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Comment by mpalmer | Hacker News Reader

The most pressing issue for the orthopaedic team was my left shoulder, which was visibly dislocated. Before attempting to reattach it, the doctor told me I would be given a dose of fentanyl: an opioid that is up to 100 times more potent than morphine. He went away, returned and started using a bed sheet to try to pop the shoulder back into the socket. Alarmed, I told him that I had not been given any pain medication. He didn’t believe me and kept using the bed sheet to try to yank my shoulder back into place. I was howling in pain as I underwent what felt like an excruciating form of medieval torture. When a nurse walked by, the doctor asked her how much fentanyl she had given me. She said she had not given it to me yet.

Horrifying.

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This is just bad medical care, assuming the description is correct. Even if they had been given the pain meds, you move the shoulder slightly to see how well the pain medicine is working, if it’s not working well enough (= patient shows evidence of significant pain), you give more pain medicine. But it’s hard to get to some level of analgesia that can control the peak of the pain that will happen during joint reduction, but also not cause respiratory depression. That’s why personally I give sedation to my patients instead of just pain medication, that’s what I’d want if I had to have the procedure done.

But if in fact it was the orthopedic team that did the reduction, they are not trained to give the same level of sedation as emergency specialists or anesthesiologists. So there is a temptation on their part to give some dose, not titrate to effect, and then just “get on with it” to save time. What they should do, and do in fact do in my institution, is have the emergency medicine doc give sedation, and then they can happily do their procedure without torturing the patient... Or the emergency docs do the sedation and reduction, which we tend to do for patients who don’t require other inpatient orthopedic care.

[Edit: Also, Bellevue is a residency training site, so this was probably a first or second year resident (they are the ones that most need the experience of shoulder reductions) https://med.nyu.edu/departments-institutes/orthopedic-surger.... But legally, the attending (supervising) physician is responsible for the care given by all the residents they are nominally supervising]

What happens to the doctor in cases like this? Seems like a slam dunk medical malpractice lawsuit but then again it's just one word against another and damages are hard to prove since pain is only experienced in the moment.

Depends on what’s written in the notes - but unless the notes specifically say otherwise, the presumption is that the patient’s recollection is the accurate one, given that this is an unusual situation for the patient to be in, but a routine situation for the doctor.

The lawyer would probably need to subpoena the nurse if the notes didn’t have adequate detail to tell one way or the other. About the “pain is only experienced in the moment” - it wouldn’t be hard to find expert witnesses willing to testify that this was unacceptable medical care. But I don’t know enough about the legal aspects to know how that would translate into a claim for damages.

> the presumption is that the patient’s recollection is the accurate one, given that this is an unusual situation for the patient to be in, but a routine situation for the doctor.

That doesn't make sense to me. The patient is in a shocking situation and intoxicated. More important is that the doctor wasn't even present for the medication so has no evidence at all.

Damages are decided by jury's emotions.

In most cases like this, nothing for medical malpractice.

Calculating damages for pain and suffering is usually based on a multiplier of the "economic" damages, the medical bills or lost income from missed work. So in a case where the pain does not result in a longer recovery(or permanent disfigurement or worse) there are no, or nearly no damages. Because of the way tort reform has worked out, it would be impractical for an attorney to represent you unless you can show $25k+ in medical damages, even if it is clear the provider violated the standard of care and it caused you a great deal of pain. Also even in a straightforward case like this, showing that the standard of care was violated is not clear

You could complain to the hospital ombudsman and your insurance co, both to prevent this from happening to others, and because it could reduce your bill.

Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. Anyway if it's really 100x more potent than morphine you'd think any person that did have it in their bloodstream would not be all that capable of stating that they have not had their medication yet.

This is one of the most pernicious aspects of the opioid crisis. Doctors are taught to be hypervigilant regarding "drug seeking behavior" which is pretty much a 1:1 list of behaviors of people whose suffering is "genuine." Number one criteria seems to be that the patient is requesting medication. In so many cases, the patient is the most reliable source of information... but when it comes to pain management, the patient is not to be trusted.

