main stated that the pain was excruciating and could be labeled as 8 on a scale of 1-10. Just then he asked for a Morphine injection. Right that moment, I was called in by my boss and I had to hand this patient over to the other doctor on duty. When I came back after 45 minutes, I found out that the patient was in fact a drug abuser. Since he had run out of his prescription for drugs, he claimed of body pain so that he could be given a Morphine injection. The patient was discharged as he said that his pain has subsided.
My feelings
From the very beginning I felt like something was wrong. The man did not look like he was in severe pain but did seem restless as one would feel when experiencing withdrawal symptoms of a drug. If I had not been called in by my boss, I would have never given him a morphine injection unless I would find out the cause of the pain, if there was any.
Evaluation
Drug abusers know that no healthcare center would deny them drugs that they are addicted to. Since morphine is commonly used to relieve pain that patient experience because of acute attacks of some diseases or when they are suffering from an end-stage disease, the drug abusers can exploit this fact and pretend like they are in extreme pain so that they can get morphine, which is form of heroin.
Analysis
Even though the man should not have been given a morphine injection since he was just a drug addict, it is not possible for the doctors or nurses to differentiate between a real patient, a drug addict or a functional patient. Under these circumstances, the doctors and nurses only make sure that they do not miss a real patient and that is the main reason why they always believe what the patient is telling them, even if their own evaluation is otherwise.
Conclusion
There are some patients, which are referred to as functional patients that have some psychological issues and therefore seek special treatment. The main in this case was also a functional patient. His psychological issue was his addiction, which he tried to mask by acting like he was in pain so that he could be given a morphine injection. The doctors need to be vigilant and critical when deciding how to treat such patients.
Action Plan
1. Every time a patient comes in with pain, take a detailed history
2. Always ask about drug history
3. Evaluate the intensity of pain on general physical examination
4. Order for lab tests; blood and urine
5. Use other diagnostic techniques like ultrasound or CT scan to find out the cause of pain
6. Provide symptomatic and specific treatment
7. If the patient is function of psychological, refer to psychiatry or rehabilitation department
Case 2
What Happened
An 80-year-old male who resided in a nursing home with a history of dementia, had suffered a mechanical fall during which he landed on his right side. Initially, he complained of pain in his left hip. When his physical examination was being performed, he complained that his entire body was hurting and that the pain aggravated when any of his body part was palpated. On examination, there was deformity, bruising or swelling. When he was inquired about his pain a few minutes later he claimed that the pain had subsided. However, when he was palpated again, the pain returned suddenly. According to the nurse, he often complained of being in pain from an incident that he happened in his teenage years. The nurse also stated that he would often reenact the entire incident.
My feelings
The old man was a known case of dementia, and this is the reason why anything can be expected of him. I do not think that he is the one to be blamed when...
Moreover, they also reenact the incidents of their past because they keep forgetting the time frame that they are in. When their complaints do not coincide with the findings of their physical examination, it can be said that they are complaining so because of dementia. Such people need special care and attention of their caretakers.
Analysis
Nurses and caretakers have to be especially very careful when taking care of old people with dementia. The reason behind the aforementioned statement is that if the patient is actually suffering from pain but the nurse believes that it is only because the patient often complains of being in pain because of previous injuries, then there is a great chance that the patient might have to bear some serious health related consequences. Nurses to tend to take the complaints of such old patients with dementia for granted.
Conclusion
The complaints of patients with dementia should never be taken for granted and should always be double checked with their physical examination. Since most of these people are old, special care needs to be taken especially if the patient complains of a mechanical fall. The bones of the old patients are friable and easy to break, therefore the nurses and doctors should always make sure that the patient did not actually suffer from a fall.
Action Plan
1. Screen for patients of dementia in old homes
2. Make sure that they are isolated from other normal people
3. Make sure that someone stays with them all the time
4. If they complain of pain or any fall, it should always be double checked with physical examination
5. Reassure and counsel them if they are complaining of being in pain because of a past event
Case 3
What Happened
A 17-year-old male patient present with 10/10 severe pain in his right upper arm. It appeared that his humerus was broken. The history of the patient was that he had fallen from his motorbike after colliding with another rider. The presentation was that of a simple fracture due to a road traffic accident.
My feelings
The aforementioned case was not very complicated but the part that bothered me the most was my judgment of pain for the patient. Many a times people go on to act more and complain more than they normally should. These people have a low pain threshold therefore they cannot bear the pain that is afflicted. For some time, I actually did think that this patient should be brave and not cry and moan so much. I was quite shocked and disappointed at the way I have been judging this person's pain. I have not just collided with another bike rider and can't possibly imagine the intensity of pain this boy was going through. I felt very bad that I judged this boy only because of his reaction to the pain he was. It is highly likely that this boy was severely hurt and was actually feeling a lot of pain. A part of me was also quite biased against his gender and age. I thought that he must have driving recklessly or trying to race with his friends. Amidst the crying and the tears, a part of me actually thought that he should deserve this for his reckless behavior.
Evaluation
Teenage boys are likely to get in motorbike accidents but it is not likely that the accident is their fault. It is highly likely that the boy was just a victim and he was not responsible at for his condition. My evaluation is that I am not as compassionate and fair as I thought I was. Even though I realized this fact late, it is good that I realized it. As a third party, I am not one to judge or conclude the level of pain a person is going through. As a health care worker, my responsibility should be to alleviate pain and distress as soon as possible.
Analysis
It appears that the stereotype of a young boy has affected me to quite an extent. This biased view is therefore interfering with my ability to judge and treat patients. I believed that young men are likely to be reckless and should own up to the mess that they have created. Furthermore, I also believed that being a…
