Hating those drug seekers

[theboo]

Hello Doctors, i have a fascination with drug seeker stories. I use to be one. I have been clean for quite a while. Please dont flame me, those days are over. I made appologies to the doctors i wronged. Its part of my treatment and healing. Well.. now to my question. I am doing a paper for my psych class, i want to know what exactly makes you hate ds so much? When i use to seek i was always polite and respected nurses and docs. I never asked for meds by name and if i didnt get any pills to go i didnt throw a tantrum. Have you ever had any ds like tbat? Tia

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[Promethean]

Hello Doctors, i have a fascination with drug seeker stories. I use to be one. I have been clean for quite a while. Please dont flame me, those days are over. I made appologies to the doctors i wronged. Its part of my treatment and healing. Well.. now to my question. I am doing a paper for my psych class, i want to know what exactly makes you hate ds so much? When i use to seek i was always polite and respected nurses and docs. I never asked for meds by name and if i didnt get any pills to go i didnt throw a tantrum. Have you ever had any ds like tbat? Tia

There are a lot of answers to this, I'm sure.

Some people get upset with drug seekers because they see them as taking up resources that people who are "really sick" need. And while you say that you were polite, many people who seek drugs are not. And even the overtly polite drug seekers are still trying to manipulate the health care provider and no one likes to feel as if theyw are being manipulated.

Also, there is moral hazard in cooperating with someone who is pursuing medication for recreational purposes. If the provider just goes along with the requests, not only may they endanger their license, and thus their livelihood and all that they have worked so hard for... they also are contributing to making someone's problem worse than it would have been otherwise. Cooperating with someone's efforts to obtain dangerous and addictive substances that are not indicated for their condition means participating in their behavior. It can be distressing for someone to feel put into that position.

I have tried to have compassion, by appreciating that people who are self-medicating with narcotics, etc., are actually treating something. Even people who appear to have nothing wrong with them and are just chasing a thrill... there is actually something very wrong if someone gets to the point in their life where they feel like that is a great idea. Having that insight allows me to firmly refuse to administer medications which are not indicated, while at the same time respecting the humanity and the other needs of the patient. It doesn't make them any less angry when I say that I will not obtain an order for Dilaudid for their migraine, but that they are welcome to take the Toradol that I have to offer them, but it makes me feel less reflexively angry at them in response.

 

[Angry Birds]

Hello Doctors, i have a fascination with drug seeker stories. I use to be one. I have been clean for quite a while. Please dont flame me, those days are over. I made appologies to the doctors i wronged. Its part of my treatment and healing. Well.. now to my question. I am doing a paper for my psych class, i want to know what exactly makes you hate ds so much? When i use to seek i was always polite and respected nurses and docs. I never asked for meds by name and if i didnt get any pills to go i didnt throw a tantrum. Have you ever had any ds like tbat? Tia

I don't know which is worse: drug-seekers or people who use bright pink font. (Just kidding.)

In all seriousness, why would we not hate drug-seekers? They are engaging in malingering, duplicitous, and fraudulent behavior. Usually, people don't like being lied to and manipulated. We're no different. Plus, we don't want to engage in and/or sustain medically harmful / unhealthy behavior. This is not to speak of the paper work and money/resources wasted.

 

[Vandalia]

"Drug seekers" are basically treated the same way from a medical perspective in that they are not given what they seek, and instead are directed toward treatment for the actual disorder.

However, there is a spectrum of drug seeking and that can result in different levels of empathy or anger as the case creates.

At one end of the spectrum are what I would call the "iatrogenic cases." These are the people who had never used a controlled substance, have a procedure, disease or accident for which these medicines were appropriately prescribed, and then become addicted as a result. These are the people I will spend a bit more time with and perhaps go the extra mile in arranging appropriate treatment as indicated and based on how receptive they are for that treatment.