Our attempts at solving the problem even seems to drive the expert doctors who are actually qualified to do so out of the field. The prescription mills force heavy handed regulations that spook the insurers and hospital legal teams, which leaves two extremes: on the one hand are doctors who can't empathize with the patient and are super strict with any sort of scheduled medication and on the other are doctors whose offices don't see enough patients taking those drugs (or even a single problematic case), so they neither know nor care about the risks and give the drug out freely. Since their numbers are so low, no one thinks to bring up the issue.

The doctors who are most qualified in making the determination are often the ones with the most legitimate patients taking those drugs but all the legal teams and regulators are completely incapable of differentiating them from the prescription mills (excuse me, "pain management centers").

> Doctors are taught to be hypervigilant regarding "drug seeking behavior" which is pretty much a 1:1 list of behaviors of people whose suffering is "genuine."

Slate Star Codex wrote about this: https://slatestarcodex.com/2019/09/16/against-against-pseudo...

Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. Like the scary "FBI warning" that only shows up if you actually pay for a DVD.

Flinging yourself from a 5 story building in order to “look genuine” get fentanyl must be pretty common in NYC.

Some doctors take pleasure in telling patients in pain that they make it up and suggest they are just drug junkies looking for a hit.

I have worked with with healthcare professionals for decades, have never once met seen an MD or nurse take pleasure in seeing a patient in pain. I’ve interviewed over 10,000 people to date.

We live in two different computer simulations I guess.

> Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts.

It's much stupider than that.

Addicts want the drug.

So all of the indicators of addiction are actually indicators of wanting the drug.

So anyone who wants the drug is, ipso facto, an addict.

There's no element of addicts trying to look more genuine. Look at that list of red flags:

- Complaining of a need for a drug.

- Asking for more of a drug.

- Asking for a particular drug by name.

- Sometimes taking a drug on your own initiative.

Moreover, addicts suffering withdrawal are... suffering. This is the reason I put quotes around "genuine" in my original comment. The distinguishing factor between suffering from withdrawal and suffering from another source of pain is a moralizing judgement call on the doctor's part.

Would you also say that a painful cleaning of an infection is also a moralizing judgment against a patient who wants to avoid short term pain?

Let's not go too far to one-sided cherry picking.

https://intervention911.com/common-signs-of-drug-seeking-beh...

- laiming they need more drugs to replace a lost or stolen prescription

- Misrepresenting their symptoms

- Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping”

- Unwillingness or inability to provide a complete health history or contact information for previous physicians

It's possible for a non-addicted person to do this, but actual statistics matter.

Many of these things are uncommon, but not particularly rare among non-addicts.

> Claiming they need more drugs to replace a lost or stolen prescription

Have you really never lost a prescription? I've lost portions of mine once or twice (i.e. I had a week left and lost the bottle). Luckily not having mine is more of an annoyance than anything, but I can empathize for someone in pain who lost theirs. Stealing medications is common in addicts as well, and for every addict that steals a prescription, there's someone that legitimately did have their prescription stolen.

> Misrepresenting their symptoms

If this can be shown objectively, I can't see any way a non-addict would do this. I fear that it sows distrust between the patient and the doctor, though. The doctor is always looking for signs of the patient misrepresenting symptoms, and the patient is always worried that the doctor is going to think that they're misrepresenting their symptoms.

> Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping”

Uncommon, but it wouldn't be entirely shocking for someone to travel for access to a better doctor. This wouldn't be that out there for someone who has cancer, for example.

> Unwillingness or inability to provide a complete health history or contact information for previous physicians

I've moved a few times in my life. My complete health history probably involves 30 or so doctors if we go back to childhood. I don't think I could even name all of them, much less have contact info for them.

The statistics do matter, but we're talking about subjecting people to pain here. The evidentiary bar should probably be higher than "you did a thing that addicts are statistically more likely to do". I think especially so when the worst case scenario is that we give an addict a fix. I'm not advocating drug use, but the harm caused seems pretty minimal, beyond the cost of administering that dose in a hospital.

I understand where they're coming from but could they not loosen the rules for the person who has a clearly visible injury?

