Sometimes, just use some common-sense:
“I’ve had new patients come in and tell me during the first visit that W, X and Y medications don’t work for them, but Z does,” said Dr. Charles Cloutier, a Prattville family practitioner. “When patients take that approach, it’s a huge tip-off.”Cloutier said he doesn’t call in prescriptions for controlled drugs after hours or on weekends, and he is cautious when he catches weekend calls for four other doctors.
“If you need pain medicine, you know how many doses you have,” he said. “If you are going to run out over the weekend, a legitimate patient will call their doctor during regular hours to get it taken care of.”
Related posts:
- Pain management and addiction
- Chronic pain and drug pushing
- "The Consulter"
- The games drug seekers play
- "Just go to the ER"
- On-call hospital tips
- Treating chronic pain with narcotics and avoiding the risk of addiction
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{ 3 comments }
Agree. I have concluded that patients who call asking for refills of narcotic pain medications after hours are diverting until proven otherwise. It is such an easy dodge when patients know a cross-covering doctor (or even a personal physician) hasn’t got the record on-hand to check when the last prescription was written and why. I have become cynical about this solely out of first-hand experience, and I usually don’t write for many scheduled drugs in the first place.
I always have my curiousity piqued when I see oxy-contin or other powerful oral narcotics on a patient’s meds list. That is a red flag.
Hopefully EMRs will allow better husbandry of controlled-substance prescribing. Right now, after-hours records access creats a too-easily exploited
opportunity for deception, diversion and abuse.
I was in a practice where this type of drug seekng behavior was par for the course. At 5 P.M. of each on-call day the answering service would page with a message that Mr/Ms X needed a prescription for pain medication. You could set your watch by it.
It was always the same story: “I’m a patient of Dr. Jones (never the guy who was actually on-call), and I need Vicodin. He told me that WHENEVER I had a sinus headache I could just call and have a prescription phoned in. I’m allergic to codeine and darvon. Here’s the pharmacy number….”
It took me a few week to catch on. I finally got to the point where I would play “Name that Tune” with these jokers, waiting for just enough BS before telling them to get lost, and hanging up on them. Unfortunately it didn’t stop the endless stream of 5 P.M. calls (not to mention the ones at other odd hours of the day or night).
Hiding the Rx pads removes spontaneous temptation, but with cheap scanning and home forms-making software, those precautions are easily defeated. States that require duplicate or triplicate copies of controlled-substance prescription slips have some advantage, but that may soon be bypassed by EMR technology that eliminates paper charting. I keep paper records, and every prescription written is photocopied for our records. It isn’t a perfect system, but it does allow for a reference beyond my encounter form notes.
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