At the other end of the spectrum are those who seek drugs to later sell. For these I gleefully call the police, and happy to stay after to speak with an officer, and would go to court to testify on my day off.

The vast majority fall somewhere in the middle and generate nothing more than a shrug and a move to the next patient. The additional variable is the level of deceit. Saything they have pain but answering everything else truthfully pushes them more toward the empathy side, while layers of lies, attempts to alter tests, and faked documents move it more toward anger.

With all that said, one of our primary care physicians said a while back that the "antibiotic seekers" were far worse than the "controlled substance seekers." I am beginning to think he might be right.

 

[The White Coat Investor]

I don't hate drug-seekers. I do dislike that they are a bit like back pain patients- major time sucks due to the amount of education required. I know I'm going to be in that room a while. I mean, if a chest pain, abdominal pain, or dyspnea is a level 5 chart, you should get a level 7 for seeing back pain and drug-seekers. You've got to pull their report, print it out, go over it with them, do a really big exam for all their multiple complaints, talk about why what they're doing is dangerous, talk about how they should be managing their pain, reassure them you will treat their pain with non-narcotics and do any appropriate work up and referral etc. It's just really time consuming. It's particularly bad because a vast majority of them also have psychiatric illness and chronic pain. Those three travel together like they were in a band.

 

[goodoldalky]

The main problem I have with drug seekers is that they are taking away critical resources from other sick patients. They are not interested in help. That's not a drug seeker. A person who wants help is a patient who comes in and says I'm hooked on XYZ, I need off, I need help. I don't mind that at all, but it's very rare. Drug seekers are there to deliberately manipulate you into giving them drug of choice. They have no interest in help. They don't want to stop. For the most part you cannot change their mind on this, and most of your breath and time in this regard is wasted. They are time and resource consuming. While they faked condition X and made their ploy for a drug, I was tied up, the nurse was tied up, the room was tied up, the CT scanner, etc... meanwhile that cancer patient 4 rooms over has real pain and can't get the nurse in there to help her, and an old man is having an MI in the waiting room, that hasn't been caught yet, because we are backed up because there is a person seeking IV narcotics tying up the room he would otherwise be in.

TO me, that is the most aggravating part of it. I could care less if you make a scene and rip up my script for acetaminophen or "baby aspirin cut in half" and write a ridiculous complaint letter and give me straight 0's on my press ganey. I've never been hurt by a drug seeker, but I see every day where one of my other patients is hurt, generally indirectly, by them, and that is infuriating.

 

[goodoldalky]

By the way, Tia, congratulations. I would love to know what it was, if anything, that helped you to change.

 

[Apollyon]

By the way, Tia, congratulations. I would love to know what it was, if anything, that helped you to change.

Hey dude, her name isn't "Tia". That is short for "thanks in advance".

Unless her name IS Tia. Then, I'm all wet!

 

[goodoldalky]

Hey dude, her name isn't "Tia". That is short for "thanks in advance".

Unless her name IS Tia. Then, I'm all wet!

Hahahaha... all these newfangled computer talk... in that case, congratulations, Bob, sounds like a Bob

 

[WilcoWorld]

First of all, if a drug seeker actually elicits hate from me, then my game is off. It happens, but when it does it's in my moments of weakness. Compassion is best, ambivalence is OK, but hate/anger only clouds my judgement and worsens the rest of my day. When I'm on my game drug seekers get a thorough history and physical, a reasonable work up (drug seekers get sick too), and a calmly-delivered explanation of why I will not be writing a prescription for narcotics.

The things that make me angry are usually one of two things - one has already been identified by @goodoldalky: 1) Intentionally deceptive drug seekers take resources away from other patients and may actually cause them harm (delayed treatment of heart attack, missed diagnosis because staff is over-extended, etc). 2) I went into medicine to help people, and some drug seekers do everything they can to make me hurt them - in addition to perpetuating their addiction the may force my hand to order radiation exposure, run up large bills, and perform invasive tests.