Could they not check the chart? Is there even a chart anymore?

There's plenty of chart, but far more hubris. In my experience, everybody writes in charts, but the rare doctor who reads them is a saint.

Personally I'd be focused there than making sure addicts don't get a bit of free medication.. that's bizarre and quite scary.

100x more potent just means you will give 1/100 the dose for the same effect. Around here, fentanyl is used in ambulances. Biggest side effect is it can stop your breath if it’s more than the dose given in lollipops (field-style first aid thing), so you have to keep an eye on the patient.

> Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue.

You'd be surprised at how questionable hospital care is run in NY, even with $450 / month insurance with a high deductible.

To protect the privacy of the person I know, here's a story from 2-5 months ago:

- Person A goes into doctor's office for something pretty common

- Doctor requests cat scan or MRI (I forgot which one is which) based on symptoms

- Person A gets the scan

- Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous

- Person A books surgery

- Hospital gives prep instructions to be performed by Person A 48 hours before surgery

- Person A does everything and goes in for surgery

- Person A is prepped for surgery and is put under anesthesia

- Surgeon comes in and looks at the scan in the operating room

- Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer

- Person A is wondering how the surgery went after coming to from being put out

- Nurse says no surgery was done and even she was able to look at the scan and see nothing was wrong

- Person A is told to go home and wait 4-6 weeks to self heal

So let's ignore thousands of dollars in bills (deductibles). All of this could have been avoided if someone actually looked at the results of the scan before going through the motions of putting someone under anesthesia and a massive amount of stress.

That's only 1 of many stories. In another case someone I knew had their blood drawn twice in the hospital because the 2nd nurse didn't believe them when they said they just got their blood drawn by another nurse 10 minutes ago. The vials were literally next to them, about 3 arm's lengths away.

Over here in the UK they generally mean well, almost without fault every one of my specialists, doctors and nurses have been awesome.

That said man do they fuck up, most recently was a fun one, I had a scheduled appointment, turned up for it, doctor was in his treatment room seeing patients, forgot to see me and went for lunch.

I mean it's minor but I'd checked in, the computer had me as waiting but he'd looked at the list, not seen me and went for lunch - I spoke to the nurse told her I didn't mind waiting while he ate and she tracked him down, he was incredibly apologetic (unnecessarily so, shit happens).

It's inevitable in a system as complex as healthcare that mistakes are going to be made but we probably should assess the proximal causes much like the airlines/plane manufacturers did to reduce the incidence.

Almost exactly the same thing happened to me (also in the UK), except rather than checking me in, they had transposed a couple digits on my NHS number and checked in a random person. Not sure if the NHS number has a check digit, and if not why not, but I digress...

Rather than going to lunch, after I sat waiting for 3hrs they closed the department. When I went up to let them know I hadn't been seen yet, they apologised profusely, called back the specialist - who had already left - and saw me after closing time.

That sounds like malpractice but I dunno.

I find it bonkers that the surgeon had no prior involvement in reviewing the case before the patient is brought into the operating room.

That's really scary.

Requiring a surgeon's consultation before scheduling seems like it would be a huge hassle to arrange, and greatly reduce the amount of surgeries they could perform.

Beyond that, I'm not sure what benefit there would be to a surgeon independently reviewing the case early. Thinking about what they'll need you do in tomorrow's surgery would distract them during today's surgery.

At least with the surgeons I know in the United States, they have days devoted to clinic and days devoted to surgery. They meet with nearly all their patients beforehand to evaluate their conditions and discuss the options. The exceptions are emergent cases or if a surgeon (resident, fellow, or attending) is assisting on someone else's case that was seen in clinic by the primary surgeon.

When I had cancer surgery, it was the surgeon (literally "the consulant") who consulted with me. He looked at the scan with me and explained my diagnosis and prognosis. We had at least one more meeting before the surgery, and I still see him every year for follow up (I think he's cutting me loose next year after six years - I will miss him he's a nice guy). Isn't this how it normally goes?

