The husband and wife team

[Yo GabbaPentin]

How many husband/wife "teams" do you all have in your practices? They ALWAYS seem to want the same meds and in my experience, are always difficult. Difficult to treat and especially difficult to catch if you suspect they are up no good. Do any of you try to limit these "teams?"

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[deleted185747]

They cannot be on the same meds. Uds must be different

 

[clubdeac]

Yeah I had a mother/dtr team like this once and it was highly suspect. Made them take different meds and when I requested a UDS from the mother, they never came back. Totally shady

 

[101N]

Often times they reinforce the bad behavior in the other: like mother-daughter FMS teams.

Insist on seeing them separately.

 

[Yo GabbaPentin]

Good... I'm happy to know that I'm not just being a dick.

 

[lobelsteve]

I have 4 husband/wife teams. Codependent and proud of it. Never have I had any issues with UDS, PDMP, or procedures. Worst is when one has a procedure that works, the other one wants it (you have to have a broken back to get cement put in it).

 

[pmrrmp]

Had one mother/daughter team that was challenging. Insisted on separate visits but they would book back to back time slots and just talk over each other. Finally just forced one to in the waiting room while the other was being seen.

No rampant drug seeking behavior in these two but neither made much progress. When one had a "flare-up" so would the other. Sad, the daughter is <18yo and the mother just feeds into her pain psyche. Every little pain becomes magnified, needs to be evaluated by a "doctor."

 

[kazuma]

Good topic, we ran across a husband/wife couple this week.

My attending recommends:
Different meds
Random UDS
Separate appointments preferably back to back so you can keep their stories straight without them comparing notes in between.
Reintegrate that absolutely no med swapping will be tolerated.


He made a point that people can easily make a residents salary or more by selling their meds so if UDS with quantitative analysis is available then utilize it. Otherwise they can take a few pills right before their appt and be "positive."

 

[jesspt]

Had one mother/daughter team that was challenging. Insisted on separate visits but they would book back to back time slots and just talk over each other. Finally just forced one to in the waiting room while the other was being seen.

No rampant drug seeking behavior in these two but neither made much progress. When one had a "flare-up" so would the other. Sad, the daughter is <18yo and the mother just feeds into her pain psyche. Every little pain becomes magnified, needs to be evaluated by a "doctor."

Parent Pain and Catastrophizing are Associated With Pain, Somatic Symptoms, and Pain-related Disability Among Early Adolescents

http://jpepsy.oxfordjournals.org/content/early/2013/12/24/jpepsy.jst094.abstract

 

[Ligament]

I've got husband/wife teams, wife/wife teams, mom/dad/three daughter teams, gradma/mom/grandaughter teams...

None on opioids, from me at least.

If they were on Sched II drugs, they'd have to be different and present differently on UDS.