A common occurrence, and harder to detect:
Make no mistake: we certainly see drug seekers in the office. Many of them are charming and have extremely legitimate-sounding stories. Over the years, though, I’ve discovered something in my own thought processes that flags them unerringly: in the course of the history and exam, in which the long-suffering patient is telling a tale of such woe, such suffering, such angst, the thought occurs to me, Could this patient just be out for drugs? and I say to myself, How could you even THINK that about this nice person! That second thought is the key. More often than not, yes: that nice person is looking for drugs.
Related posts:
- Has drug seeking behavior reached the tipping point?
- Glenn Beck and the drug-seeking patient
- The skill of drug seeking
- Is fibromyalgia real, and if so, are drug companies profiting from the uncertainty of the disease?
- Drug seeking in the ER
- Drug seeking, without finesse
- Drug seeking and the community
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{ 8 comments }
way to find more excuses not to treat people in pain. why is it that doctors don’t give a rat’s ass about anyone’s quality of life but their own?
You’re right. We always look for ways not to treat people. Anyone who would ask for pain meds must need them.
Funny how they never seem to need crutches when you run into them at the mall, though.
I seem to remember a doctor who tried her best to treat people’s pain. Oh yeah, she was charged with murder.
It’s just so damn complex. Your spineless doc who doesn’t want to treat pain is another person’s candyman, is the DEA’s suspect. You have a patient who presents with mild non-specific pain, ask ten people how to proceed and the answer would vary from person to person. Some would prescribe, some would refuse, some would “street” them, some would arrest those who treated, some might just euthanize. This is the inherent problem with governing a subjective treatment with black/white laws. It won’t work.
I personally think that this doctor’s way of handling drug seekers is reasonable. I used to shadow a doctor who made his pain med patients tak edrug tests to prove they were taking it at the right dosages and not selling, he also had them sign agreements to fill at one pharmacy. If they broke the agreement he stopped prescribing.
I usually have a half dozen chronic pain patients most of whom no-one else will touch. All of them sign a contract: one name, one doctor prescribing, one pharmacy, a regular monthly visit, accept referrals to a specialist or pain center if I recommend it, drug test several times a year. Anyone who wants a reocurring narcotic prescription signs one. I have one who is very tolerant of oxycodone but has multiple medical problems and is a borderline personality as well. I have discussed her case with the state med board legal rep as well as all of the pain clinics in the eastern part of the state and no-one else has any better ideas. I tell every one of them that I am not about to compromise my license over them and if they cross the line they are out. I have to dismiss about one or two a year. The first job in dealing with someone who needs a narcotic pain med is finding out what causes the pain. Then the best way to treat the pain. Yes, I get fooled occasionally, but this is a small community and it is pretty rare.
I guess the first poster thinks that I shouldn’t worry about my quality of life in the federal pen?
Before prescribing pain medication be sure to get your local District Attorney, as well as the DEA to sign off on it. It’s amazing how much medical knowledge these attorneys have!
Why could you be prosecuted for prescribing someone a few ultrams, when you have diagnostic tests results to prove the claim of chronic pain?
WHICH tests might those be?
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