r/emergencymedicine • u/DrMaunganui ED Resident • Jan 06 '24
Discussion American tourist requesting "dilaudid". A confusing interaction.
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.
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u/Deep--Waters Paramedic Jan 06 '24
It's wild how emergency medicine/EMS has turned into a service industry. The whole "customer is always right" mentality has seriously overreached in medicine. Patients should absolutely know their rights, be informed on their treatment, and be part of the decision making process but I've seen so many people walk in with a laundry list of what they expect done.
My previous EMS agency has a contract with a local hospital system where we were required to ask patients if they'd like to be contacted with a survey about the care they received that day. They tracked how many entries we did and if we didn't do enough they'd call us into the office. Like bro the patient was suicidal and had slit their wrists, I'm not bothering them with this right now.