My understanding is that (1) the patient has the right to be explained what the surgery will be, what is their prognosis, what are the risks etc, so they can give informed consent - not sure who other than the surgeon could do this; and (2) that surgery needs to be planned, the surgeon needs to know how many nurses they will need, whether they need any assisting surgeons etc. This is all medical knowledge, a surgeon is not waiting in an operating room and operating whoever they bring in.

The whole story smells of very bad medical practices (and I'm speaking with the perspective of someone living in a formerly communist country, not some medical Mecca).

>- Person A goes into doctor's office for something pretty common

>- Doctor requests cat scan or MRI (I forgot which one is which) based on symptoms

>- Person A gets the scan

>- Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous

>- Person A books surgery

>- Surgeon comes in and looks at the scan in the operating room

>- Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer

This seems really unusual. I'd also say that (as someone who lives in NYC), I can't imagine things going this way.

I have never heard of a surgeon not reviewing the radiology reports, preparing a surgical plan and consulting with the patient pre-surgery.

If this is true, it's flat-out malpractice.

Given the sheer number of people, resources and precious operating room time involved in ordering, prepping and performing surgery, your story stretches credulity well past the breaking point. To put a fine point on it, I call bullshit.

I had surgery a couple years ago. I had specific symptoms and went to my doctor.

He referred me to an actual surgeon who ordered an MRI. The MRI showed what we expected it to show and then the surgeon ordered an additional scan to cover more area to make sure he understood exactly what was necessary. He then recommended surgery.

Not taking the surgeon's word for it, I sought a second opinion. Fortunately, my ex's brother was a surgeon in the same specialty and he offered to look at the MRI (I would have gone to another surgeon myself had he not been available to me).

He completely concurred with the surgeon and I had a successful surgery.

However, the normal process for surgical procedures, especially since there are significant pre-surgery protocols including medical history workups, blood work, discussions about what the surgery entails and risk factors, as well as a pre-surgery consult with the surgeon and/or his scrub nurse.

What's more, the surgical team (not with the patient) will meet at least once pre-surgery to review the surgical plan (which includes reviewing any imaging), and this may result in additional testing if there's any ambiguity.

And none of that is optional. What's more, on the day of the surgery during prep they will mark the location to be operated upon and confirm, multiple times, via existing imaging, discussions with the patient to confirm, specifically, what the surgery is for and what procedure is to be performed.

All of that is done before any sedation or anaesthesia is administered.

So no. That's not a credible story.

You're conflating bad medicine with cheap medicine. Unnecessary surgery is exactly what I'd expect from bad medicine charged at "whatever the seller wants" prices.

>Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue.

i somehow think that a medical doctor should be able to tell whether a person has an opioid [at least in a pain relieving dose] in their system.

FWIW, I had a pretty bad bicycle accident and was administered morphine, dilaudid, and fentanyl (in that order) at various times in the hours following. Only dilaudid had any affect at all on my clarity of thought.

if it's really 100x more potent than morphine you'd think any person that did have it in their bloodstream would not be all that capable of stating that they have not had their medication

This is off topic, but when a drug is 100x more powerful, they just give 100x less of it. So whether you get morphine or fentanyl the effect is approximately the same - and that's intentional.

I've dislocated my shoulder twice. The first time they gave me strong opiates and then put it back in. It was painless.

The second time the doctor said pain killers would be dangerous and insisted I have absolutely no pain killers in my system before reseting it.

His description of it feeling like medieval torture is apt.

I've dislocated my shoulder once and it was reset without any pain killers.

While the method indeed is quite similar to medieval torture, it was certainly not the worst pain I experienced that day.

Although I might have been lucky that the doctor worked in a ski resort and was very skilled in "the art of resetting shoulders".

My first one with the opiates was at a ski resort too! First run of the day, dislocated on the bunny run. Ironically, it relocated itself when I stood up, so I was like, "oh hey it's ok!". Then I started doing arm circles to prove it was ok, and that's when it got stuck out. :(

Doctors, surgeons in particular, are both project manager and individual contributor. At peak IC work load, the manager role gets starved for cycles. A failure to track "X was intended - did it actually happen?" is a typical of this.