 

[shoal007]

in addition to all the above posters. what bothers me most is that I am skeptical and cynical in my job. its hard to know who has real pain or is there for a fix. I just end up giving the drug addicts what they want until ive figured their game. Once ive figured them out, the wasted resources and time makes me sick. I try not to make it change how I treat patients who have real pain.

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[Doctor Bob]

congratulations, Bob, sounds like a Bob

Thanks

 

[Birdstrike]

Hello Doctors, i have a fascination with drug seeker stories. I use to be one. I have been clean for quite a while. Please dont flame me, those days are over. I made appologies to the doctors i wronged. Its part of my treatment and healing. Well.. now to my question. I am doing a paper for my psych class, i want to know what exactly makes you hate ds so much? When i use to seek i was always polite and respected nurses and docs. I never asked for meds by name and if i didnt get any pills to go i didnt throw a tantrum. Have you ever had any ds like tbat? Tia

I personally have never "hated drug seekers" as you term it. I just take each patient one at a time. If there's legitimate medical need for a pain medication, opiate or not, I prescribe it. If there's not, then I don't. I don't get emotional about it. I don't argue about it. I do what I think is justified and I don't do what's not. (As a side note, I think "drug seeker" not a good term because it equates someone with a broken leg who might be "seeking drugs" for good reason, with a dealer coming into the ED to score some pills to sell. That being said, it's a term used widely.)

Where I think a lot of doctors go astray, is when a patient tries to suck them into an emotional vortex to get a certain treatment. I don't go there. If they disagree with my assessment, they can get a second opinion. If they agree, that's great. As a physician you have to step back and ask yourself, "If this exact discussion involved someone requesting a blood pressure or cholesterol medication, would there be such a dramatic emotional overlay involved as there is right now involving an opiate?" The answer is almost always, "No." Therefore, don't allow yourself to be sucked into a position where you think you need to convince such a patient to see your argument. That puts them in total control. You're selling advise and treatment, not persuasion.

Some people simply cannot compartmentalize in this fashion and they build up an anger, bitterness and disdain for anyone appearing to need/want/desire/request an opiate. I get that. There are few things that add fuel this fire, particularly in the ED.

1. EMTALA- An outpatient doc has an easier time of saying, "I recommend _________ (insert one or more non-opiate treatment options)" and if the patient disagrees, they can direct them towards a second (or third, or fourth or fifth) opinion and isn't required to necessarily accept any particular patient into their practice. In the ED, however, patients have you by the ****. EMTALA requires the doc by law, to be your doctor, once the doc says, "Hello." The doctor patient relationship is out of balance here, and it favors the patient, BIG TIME. A doctor in an outpatient office can up and walk out of the room if a patient wants to angrily argue about recommended treatment. If the patient refuses to leave, they have no legal right to stay there, loiter or be disruptive. In the ED a patient has the legal right to be there. Even if a doc discharges them, they can check back in once, twice, eighteen times in a row and keep being increasingly difficult. There is no other medical setting where the law empowers a patient so greatly to make a doctor's life hell to an extent bordering on abuse, if a patient wants to.

2. The Corporatization of Emergency Medicine- This allows non-physician administrators to treat doctor patient interactions as consumer interactions under the "customer is always right" principle. This is catastrophic to the physician patient interaction, the hippocratic oath and catastrophic to patient care. Under this mindset, an opiate addict teetering on the edge of overdose needs to be made happy with the one thing that could kill him. The heart patient needs to be made happy with the double cheese burger, large fries and regular coke because, "Patient satisfaction equal profits. Profits equal God."

Patient satisfaction doesn't always equal health or good medicine and often means the opposite. But the suits don't care. They care about profits, period. End of story. The suits never had to take an ethical oath. The suits don't have to lose sleep at night if a doctor dose the wrong thing for a patient to get "scores up."

