Sep 18, 2010

mistaking a miscarriage for a drug seeker?

Three years ago I miscarried at 12 wks - an awful event that I documented in this blog post, in which I explored the psychological turmoil that surrounded my pregnancy loss. What I didn't write about at that time was the physical experience of the miscarriage. It was long and painful.

Yesterday, a post at one of my favourite medblogs "ER Stories", (where 'ERP' writes about life in the emergency room from a physician's perspective) touched me. The post lamented that medical staff discussed withholding pain medication from a known drug-seeker...who was dying of cancer. After yesterday's tone of compassion, I was disappointed to read today's post about drug seekers and how doctors are keeping score. I appreciate that ER physicians must make difficult calls for each patient, but the 'keeping score' attitude results in a culture of suspicion that undermines patient care.

Case in point: my miscarriage. After waiting nearly a week for the pregnancy to abort (they advised against a D&C), I was a physical and emotional wreck. The miscarriage lasted three days - over the May long-weekend. The only option for pain relief was the emergency room.

In the ER, I waited hours to be seen so that I could ask for pain relief and to find out how much blood loss was to be expected. The doctor who saw me asked me if I had tried Advil. Seriously? Who in their right mind would wait hours at night in a busy ER next to angry drunken people and police if they weren't in a LOT of pain and had tried everything else? He went on to ask me if I wanted to be examined. I don't know, you're the flippin' emergency room doctor. I've never miscarried before. You tell me - Is this normal?

The doctor treated me with a skepticism I would hope would have been reserved for repeat customers with a history of drug abuse. It was humiliating and made an awful experience even worse. Did he doubt I was really having a miscarriage? I would happily give consent for an internal exam to clear up any concerns about 'faking it'. Perhaps he thought that I was exaggerating the pain? Perhaps; even I was surprised at how painful it was - it was nothing like any period pain I had ever experienced. It was clear that he certainly didn't care.

Did he feel like he had scored after he failed to treat my pain?

Doctor 1 - Patient 0


  1. On palliative care rounds we saw an orthopedic patient who had just had surgery for a displaced femur fracture. He OBVIOUSLY needed better pain management. He was grey and sweaty, and clinging to the sides of his bed with white knuckles. He grimaced with pain with every breath he took. You know what the NP said who called the consult? "Well, we weren't sure we wanted to call you guys. I mean, this patient is kind of a wimp. But we decided to anyway." I hope the patient actually got the medication we recommended. He was being tortured.

  2. Unbelievable, they really called the patient "a wimp"? How did you respond to that kind of comment?

    I imagine when people go into nursing and medicine they start out with good intentions of helping people. What happens along the way to erode compassion?

  3. If a vet did that do a dog, he could be in front of the board.

    It is really shameful that people can be tortured in hospitals. Pain management in this country is improving, but it still has a long way to go in some places.

  4. OMG, Penelope, I'm so sorry you had to go through that. I just don't know what is wrong with some people, but the lack of compassion you experienced is just sickening...

  5. Penelope, The palliative care attending was flabbergasted and made a snide comment to me about it afterwards. He was appalled as well. Unfortunately, if you call people out on that sort of thing, the patient is usually the one who suffers.

  6. Wow -- I had several miscarriages, all of which were very early (i.e. 9 weeks or before), and found them excruciatingly painful and, as you say, nothing remotely on the same level as my period pain. I was surprised each time at how painful they were, and I guess I will count myself as even luckier than I realized because I was able to talk to someone from my OB's office each time and was offered prescriptions for pain meds over the phone.

    I'm so sorry that you had to undergo that kind of treatment at such an emotionally devastating time. :-( I guess it's clear I'm not a medical professional, because I would think that they should err on the side of giving pain relief even if that means occasionally giving an addict his/her fix. Sigh.

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