Having someone with you can help. "He's right, Doctor, the nurse hasn't yet ...". A role of maintaining a clear picture of project state, making sure everyone is on the same page, and more.

This is a really long winded way of being apologetic about bad practice.

Patients lie all the time, but if a patient warns them they have received no pain medication or muscle relaxants or whatever, then their job was to check their medical record or with the staff nurse if it was true or not. Any other argument is a distraction.

Consider "Weather is bad all the time. It's the pilot's job to run that checklist as written. Then this (hypothetical) plane wouldn't crash so often. Any other argument is a distraction."

In UX design, there's "stupid users, they keep doing it wrong", versus seeking to understand user errors and prevent them. In medicine, with medical error a leading cause of national death, those are blaming individuals, versus seeking to understand errors, and systemically reduce their prevalence.

I get it, but in this case it is the DOCTOR basically thinking "stupid users". Nobody was endangered, the patient was just put in a heck of a lot of pain because the doctor assumed they were lying or wrong and it wasn't even worth checking, because their pain didn't matter that much to the doctor.

The hospital is a PRIME place for systems meant to avoid mistakes. (Although your example with checklists and pilots is odd; the checklist IS such a system, a remarkably successful one. And over the last 10 years, is used more often in hospitals too. I guess you could say that every checklist should have TWO people check it off or something, but it's such successful technology at reducing mistakes I'm not sure I've seen this suggested).

But no system can make up for doctors who don't respect patients or care about their pain.

Sorry I was unclear. The distinction between "blame the pilot" and "determine root causes, so we can work to prevent recurrence", is relatively familiar in an aviation context. So say, a recurrent checklist failure, might prompt checklist improvement, rather than merely blaming pilots. Perhaps shortening a landing checklist, by moving items to a less tense approach checklist.

So I attempted to illustrate by analogy, that describing a common reason why something happens, isn't being apologetic, or a distraction. Here, it seems possible that head-down engagement in physical manipulation, might have distracted from patient communication and care management. As that flavor of failure is not uncommon.

Regards tech to reduce mistakes, it will be interesting to see AR attempt to blend medical records with point of care. To see the patient, is to see their status. To administer an injection, is to have it recorded. But yeah, culture change is core, and hard. And tech doesn't yet provide great leverage on that. Or sometimes, as with VA OR teams composed by randomized assignment, something non-ideal has been knowingly chosen for its larger-scale properties, and the tech task is to mitigate negative impact. By for instance, detecting when meds were requested, but absent a team familiar with working together, didn't happen. There was a VA trauma surgeon shopping around a request to implement that years back.

> head-down engagement in physical manipulation, might have distracted from patient communication and care management.

No, a spade is a spade, the patient clearly said the Doctor didn't _believe_ him.

This isn't an in-the-zone 'tunnel vision' moment from the doctor, this isn't high stress shutting off the outside world, or CSR type reaction. This is someone _assuming_ a patient was telling a lie, who then lacked the duty-of-care to confirm it, before inflicting unnecessary pain.

I am all for checklists, they are a big part of my work processes and they are desperately needed in many medical and nursing workflows, but this particular case is just lack of common sense and duty-of-care.

I take your point, but this is absolutely not it. The commenter above you is saying that, if the "checklist item" for a doctor who is told by a patient "I didn't get pain medication yet" is not "verify that information", then the checklist _itself_ is wrong and needs to be changed. There's minimal negative impact (a delay to treatment if the patient was lying) and huge positive impact (avoiding doing a procedure without appropriate pain medication)

That's true and it's only recently that I realized the importance of it. It's imperious that patients be accompanied by a loved one or someone they can trust to look out for their interests and provide an adversarial viewpoint to the medical staff. Patients who are gravely injured/sick can not advocate for themselves and doctors will not listen.