Bottom line: The corporatization of Emergency Medicine (and all of Medicine) forces doctors to face having to consider violating their ethical oath every day, not to their benefit, not to the patients' benefit, but to the benefit of some guy in a suit who rakes in profits at the doctor and patient's expense, AND most of all doesn't give a **** about any specific patient interaction, unless it causes him trouble (loss of business, complaints lawsuit.) In other words, doctors mostly want to do the right thing, and this makes it very hard at times.

3. The obvious: Many patients forget an emergency department primarily needs to be an Emergency Department. When there are kids run over by cars being brought in, gunshots in the trauma bay, and other life or limb threatening patients waiting, non-verifiable pain syndromes ultimately are viewed with less urgency. Not that pain without an imaging-verifiable source isn't real, it's just that I don't know of any triage protocol that puts it on the level with acute MI or ruptured AAA.

 

[BJJVP]

While I rarely hate drug seekers, I always hate their negative impact on the emergency department's efficiency, the care of critically ill patients, and staff morale. The fact that our system is set up to make doing the right thing virtually impossible only adds to the frustration. There is a subtle, but significant difference between hating the patients, and hating my participation in their care.

A similar situation exists for me with kids. I don't hate kids, but I would hate to be a pediatrician.

 

[GeneralVeers]

Birdstrike,

I disagree that patients can sign in again and again. After seeing the patient once, I've met the EMTALA burden. I usually tell staff to inform the patient I will not be seeing them again, and if they sign in they will be waiting until morning for the next doctor. After being told this, I've never had a patient sign in again.

 

[shookwell]

When an administrator tells you to give medications, tell them to come in and write it themselves with their own DEA number. I agree with generalveers, coming back in again and again doesn't bother me, I will do and document a medical screening exam and then let them sit there and complain all they want.

I once had an administrator come tell me to do an unindicated MRI after a patient complained that their PMD has sent them in for an MRI and I wasn't doing it, I discharged the patient and told him he can order it himself (which he did, and it was negative).

 

[Perrotfish]

When an administrator tells you to give medications, tell them to come in and write it themselves with their own DEA number. I agree with generalveers, coming back in again and again doesn't bother me, I will do and document a medical screening exam and then let them sit there and complain all they want.

I once had an administrator come tell me to do an unindicated MRI after a patient complained that their PMD has sent them in for an MRI and I wasn't doing it, I discharged the patient and told him he can order it himself (which he did, and it was negative).

The force is weak with your admin. A good administrator never tells a physician to order an MRI/medication/whatever. A good administer counsels the physician on Empathy. He talks about tone of voice and listening, and makes it clear that if the patient knew he was being HEARD he wouldn't have even WANTED the MRI. He assigns empathy training. The online component alone takes 4 hours. If the physician brings up the fact that the MRI wasn't indicated he makes it clear that ITS NOT ABOUT THAT and assigns cultural competency training to accompany the empathy training. But most of all he makes it clear that the hospital will NEVER make you do something that's not indicated. You are the physician, and the administration is here to help, not to make medical decisions. Of course if you decide to order the MRI next time, that's your choice.

 

[deleted109597]

I think the above needs an angry facebook emoticon rather than the like, but I've only got one choice. @Lee, are you listening?

 

[Birdstrike]

The force is weak with your admin. A good administrator never tells a physician to order an MRI/medication/whatever. A good administer counsels the physician on Empathy. He talks about tone of voice and listening, and makes it clear that if the patient knew he was being HEARD he wouldn't have even WANTED the MRI. He assigns empathy training. The online component alone takes 4 hours. If the physician brings up the fact that the MRI wasn't indicated he makes it clear that ITS NOT ABOUT THAT and assigns cultural competency training to accompany the empathy training. But most of all he makes it clear that the hospital will NEVER make you do something that's not indicated. You are the physician, and the administration is here to help, not to make medical decisions. Of course if you decide to order the MRI next time, that's your choice.

