For his third rule, he writes: "Never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine. I've seen people in 10/10 pain and you sitting there playing Tetris on your cell phone are not 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm. Even when I passed a kidney stone, the worst pain I had was probably a 7. And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8."
On the other side of the coin, a person can easily access the Internet to find suggestions on how to get their hands on pain pills at the ER.
Opiophile.org is a website that offers discussion forums for people who use opiates, and for those who are researching or have questions regarding opiates. In 2007, a member under the name, limitless_euphoria, posted suggestions on how to convince ER doctors of pain:
"I think it's ONLY when I started making it known that I've had a whole history of problems for a while and this and that—right there I'm setting off the "drug seeker" alarm. If I play like I'm just a first timer dumb-dumb (which is easy to do at a location I haven't burned) perhaps I'll fair better… LE should at least walk away with 10-15 percs or maybe 10-20 vics. If God is really smiling down upon me maybe even a morphine or a dilly shot (doubtful nowadays: the only thing they gave me dilly for was the appendix—and I still can't get that sh** out of my mind)."
Many ER doctors say they don't have time to debunk whether a patient is telling the truth, and most want err on the side of compassionate care anyway. Others say it is past the point of their job description. So, in a high-impact, high-stress environment, what systems can be implemented to avoid feeding into this growing problem?
"I think a cooperative database that is more comprehensive across states would be helpful as long as it is updated regularly," said Dr. Abhi Mehrotra, assistant medical director at the University of North Carolina Department of Emergency Medicine. "We need coordination on the federal level."
And some hospitals have already put such databases into place. In fact, 38 states have prescription drug monitoring programs. Many more are due to come into play soon.
At Baylor College of Medicine in Houston, Texas, an Electronic Medical Records system is in place that connects more than 20 clinics and two large hospitals in the Harris County Hospital District. Dr. Bobby Kapur, associate chief of Academic Affairs at Baylor College of Medicine, said that physicians are able to keep track of patients' visits and medications in the region.
But the system, like many others that have been set up in large, prestigious hospitals in the United States, has limitations since it does not span across regional or state lines.
"If the patient had visited an [emergency department] in a hospital outside of our system, then we would not have access to that particular patient visit," said Kapur.