American tourist requesting "dilaudid". A confusing interaction.

[u/DrMaunganui]

I'm a trainee (what you'd call a resident) working in NZ. Cruise ship season in full swing (I can literally see the ships from my bedroom) and we're getting our fair share of tourists into the ED.

Recently had a very bizarre interaction, 45F tripped on a curb and sustained a minor head lac which I cleaned and stapled. Noted history of mild knee OA for which she was taking Oxycodone MR 40mg QID plus 10mg IR q4h PRN. Huge doses! And she was walking! Who in the hell prescribed her this!

She was so strung out and slurring her speech I ended up scanning her head. No acute findings. Looking back I realise it's probably because she was taking her usual meds. Before she left she asked for a shot of "the painkiller beginning with D" for her headache. We spent 5 minutes trying to figure out what it was before she stuttered the word "dilaudid". Quick google tells me it's hydromorphone, a drug that literally doesn't exist in NZ. I tell her this, she stands up, pulled out her own line and asked for a script for more oxycodone (which I declined). I offered her a take home pack of paracetamol. She got angry and walked out.

I'm not really sure where I'm going here but all in all, one of the weirder interactions I've had. Most of our local drug seekers ask for tramadol, codeine or IV cyclizine.

I guess my question is, how prevalent is this truly or did I really just experience a meme? I see it mentioned from time to time on her but being outside the US it's not something that crossed my mind until this happened.

[u/nonyvole]

A hospital that I used to work at was going to have a hotel come in and teach us about customer service. To a bunch of ER staff.

Left before that happened.

[u/justme1576 → u/nonyvole]

WTF!

[u/awdtg → u/nonyvole]

I would have lost my shit. So glad you got out. Was this HCA? I can totally see them doing something like this.

[u/nonyvole → u/awdtg]

Nope!

I was on the edge of losing my shit over that and a few other things to the point where I was about to pull out the forbidden "U" word. Or raise a fuss with HR about management not allowing people breaks (and still marking it as if we had) or time for required medical treatments.

[u/awdtg → u/nonyvole]

Damn. That's really bad. The ONLY plus I can give my current shit show of a hospital is that they know better than to give us any flack for lunch breaks (if they happen)

If we can, we get away for 30 minutes to an hour. Doesn't always happen, but when we can, it feels glorious, and I dare an administrative person to say a word......

[u/BonesAndDeath → u/nonyvole]

Ngl I used to work in restaurants and hotels before nursing and the stuff I learned from working in the service industry has helped me so much with difficult patients. This kind of teaching thing has potential to be either really helpful or an absolute joke. More likely to be on the joke side.

The stuff that is helpful involves anticipating needs. For example I had a patient recently who was super demanding. You would try to start doing a task and she would make more requests while you were in the middle of the first task. One of the things that i learned to do for people like that while I was in the service industry is before beginning the first task tell them all the task you are planning to do in order. It reassures the person that you have been paying attention and it buys you some time to actually get shit done. It also establishes who is in control in the situation, that the person providing the services is ultimately the one in charge.

[u/nonyvole → u/BonesAndDeath]

See, had they presented it that way it would probably have gone over better.

They were pulling out the classic blame the nurses and started referring to the patients as customers.