Punitive physician "empathy training" for not ordering an unneeded MRI?
A future CMO right here.
I guarantee it.

And I don't doubt this nonsense will likely happen at some point, if not already. Lol smh

 

[shookwell]

The force is weak with your admin. A good administrator never tells a physician to order an MRI/medication/whatever. A good administer counsels the physician on Empathy. He talks about tone of voice and listening, and makes it clear that if the patient knew he was being HEARD he wouldn't have even WANTED the MRI. He assigns empathy training. The online component alone takes 4 hours. If the physician brings up the fact that the MRI wasn't indicated he makes it clear that ITS NOT ABOUT THAT and assigns cultural competency training to accompany the empathy training. But most of all he makes it clear that the hospital will NEVER make you do something that's not indicated. You are the physician, and the administration is here to help, not to make medical decisions. Of course if you decide to order the MRI next time, that's your choice.

Fourth administrator/director in as many months at that place. I quit shortly after. The job market is still in our favor, let's hope it stays that way.

 

[VA Hopeful Dr]

Punitive physician "empathy training" for not ordering an unneeded MRI?
A future CMO right here.
I guarantee it.

And I don't doubt this nonsense will likely happen at some point, if not already. Lol smh

Oh it does, but I got it just for not giving antibiotics for colds...

 

[WilcoWorld]

Birdstrike,

I disagree that patients can sign in again and again. After seeing the patient once, I've met the EMTALA burden. I usually tell staff to inform the patient I will not be seeing them again, and if they sign in they will be waiting until morning for the next doctor. After being told this, I've never had a patient sign in again.

Veers for President (of ACEP)

 

[Siggy]

Hello Doctors, i have a fascination with drug seeker stories. I use to be one. I have been clean for quite a while. Please dont flame me, those days are over. I made appologies to the doctors i wronged. Its part of my treatment and healing. Well.. now to my question. I am doing a paper for my psych class, i want to know what exactly makes you hate ds so much? When i use to seek i was always polite and respected nurses and docs. I never asked for meds by name and if i didnt get any pills to go i didnt throw a tantrum. Have you ever had any ds like tbat? Tia

Why? Because drug seekers waste time and resources, cause physicians to think patients are lying about their home meds and level of pain, and represents moral, legal, and civil hazards.

We're tasked with controlling people's pain, but blamed for the opiate epidemic.
We get concerned about giving into addicts, so we under dose medications (I die everytime I see a q3 or q4 hour PRN dilaudid order), and then blame patients because they're "clock watching" when we underdose their meds.
I can't believe patient's when they say they "take Percocet" at home because I've been straight lied to.
Patients complain of chest pain, ABD pain, sickle cell, and other diseases in order to get their fix. This takes time to evaluate them that could be better treating patients with real pathology. Addiction treatment isn't an ED or acute care hospital treatment issue.

...but when we don't get you your Percocet and turkey sandwich as you lie about your sickle cell or crushing chest pain you then complain to admin or give bad customer survey scores... which affects our job security and pay.

Oh, and at some point that "crushing chest pain" you always complain about when you need your fix is going to be real cardiac chest pain.. which if we miss because we've seen you seeking 100 times before with the same story, then it's our fault that you cried wolf 100 times before when there was no wolf.

 

[doctalaughs]

When an administrator tells you to give medications, tell them to come in and write it themselves with their own DEA number. I agree with generalveers, coming back in again and again doesn't bother me, I will do and document a medical screening exam and then let them sit there and complain all they want.

I once had an administrator come tell me to do an unindicated MRI after a patient complained that their PMD has sent them in for an MRI and I wasn't doing it, I discharged the patient and told him he can order it himself (which he did, and it was negative).

Isn't it illegal for an admin to order tests themselves? Technically you could turn them in for billing fraud.


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[shookwell]

Isn't it illegal for an admin to order tests themselves? Technically you could turn them in for billing fraud.

Not if they're a physician and they come see the patient and write a note. Perfectly legal. Just stupid.