I was recently hospitalized after an accident and was unable to have any family with me because of covid measures. As a result I received the worst medical care I've ever experienced. Including but not limited to: waiting 8 hours in the ER with four broken limbs and no painkillers, having procedures done with no painkillers that required them, being given dangerous dosages of drugs because of a miscommunication between teams despite my protests, having sequels from surgeries that were never addressed by the medical team and that I was too high to ask about, having to program my own medical bed so that it'd stop shaking my broken limbs after 5 hours of unanswered pleading with the staff, having to solve severe complications from the drugs with the help of my family doctor, not eating anything for a week without anybody getting worried... I could go on. I'd experienced similar issues during previous hospital stays, these sort of things happen regularly in hospitals, but I always had someone trustworthy with me to point them out and make a fuss before they became real problems.

They're also known for thinking their always right and not asking the team if the patient got their painkillers is exactly in character for that stereotype.

this happens a lot. my stepfather was in the hospital, a nurse came in and gave him a shot of morphine and walked out. another nurse came in and before my mom could stop her gave him another dose. He coded from the overdose but pulled through.

my sister worked as an admin in some department at a hospital I can't remember. a patient coded and they did nothing because they were marked do not resuscitate but the patient came back on their own. Afterwards, the nurses found the patient was labeled incorrectly.

I've told my wife and mother (mom is an RN) that if any of our family go into the hospital they are not to be left alone.

This is why checklists have become are a huge thing in the medical field.

In your scenario, imagine if the first nurse had it drilled into her that she must tick a box on the patient checklist, which lies very visible next to the patient and is almost impossible to not notice, and you have a physical system that makes it difficult to commit mistakes

That sure would be nice.

I haven't had any problems of this scale, but my doctor can't even schedule a follow-up appointment 3 months in advance.

They can't even use a calendar, much less a checklist.

My pills are prescribed for 3 months and they always manage to hem and haw and almost miss the window as if the passage of time was a recent concept that their practice was unequipped to deal with.

On the other hand, every psychiatrist I've ever had, had no problem getting my anti-psychotics or anti-ADHD medications sent to the pharmacy inside of a day.

A lot of medical software is severely lacking, and general practitioners often operate solo practices where they operate by the doctor's preferences (which might make everyone else's life very difficult, such as the people who have to handle recurring appointments). I've been around some doctors that will do things like ban using the recurring appointments because when they double click the appointment it takes them to the "edit recurring appointment" page, not the "take patient notes page". So yes, their office may be literally unequipped to handle the passage of time because either their EHR system sucks, or the doctor is making everyone else's life hard.

Psychiatrists seem to operate out of groups more often (I see far fewer solo psychiatrists). Groups mean that you have to have EHR software that works well enough to transfer patients between doctors, and you have to have standards set up to where doctors can read patient histories from other doctors. Basically your EHR system needs to be functional, which has nice side effects like making scheduling and prescription refills work correctly.

Everyone in a hospital should have an advocate with them. My girlfried was going through treatment and one day they tried to give her a shot, insisting that she needed it. She is deatly allergic to most things. I pushed back, refusing the treatement. They were looking at the wrong chart.

I've gone to visits with a partner with metastatic breast cancer, my father with colon cancer, and my mother with metastatic lung cancer.

It's incredibly useful to have two sets of ears listening to what the doctors are saying so that you can clarify what they said.

All too often we weren't given anything in writing except what I was doing myself. That's improved quite a bit but it's still amazing to me that people downplay the usefulness of electronic medical records and the printouts that you usually get.

Jesus christ man that is terrifying beyond belief. Glad your dad pulled through, hope he sued them and won.

You should complain to the medical board. If the guy is too lazy to look at the chart, what else isn’t he doing?

I had spinal fusion and due to an unrelated issue ended up on the medical floor instead of the neurologist floor overnight. I had zero pain medication after a significant surgery and couldn’t sleep. The floor nurse and useless hospitalist straight up accused me of attempting to get pills.

The surgeon came to do rounds in the morning and was visibly shocked, and the overnight bozos didn’t do other stuff, because they never read the orders.

The doctor must have been making a bad inference. They must have assumed he had already had been given opiods because he didn't look like he was in that much pain (before the reduction). I wonder if he wasn't guarding his shoulder (because of the spine injury), which would probably make him look like he had already been given painkillers. Dislocated shoulders are incredibly painful if they are in the wrong position. And not particularly painful in the right position.

