The interview before transferring to a new doctor

Today I met a man who wanted to interview me before transferring his records.

He was about my age and seemed polite and pleasant enough. He told me his doctor of a dozen years had started to taper him off his long-term narcotics after he reported some of them missing because of theft. He used to take the equivalent of about 1,200 mg of morphine per day for his back pain. Our office classifies anything over 120 mg of morphine as a high-risk dose.

He left that practice and transferred his care to a hospital run clinic across his hometown. His next doctor at first prescribed him the medications, and then quickly begun tapering him off them. The story was a little vague as to exactly why.

He then landed in the hospital for something unrelated, and the report from that admission was available on our state’s medical information sharing website. He told the hospitalist that he was on the high dose that actually two doctors had already tapered him off. The hospital doctor called his new primary care doctor to clarify things and was told the patient had failed a urine drug test because it contained a painkiller he was supposed to have run out of months before. He told me he wasn’t trying to deceive the hospital; he just thought they wanted to know what he used to be on before things changed. He also told me he had kept a few of the discontinued pills on hand, and had used them when his main medicine was being tapered.

The man said he had been off his narcotic painkillers for a few weeks now. He drove himself the 25 miles to our clinic, and he walked the long way from the parking lot to my corner office. He sat in a relaxed position in the office chair across from me, but he told me that he had suffered a big loss of quality of life when he lost access to his narcotic prescription.

After he was done telling me about what it felt like to be tapered off his pain medications, and as a by-the-way, he also told me he needed to get back on the amphetamine he had been on for his attention deficit disorder.

I listened carefully and told him with my most gravelly and serious voice that I didn’t think any doctor would prescribe the kinds of doses he used to be on, and that he did seem to function without them — at least to a degree. I told him that his best bet was probably to talk with the doctor he had known for twelve years. I told him that particular practice has a committee that reviews the care of their difficult pain patients, and he could ask for their involvement. I offered to take care of his other medical needs if he wanted me to, but that there was not enough trust between us for me to just give him narcotics again because of the history he provided me with.

He thanked me politely, rose from his chair, offered a firm goodbye handshake and walked slowly down the hall back to the reception area.

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

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