 

[Angry Birds]

Without drug seekers we could give (narcotic) drugs to everyone who needs them. Now we are left guessing who really needs them and who's only seeking. Yeah, drug seekers suck.

 

[GeneralVeers]

Without drug seekers we could give (narcotic) drugs to everyone who needs them. Now we are left guessing who really needs them and who's only seeking. Yeah, drug seekers suck.

Agreed. There are only two approaches:

1. Give everyone drugs and be a candyman (and potentially harm people)

2. Spend time and effort trying to sort out who's legit and who's a seeker. Typically it wastes about 5 minutes of my time per patient looking at old records, drug database, and arguing with patient.

 

[Birdstrike]

"DEA orders opioid production cut by 25% in 2017"

http://www.rt.com/document/57f4503bc46188f2278b469b/amp?client=safari

Glass half full: This will decrease available opiates for abuse, reducing harm, reducing drug abuse sequelae in the ED & drug abuse related ED visits.

Grass half empty: Reducing supply will create pharmacy shortages increasing the number of desperate people going to the medication source of last resort, "the ED," and increase street drug use, which will be seen in the ED as an increase in ODs, abscesses, HIV, heroin withdrawal, etc.

 

[Birdstrike]

The sooner you realize this, the better:

If you practice clinical adult medicine, you can never avoid having to see patients who are addicted to opiates, who will try to manipulate you to get opiates. From opium, to heroin, to oxycontin and designer opiates, this has been going on for thousands of years. The pendulum swings from one drug to another, but the problem never goes away. Ever. Ever. Ever.

Whether in EM, ortho, primary care, spine surgery, OB/Gyn, psych, pain or others, patients will present to doctors to try to get opiates. Period. End of story. You can't change it.

What you can change is, 1) When you see them, 2) Where you see them and, 3) How much control you have over your treatment of them.

In EM, it's a perfect storm of the worst of these three worlds. You're seeing them at 3 am on a holiday, in a chaotic EM while also responsible for critical patients, with as little autonomy as a physician can possibly have (setting ruled by EMTALA & hospital administrators). Satan couldn't have designed a better system for burning out a Homo sapiens frontal lobe empathy and optimism centers.

Most other specialties excel at at least 1 of these 3 factors, some 2 or 3 out of three, thus significantly lower rates of burnout despite much greater work hours.

It's not the patients fault. Its not your fault. It's the EDs fault.

 

[WilcoWorld]

"DEA orders opioid production cut by 25% in 2017"

http://www.rt.com/document/57f4503bc46188f2278b469b/amp?client=safari

Glass half full: This will decrease available opiates for abuse, reducing harm, reducing drug abuse sequelae in the ED & drug abuse related ED visits.

Grass half empty: Reducing supply will create pharmacy shortages increasing the number of desperate people going to the medication source of last resort, "the ED," and increase street drug use, which will be seen in the ED as an increase in ODs, abscesses, HIV, heroin withdrawal, etc.

Seems like a pretty blunt instrument for the job. Especially when there's another blunt instrument available.

 

[Apollyon]

Seems like a pretty blunt instrument for the job. Especially when there's another blunt instrument available.

Now you made me literally LOL after a ****ty shift!

 

[WilcoWorld]

Now you made me literally LOL after a ****ty shift!

Thanks man, glad I could help!

In all seriousness, it seems like a poorly conceived solution. It's like fighting antibiotic resistance by limiting penicillin production.

 

[VA Hopeful Dr]

Thanks man, glad I could help!

In all seriousness, it seems like a poorly conceived solution. It's like fighting antibiotic resistance by limiting penicillin production.

Apparently there are some insurance companies that will not pay for office visits if you overuse antibiotics.

Basically if you prescribe antibiotics to treat strep without either a positive rapid test or culture, they don't pay for the visit.

I like that approach.

