A Pained Life: ER Protocols

By Carol Levy, Columnist

When I read about people going to the emergency room to be treated for breakthrough pain, it is rare for anyone to say they felt they were well-treated. They tend to say they were disbelieved, looked at as a drug seeker, or the ER doctor did not give them enough meds to last until they could see their pain management doctor.

I have almost always replied, “Ask your doctor to send a protocol letter to the ER. Then if you have to go they will know what you have and how your doctor wants it treated.”

It occurred to me that it would be a good idea for me to query some ER's and see if this was in fact good advice.

After talking with one nurse, I did not feel it necessary to talk with any others.

She told me too often patients come in who are known to be drug addicts or drug seekers. Often they come in complaining about chronic pain.

This can make it hard to distinguish who is truly in pain vs. someone feigning pain merely to get narcotics. 

I asked if a letter from a doctor explaining what the patient has and what could be done for them would help.

"That won't work," she said.  I asked why not.

"Very simply, the doctor would have to constantly be updating the letter,” she explained. “A letter written 6 months ago would be ignored. Things change, the patient may change, and we could not rely on something written that long ago. If a doctor sent us a protocol letter it would have to be updated every month or so and no doctor is going to go to the trouble to do that."

That made a lot of sense. Both that a doctor would not be willing to take the time and that the protocol letter would have to be a recent one.

“What if a patient called their doctor's office and then the doctor called the ER with instructions about what to do for the patient?” I asked.

“That would work. And is probably the best thing for someone to do,” the nurse told me.

I know it is hard to wait when you are in pain. I know the idea of giving the doctor time to call back -- say in an hour -- would seem like the longest hour in the world, especially when the pain feels insurmountable.

Most ER physicians don’t know us when we come in. We are just another stranger, saying we are in pain and often asking for narcotics. If we give our doctors the time to call them, the chances are much greater that an ER visit will have a better outcome – instead of leaving us feeling disrespected, mistreated, or not treated at all.

Carol Levy

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.