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Liar, Liar!
Apparently you lie to us, your health care providers. This comes as a complete SHOCK and SURPRISE to me.
I once worked with a patient with whom I had a pain management agreement. He had chronic pain from an injury and I was prescribing twice-daily, long-acting narcotics for him. A pain agreement basically says that the individual will only go to one office location for their narcotic prescriptions, that they agree to submit to random urine testing at the discretion of the health care provider, and that they will call the office if there is ever any need for increased medication use.
If they have a prescription written in an emergency department (ED) they must notify the provider on the next business day if the prescription is filled; they always have the option of increasing the medications that they have and calling in notification on the next business day. If they need assistance to know how to utilize the medications they have on hand, they can call the office or the doctor on call and ask.
So Mr. X and I had a pain agreement and it seemed to be working out well. He kept his appointments with me, rarely escalated his medications, and didn't balk at random urine tests, which always indicated that he was taking the medications that were being prescribed. This is important because sometimes patients are selling their prescription medications on the street it seems that that their pain becomes a non-issue when they're rolling in cash.
One day I got a call from a pharmacy tech who was concerned because Mr. X was in her pharmacy with a prescription from an ED about 40 miles away, and he was generously offering to pay cash for the medication. Note to people who abuse prescriptions: paying cash is a red flag to pharmacy personnel. So I thanked the tech for calling and asked her to not fill the prescription, but to ask the patient to call my office for an appointment.
The next day he appeared before me, telling me that he'd been visiting his sister in the northern part of our fair state, when he slipped and fell on ice. This happened, I should know, when he was hurrying out of her house behind the paramedics who were taking her to the hospital, where she now lay dying. He was taken to the ED with her. Note to people who abuse my prescriptions, keep it simple. The more elaborate the story, the more suspicious I get. And two injured people are never transported together in the same ambulance, except possibly under an extreme circumstance, like mass casualty. If you're going to try to lie to me, Keep it Simple Simon (KISS).
During his appointment Mr. X and I had a reminder conversation about his pain management agreement and what he was supposed to do with a new prescription. It was now two days since the fall, and since the day of his pharmacy visit had been a business day, Mr. X was reminded that he should have called my office before going to the pharmacy; he would have been given an appointment to be seen and examined on that same day. In case you're losing track, seeing me the day before would have been nearly 24 hours after the fall. I make this point because he didn't race right out to get his prescription filled on the day of the accident, but he said it was because he chose to suffer while he sat at his dying sister's bedside over night. (Can you say KISS?)
After examining him and finding evidence of a fall, Mr. X was given prescriptions for anti-inflammatory medications and muscle relaxants, as well as a few short-acting narcotics to use for break-through pain. He also got a referral to physical therapy. He left, appearing satisfied with our interaction. Little did he know though, I wasn't done with Mr. X (cue foreshadowing music).
In the state where I practice a health care provider can request a report from the Board of Pharmacy regarding an individual person for whom they provide services. This report will list all of the narcotic prescriptions that an individual has filled over the previous year, where they were filled, and who wrote the prescription. The report is sent via web-secured report or by regular postal mail. When Mr. X and I saw one another next, I was ready for him. I would almost swear that my office colleagues were trying to eavesdrop at the door of the exam room, except I know them better. The conversation went something like this:
"Hi Mr. X, how's your back since I saw you last? Are you going to PT?"
Mr. X says, "oh I'm feeling much better."
"Well that's really great. I really like physical therapy to move an injury like that along. You haven't had any other problems since I saw you last have you?"
Mr. X says, "no, no problems."
"Well Mr. X, that's really great, so then I'm wondering why you had another visit to the ED at (hospital where his sister last lay dying)? How's she doing by the way, is she still there in the hospital?"
Mr. X says, "No, she got better!" (Gets puzzled look on his face).
Me, smiling happily, "that's great huh? Because last I knew you were afraid she was going to pass on. So it's really terrific that she's doing better. So how come you went to the ED?"
Mr. X, keeping up the puzzled look for a minute, says "I don't think I recall going to the ED since I saw you last. Just that time we already talked about."
Moving in for the kill, I pick up my several page report from the Board and put it in front of him. On it I had made a line with a yellow highlighter that demarcated the month in which we signed the pain agreement. He looked at the page, and asked, "What's that?"
I explained the report to him, including pointing out all of the prescriptions that he had obtained from other providers since signing the agreement. Little beads of sweat were beginning to form on Mr. X's upper lip, and the smoke was circling his head. He was thinking hard about how he was going to explain this one.
I let him sweat for a minute. Then I said, "Mr. X, I know that you have legitimate pain. I agree with you that you need narcotics or some other treatment to control that pain. But you did not follow the rules of our agreement, and I have a professional license to protect. So I am not going to prescribe any more narcotics for you. I will give you non-narcotic medications for pain, and I will be happy to assist you to manage your other health concerns. When you go to the front to check out today they will give you the referral list for the pain management specialists that we work with. You may call them and make an appointment with one of those physicians and let my office know when that appointment is going to be. We will send a letter of referral for you, but you should know that the doctor will know why I have stopped prescribing narcotics for you. I would strongly suggest that you not repeat this performance with him."
I walked out of the exam room. Sweating. This was the WORST thing I have ever had to do, and unfortunately it wasn't the last time that I've had to do it. But I'm getting better at it (read: I don't sweat as much). Don't LIE to ME.
