Monday, March 7, 2011

the straight dope

 Although this NP takes chronic pain seriously (like one patient who was a subway attendant and was beat up on the subway landing by thugs, or another who was shot in the back in Vietnam.... and the list goes on) my office will not become the local ghetto candy shop if you know what I mean..... gotta be careful with your "rep" in these parts, because word gets out fast, and before you know it, if you could have a quarter for ever prescription with the prefix "oxy"... let's just say that I would be retiring in style....

But seriously... we have created a system where patients with legitimate pain concerns cannot access the help that they need (PT, OT, accupuncture, chiropractic.... and the list goes on) and therefore, become addicts to pain medication, and need higher and higher doses (and methadone) as their narcotic receptors quickly adjust to levels of opiates strong enough to tranquilize a charging rhino.

The secret to good practice... consistent limits which patients are well aware of... trust me, those with legitimate concerns will follow up on time, and you will soon weed out the "seekers" or "street merchants" from the "legits"....

No Narcotic refills in triage... no exceptions, same story every time.
Most of the NP triage frequent narcotic refill fliers get the picture after one or two or twelve reiterations of this same policy... but some have become extra savvy..... take mr "Smith"

me (in waiting room); Mr "Smith" I notice you are here for a refill, does that refill request contain a narcotic medication
Mr Smith; no, it's for my blood pressure
me; excellent, that is a refill I can consider, come back to the office with me and let's discuss
Mr Smith (now in office); so... I'm out of my oxycontin and my blood pressure is really high because I'm anxious
me; *shakes head, and points at door*... mr Smith, you know our policy hasn't changed, anything else I can do for you today
Mr Smith; *gets up, opens door, escorts self out of clinic.

sigh... well, at least there was no yelling or calling of security this time..... now if I can just find a way for him to make it to his follow-up appointments, that would truly be dope.


  1. Tell him you MAY consider the refill next time at the followup appointment... no promises!

  2. Mr Paper (or is that Turkey?) best not to open that can of worms.. to an addict, "may" = come on by the next time you are out of narcs, or better yet, sold them to a friend. Sad but true. Consistent rules with patients prevent horrible clinic days down the road with lines of narc seekers through the door.

    by the way... kudos on first comment mr Turkey (or is that paper?)