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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 woul

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.

WJW 6y ago
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.
- klyrs 6y ago
  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.
  - akiselev 6y ago
    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").
  - ReactiveJelly 6y ago
    > 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-pseudoaddiction/ 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.
    - deleted 6y ago
      [deleted]
    - watertom 6y ago
      Flinging yourself from a 5 story building in order to “look genuine” get fentanyl must be pretty common in NYC.
      - intricatedetail 6y ago
        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.
        brooklyndude 6y ago
        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.
    - thaumasiotes 6y ago
      > 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.
  - corobo 6y ago
    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?
    - klyrs 6y ago
      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.
      - corobo 6y ago
        Personally I'd be focused there than making sure addicts don't get a bit of free medication.. that's bizarre and quite scary.
- martinmunk 6y ago
  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.
- nickjj 6y ago
  > 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.
  - noir_lord 6y ago
    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.
- trhway 6y ago
  >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.
  - deleted 6y ago
    [deleted]
- sk5t 6y ago
  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.
- refurb 6y ago
  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.
s5300 6y ago
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
- alex_anglin 6y ago
  I'm sure you would agree that it is gross negligence nonetheless.
  - tamaharbor 6y ago
    More people will die from medical mistakes than from Covid this year.
- happytoexplain 6y ago
  Reseating a dislocated joint without pain medication, without any other context, is not the horrifying part.
- freedomben 6y ago
  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.
raldi 6y ago
This is an incident that desperately needs an application of the Five Whys.
mattr47 6y ago
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.
- mikeyouse 6y ago
  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.
  - dkdk8283 6y ago
    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.
    - adwi 6y ago
      > IM nail https://en.m.wikipedia.org/wiki/Intramedullary_rod https://en.m.wikipedia.org/wiki/Intramedullary_rod
    - mikeyouse 6y ago
      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.
aidenn0 6y ago
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.
chasd00 6y ago
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.
- arkitaip 6y ago
  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
  - ReactiveJelly 6y ago
    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.
    - curryst 6y ago
      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.
mncharity 6y ago
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.
- DoingIsLearning 6y ago
  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.
  - mncharity 6y ago
    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.
    - jrochkind1 6y ago
      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.
jedberg 6y ago
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.
- rubenbe 6y ago
  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".
  - jedberg 6y ago
    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. :(
Spooky23 6y ago
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.
strstr 6y ago
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-Reduction-Techniques-Yuan.pdf http://www.emdocs.net/wp-content/uploads/2015/01/Shoulder-Re...
ghufran_syed 6y ago
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-surgery/education/residency/rotations 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]
- xmprt 6y ago
  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.
  - ghufran_syed 6y ago
    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.
intricatedetail 6y ago
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.

WJW 6y ago

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.

klyrs 6y ago
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.
- akiselev 6y ago
  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").
- ReactiveJelly 6y ago
  > 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-pseudoaddiction/ 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.
  - deleted 6y ago
    [deleted]
  - watertom 6y ago
    Flinging yourself from a 5 story building in order to “look genuine” get fentanyl must be pretty common in NYC.
    - intricatedetail 6y ago
      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.
      - brooklyndude 6y ago
        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.
  - thaumasiotes 6y ago
    > 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.
- corobo 6y ago
  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?
  - klyrs 6y ago
    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.
    - corobo 6y ago
      Personally I'd be focused there than making sure addicts don't get a bit of free medication.. that's bizarre and quite scary.
martinmunk 6y ago
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.
nickjj 6y ago
> 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.
- noir_lord 6y ago
  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.
trhway 6y ago
>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.
- deleted 6y ago
  [deleted]
sk5t 6y ago
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.
refurb 6y ago
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.

s5300 6y ago

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

alex_anglin 6y ago
I'm sure you would agree that it is gross negligence nonetheless.
- tamaharbor 6y ago
  More people will die from medical mistakes than from Covid this year.
happytoexplain 6y ago
Reseating a dislocated joint without pain medication, without any other context, is not the horrifying part.
freedomben 6y ago
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.

raldi 6y ago

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

mattr47 6y ago

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.

mikeyouse 6y ago
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.
- dkdk8283 6y ago
  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.
  - adwi 6y ago
    > IM nail https://en.m.wikipedia.org/wiki/Intramedullary_rod https://en.m.wikipedia.org/wiki/Intramedullary_rod
  - mikeyouse 6y ago
    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.

aidenn0 6y ago

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.

chasd00 6y ago

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.

arkitaip 6y ago
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
- ReactiveJelly 6y ago
  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.
  - curryst 6y ago
    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.

mncharity 6y ago

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.

DoingIsLearning 6y ago
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.
- mncharity 6y ago
  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.
  - jrochkind1 6y ago
    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.

jedberg 6y ago

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.

rubenbe 6y ago
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".
- jedberg 6y ago
  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. :(

Spooky23 6y ago

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.

strstr 6y ago

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-Reduction-Techniques-Yuan.pdf http://www.emdocs.net/wp-content/uploads/2015/01/Shoulder-Re...

ghufran_syed 6y ago

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-surgery/education/residency/rotations 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]

xmprt 6y ago
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.
- ghufran_syed 6y ago
  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.

intricatedetail 6y ago

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.