I can't imagine having a shoulder reduced while having a broken back and ribs (and wrist!). The forces required (and precise positioning) to do it comfortably would be hard if they had a broken back. My shoulder was reduced via the Snowbird method [1], which was not very painful. It requires a ton of force on your spine (and an assistant pulling on you ribs!), so obviously a no-go in this case.

[1] http://www.emdocs.net/wp-content/uploads/2015/01/Shoulder-Re...

I had a tooth extraction without numbing when I was a kid. Dentist didn't believe it hurt because so many kids freak out for everything dentist related.

Since then I've had many injuries, but in terms of acute pain, that was the worst. Only thing that came close was when my appendix burst.

This is an incident that desperately needs an application of the Five Whys.

I've had both morphine via IV and fentanyl via a lollipop. Both were in Afghanistan and as far as pain relief goes the morphine was way better for me, because I got a large dose in my bloodstream. I totally understood at that point why people get addicted to that stuff. I did not care about anything at that point. The fentanyl just did not have a strong effect on me.

Most fentanyl is administered IV as well, the “100x more potent” stuff is mostly misleading because the doses are different but it is substantially more effective than morphine.

My wife does anesthesia and if they’re going to use opioids at all, it’s almost always IV fentanyl. It’s extremely rare that patients report any pain afterwards. Though there’s a big movement toward opioid-free surgery so that’s promising.

As someone who went through a IM nail procedure I couldn’t have done it without opiates. I didn’t get addicted either. It’s a valuable drug that was abused.

> IM nail

https://en.m.wikipedia.org/wiki/Intramedullary_rod

Yeah it’s absolutely indicated for some surgeries but unfortunately it’s “defaulted” for many as well, so people end up going home on prescriptions for it after cases where they didn’t really need it. The movement is to ID which cases don’t call for it and then use alternative anesthesia / analgesia to make the post op care consist of extra strength Motrin instead of opioids. The other part is to dramatically reduce the number of doses that people are sent home with. Small barriers to access have a huge impact on addiction.

> Small barriers to access have a huge impact on addiction.

At the expense of those who legitimately need it. Given how ridiculous the current climate has become, I would almost certainly preemptively purchase black market opiates prior to a procedure if the timing allowed for it. (At this point, I almost feel compelled to keep some on hand for family in general based on past experiences.)

I have a small bit left over from my surgery in my freezer in case of an emergency. It’s been a number of years but I’m planning to keep it around.

I remember when they were pumping my dad with propofol and fentanyl for a hemorrhagic stroke to medically induce a coma and let the brain heal. It was like flipping a light switch knocking him out instantly.

I'm scared of this stuff after seeing what it can do to a full grown adult but totally understand the medical necessity for it as it saves lives.

I had morphine for appendicitis. It didn't appear to do anything for me. :(

You may have needed a higher dose. That sucks though.

Any time I've had any sort of opioid the only thing it did for me is make me feel extremely sick.

Many psychopaths assume a position where they are given trust and they can exercise control over vulnerable people without being questioned. I have seen these people working as pain specialists. They get money from pharma industry and prescribe ineffective pain meds or do it in a way that harms the patient. Some tools in their box are telling patients their pain is only in their heads, that they are nothing wrong, asking patient if they come to get drugs, prescribing opioids where other way are more effective, cutting the doses so people feel withdrawals and so on. The biggest nightmare of these people is medical cannabis as it changes perception of pain and in many cases they lose power over patient.

Ehh. Not the worst thing. People with Ehlers Danlos have to pop visibly dislocated joints back into place daily (and yes, it's very much painful as fuck)

Arguably the most horrifying is when a male dislocates their hip and one of their testicles falls back into that area. You can imagine what happens when somebody attempts or succeeds in shoving the bone back into it's socket when there's a testicle also sitting in the socket. May be more traumatizing for the nurse that shoves it back in once they realize what they've done :D

I'm sure you would agree that it is gross negligence nonetheless.

Reseating a dislocated joint without pain medication, without any other context, is not the horrifying part.

Damn man, please have some compassion for others who may not have as high a pain tolerance threshold as you. Not everybody experiences everything exactly the same.

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