Urgent Care

OPS

Urgent Care

By Mike Rubin Feb 28, 2012

Drug seeking: “A set of behaviors in which an individual makes a directed and concerted effort to obtain a medication.”

—Peggy Compton, PhD, RN, 1999

On December 23, 2011, I became a drug seeker. I was bringing one of our dogs, Brandi, to the vet. Brandi is old and doesn’t hear very well. It was hard to coax her out of the car (she refuses to lip-read unless it’s about food), and I was too impatient to follow proper lifting technique—i.e., wait for my wife to do it. Twenty-five pounds of Brandi hauled sideways was just enough to tweak my back’s chronically compressed S1 nerve root. I made a howling noise similar to Brandi’s as we both fell to the pavement. Only one of us needed emergent care.

This might be a good time to mention I hate hospitals. Also ambulances. The former make mistakes, and the latter crash sometimes. Even if I didn’t have a deductible higher than a year’s worth of mortgage payments, I wouldn’t have consented to an ED unless I was too altered to consent to anything. I told my wife to head for our family physician’s office—a place that boasts “convenience and comprehensive services,” including a walk-in urgent-care facility with “extended hours.”

Urgent care turned out to be occasional care; all of the doctors and almost-doctors had gone home for the holidays, when people supposedly know better than to get sick. So much for convenience and extended hours. I began to “doc-shop.” There’s another dirty word for you. My goal was to find a medical professional high enough on the FDA’s food chain to prescribe narcotics—no, not Tylenol 3 or tramadol, but something strong enough to moderate my agony. Hydrocodone and oxycodone do that job very well. They also happen to be two of the most abused drugs on the planet.

I grabbed the summary of my most recent MRI and headed to a nearby clinic offering walk-in service seven days a week. This was no sleazy storefront operation that dispenses pharmaceuticals like fast food, but rather a semi-respectable medical group I’d driven past many times. Based on my experience trying to expedite tightly controlled meds for patients in pain, I knew I’d have to make a persuasive case—something more convincing than “I hurt a lot.” Yes, drug seeking has its rules. They make me feel like I’m trying to score smack: Don’t ask for a particular drug, don’t suggest a dose and don’t look like you’re in too much pain. Moaning can be counterproductive.

After a cursory examination by some level of clinical assistant, who blamed her stethoscope for not being able to detect my blood pressure through two layers of clothing, I was assessed by the on-duty physician. During the 30 seconds I figured I had to portray two years of paroxysmal misery, I highlighted lifts that went badly, lumbar impingement and my regular doctor’s oxymoronic holiday hours. The outcome seemed inconclusive, so I flashed my MRI results. Best $600 I ever spent. “Well, we’re not a pain clinic,” the internist wavered, “but I’ll give you something to get you through the weekend.” Five minutes and one prescription for 15 Vicodin later, it was over—until the next time my CNS doesn’t conform to business hours.

Later I pondered the doctor’s protestation about running a “pain clinic.” When I was hunting for an open-minded MD, I never thought to Google pain, as if it were a separate branch of medicine. Perhaps we wouldn’t need dedicated facilities if we all did better jobs of keeping patients comfortable. Part of the problem is the stigma we often attach to those who assert their discomfort. Consider this alternative definition of drug seeking from emergency physician Brian Goldman, MD (1999): “Individuals who knowingly break the law by seeking and obtaining controlled drugs in order to sell them on the street.” In “On the Meaning of ‘Drug Seeking’” RN Margo McCaffery and colleagues list 10 alleged characteristics of drug-seeking behavior, then discredit their reliability before concluding that the term drug seeking “conveys no well-established criteria” and “should not be used because it creates prejudice, bias and barriers to care.”

Some drug seekers are abusers, but which? If there were reliable ways to measure pain, we wouldn’t ask patients to grade it themselves. Caregivers should focus on relieving pain, not judging it. I can only hope for as much the next time I’m hurting.

Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.

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