 

[Birdstrike]

Seems like a pretty blunt instrument for the job. Especially when there's another blunt instrument available.

Good one.

But in all seriousness, my main problem with marijuana for pain (other than the Federal illegality of it) is that in my experience, people that claim to be using MJ for pain, usually want access to it, and opiates also.

 

[Birdstrike]

Thanks man, glad I could help!

In all seriousness, it seems like a poorly conceived solution. It's like fighting antibiotic resistance by limiting penicillin production.

Similar to the futility Choosing Wisely is attempting (by limiting antibiotic distribution, instead of production.)

 

[Birdstrike]

Apparently there are some insurance companies that will not pay for office visits if you overuse antibiotics.

Basically if you prescribe antibiotics to treat strep without either a positive rapid test or culture, they don't pay for the visit.

I like that approach.

From a financial standpoint this is a very stupid solution by the insurance companies. A $4 antibiotic (necessary or not) is much cheaper than a rapid strep test or culture.

 

[WilcoWorld]

Good one.

But in all seriousness, my main problem with marijuana for pain (other than the Federal illegality of it) is that in my experience, people that claim to be using MJ for pain, usually want access to it, and opiates also.

Yeah, I'd raise my eyebrows at that request.

 

[Arcan57]

Good one.

But in all seriousness, my main problem with marijuana for pain (other than the Federal illegality of it) is that in my experience, people that claim to be using MJ for pain, usually want access to it, and opiates also.

Do you have any patients that are playing with the low THC: high cannabidiol (sp?) stuff? The issue with THC would seem that it's feeding into the "escape from crappy reality/decreased functionality" cycle that increases addiction risk with opioids.

 

[Birdstrike]

Do you have any patients that are playing with the low THC: high cannabidiol (sp?) stuff? The issue with THC would seem that it's feeding into the "escape from crappy reality/decreased functionality" cycle that increases addiction risk with opioids.

Not that I know of. The drug screens I use are pretty good, too. LC mass spec, extremely accurate down to the metabolite & micro-quantities (not the worthless point of care dipsticks which are very inaccurate). The fact that I'm in a state where MJ is still illegal (state & federal) makes it easier. I treat it just like the guys who give me my DEA license treat it, as a schedule I, just as you'd treat heroin or cocaine. Use of illicits (even MJ) = absolute contraindication to opiates. Now and forever. (Not my rule, complain to the DEA).

I'm happy to treat will a wide array of non-opiate pain treatment options (injections, nerve ablations, physical therapy, surgery, nsaids, non-benzo muscle relaxers, spinal cord and dorsal root ganglion stimulators, and alternative treatments, chiro, etc). If you refuse them, you are refusing treatment, I'm not refusing you treatment. If you disagree, and feel opiates are a must, there's 10 other board certified Pain MDs within a 30 min drive.

 

[VA Hopeful Dr]

From a financial standpoint this is a very stupid solution by the insurance companies. A $4 antibiotic (necessary or not) is much cheaper than a rapid strep test or culture.

In an ideal world, that would be true. But what about admissions for c. diff, second visits (usually UC or ED which are more expensive compared to PCP visits) for less severe side effects of the antibiotics, yeast infections, and so on?

Heck, a single inpatient stay for c. diff could pay for several hundred strep cultures, several thousand if flagyl doesn't work since PO vanc and the newer drugs are so insanely expensive.

Plus, its in their best interest to fight antibiotic resistance as well since newer drugs are more expensive. Penicillin/amoxil are free at many pharmacies (or worst case $4 like you pointed out). Levaquin still runs more like $30 while your third generation cephalosporins are more like $60-120 depending on which one you use.

 

[deleted109597]

This is the real problem. http://www.esquire.com/news-politics/politics/news/a51673/drug-companies-opiates-west-virginia/
Remember, insurance companies aren't paying for most of these. It's cash. And they're being diverted usually. How else would 9 million pills sold from one pharmacy in a town of 392 happen.