Recent "The Poison Review" article on ED opioid Rx

[TrumpetDoc]

http://www.thepoisonreview.com/2014...id-analgesics-increased-49-from-2005-to-2010/

Ya think!???

But whatbis missing is a good study as to why. Now, scientifically no good study could likely be done. BUT, for the lay public, one could be done.


From a guy who was stingy with the narcs out of training who admittedly increases opioid meds overtime:
I kept ALL of my low Patient sat results that were low. Now, even marginal/middle ground ones screw your rank, but low ones bugged me. So I wanted to see the trends. My former employer (a CMG) published all of our results for us to see. All indiv. actually scanned press ganey copies we could see and review.

An OVERWHELMING theme was lack of "pain meds" prescribed. Or "just a few days" of pain meds.

So, I took a few months to change my practice and just some out the norco.
With no change in bedside pattern (actually would spend LESS time talking with pts), percentile went from below 50 to 90s three mo straight in 2011. Went back to my usual practice and DOWN it went!!
No change in EMPATHY, SIGNPOSTING, APOLOGIZING, etc. If anything I was less informative with them and l know I sown far less time with many.
I Never sat down with pts (mostly due to lack of seat aside from garbage). I was careful not to alter as much as I could.

Am I trying to publish something? Of course not. Will there be day to day changes? Sure. But my prescribing patters can be seen on paper and correlate.

Major point is...I still see WAY too much norco/ocy prescribed from the EDs! I imagine a lot has to do with the general thought that we under treat pain, bla bla bla. But I have no reservation in going for IV narcs I people with pain!! And I have not met a lot of colleges who would.
The problem is the walking wounded and our I obsession with complete alleviation of pain!

INJURIES HURT!!!!
And will hurt for a while!!

But I have been approached regarding my patient sat. scores, and my livelihood threatened (job). So I decided to change "one thing". If not, I was very much ready to move on to another line of work.

So now I have another gig with a dem group. We do well. Our hospital uses their own patient sat score which actually favors us.

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[deleted109597]

There are still a large, very vocal group that argues we aren't doing enough for pain. I agree that on occasion, people don't get enough IV opioids during painful conditions, and yes, we can do better.
Sadly, many hear this as "we don't prescribe enough pain meds to go home with", and that group is both doctors, nurses, patients, administrators, and politicians.
NY has it right by limiting the amounts given, and TX allows us the ability to not prescribe schedule IIs ad lib.

 

[gman33]

I'm sure it is difficult to practice good medicine in an environment where patient satisfacation impacts your career and pay.
It's easy for me as a resident to say, I'm not giving this guy a perc rx.
don't know what I'll do once I'm out in practice.

 

[sacrament]

There are a large number of patients out there who, in order to "satisfy", would need to be administered inappropriate medical care. In my field, that means patients with objectively non-cardiac chest pain who demand multiple cardiac caths and/or stress tests, and are "unsatisfied" if these inappropriate and potentially harmful avenues are denied. "Patient satisfaction" is a deeply, inescapable flawed metric in any number of ways.