Related Topics:
Technorati Tags: medical practice, medicine, pain management
I once worked with a patient with whom I had a pain management agreement. He had chronic pain from an injury and I was prescribing twice-daily, long-acting narcotics for him. A pain agreement basically says that the individual will only go to one office location for their narcotic prescriptions, that they agree to submit to random urine testing at the discretion of the health care provider, and that they will call the office if there is ever any need for increased medication use.
If they have a prescription written in an emergency department (ED) they must notify the provider on the next business day if the prescription is filled; they always have the option of increasing the medications that they have and calling in notification on the next business day. If they need assistance to know how to utilize the medications they have on hand, they can call the office or the doctor on call and ask.
So Mr. X and I had a pain agreement and it seemed to be working out well. He kept his appointments with me, rarely escalated his medications, and didn't balk at random urine tests, which always indicated that he was taking the medications that were being prescribed. This is important because sometimes patients are selling their prescription medications on the street it seems that that their pain becomes a non-issue when they're rolling in cash.
One day I got a call from a pharmacy tech who was concerned because Mr. X was in her pharmacy with a prescription from an ED about 40 miles away, and he was generously offering to pay cash for the medication. Note to people who abuse prescriptions: paying cash is a red flag to pharmacy personnel. So I thanked the tech for calling and asked her to not fill the prescription, but to ask the patient to call my office for an appointment.The next day he appeared before me, telling me that he'd been visiting his sister in the northern part of our fair state, when he slipped and fell on ice. This happened, I should know, when he was hurrying out of her house behind the paramedics who were taking her to the hospital, where she now lay dying. He was taken to the ED with her. Note to people who abuse my prescriptions, keep it simple. The more elaborate the story, the more suspicious I get. And two injured people are never transported together in the same ambulance, except possibly under an extreme circumstance, like mass casualty. If you're going to try to lie to me, Keep it Simple Simon (KISS).
During his appointment Mr. X and I had a reminder conversation about his pain management agreement and what he was supposed to do with a new prescription. It was now two days since the fall, and since the day of his pharmacy visit had been a business day, Mr. X was reminded that he should have called my office before going to the pharmacy; he would have been given an appointment to be seen and examined on that same day. In case you're losing track, seeing me the day before would have been nearly 24 hours after the fall. I make this point because he didn't race right out to get his prescription filled on the day of the accident, but he said it was because he chose to suffer while he sat at his dying sister's bedside over night. (Can you say KISS?)
After examining him and finding evidence of a fall, Mr. X was given prescriptions for anti-inflammatory medications and muscle relaxants, as well as a few short-acting narcotics to use for break-through pain. He also got a referral to physical therapy. He left, appearing satisfied with our interaction. Little did he know though, I wasn't done with Mr. X (cue foreshadowing music).
In the state where I practice a health care provider can request a report from the Board of Pharmacy regarding an individual person for whom they provide services. This report will list all of the narcotic prescriptions that an individual has filled over the previous year, where they were filled, and who wrote the prescription. The report is sent via web-secured report or by regular postal mail. When Mr. X and I saw one another next, I was ready for him. I would almost swear that my office colleagues were trying to eavesdrop at the door of the exam room, except I know them better. The conversation went something like this:
"Hi Mr. X, how's your back since I saw you last? Are you going to PT?"
Mr. X says, "oh I'm feeling much better."
"Well that's really great. I really like physical therapy to move an injury like that along. You haven't had any other problems since I saw you last have you?"
Mr. X says, "no, no problems."
"Well Mr. X, that's really great, so then I'm wondering why you had another visit to the ED at (hospital where his sister last lay dying)? How's she doing by the way, is she still there in the hospital?"
Mr. X says, "No, she got better!" (Gets puzzled look on his face).
Me, smiling happily, "that's great huh? Because last I knew you were afraid she was going to pass on. So it's really terrific that she's doing better. So how come you went to the ED?"
Mr. X, keeping up the puzzled look for a minute, says "I don't think I recall going to the ED since I saw you last. Just that time we already talked about."
Moving in for the kill, I pick up my several page report from the Board and put it in front of him. On it I had made a line with a yellow highlighter that demarcated the month in which we signed the pain agreement. He looked at the page, and asked, "What's that?"
I explained the report to him, including pointing out all of the prescriptions that he had obtained from other providers since signing the agreement. Little beads of sweat were beginning to form on Mr. X's upper lip, and the smoke was circling his head. He was thinking hard about how he was going to explain this one.
I let him sweat for a minute. Then I said, "Mr. X, I know that you have legitimate pain. I agree with you that you need narcotics or some other treatment to control that pain. But you did not follow the rules of our agreement, and I have a professional license to protect. So I am not going to prescribe any more narcotics for you. I will give you non-narcotic medications for pain, and I will be happy to assist you to manage your other health concerns. When you go to the front to check out today they will give you the referral list for the pain management specialists that we work with. You may call them and make an appointment with one of those physicians and let my office know when that appointment is going to be. We will send a letter of referral for you, but you should know that the doctor will know why I have stopped prescribing narcotics for you. I would strongly suggest that you not repeat this performance with him."
I walked out of the exam room. Sweating. This was the WORST thing I have ever had to do, and unfortunately it wasn't the last time that I've had to do it. But I'm getting better at it (read: I don't sweat as much). Don't LIE to ME.
Related Topics:
Technorati Tags: medical practice, medicine, pain management
Labels: chronic pain, narcotic prescriptions, pain management agreement
