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Worst. patient. ever.

Discussion in 'Pain Medicine' started by ghost dog, 11.29.11.

  1. ghost dog

    ghost dog

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    Just had a doozy.

    This joker was the rudest patient I have ever had in my career....

    I saw him 4 times. At every visit: rude to myself, my admin, my RN, AND the pharmacist downstairs. He actually tried to intimidate her.

    After I told him that I would not accept this sort of behavior, he had the nerve to get up in my grill about it - and stormed out.

    And of course - aggressively demanding percocet (multiple times). Inappropriately doubled his newly scripted Fentanyl patch (courtesy of his family MD).

    What an asshat :mad:
  2. 101N

    101N

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    At least it occurred at the end of the day. When I get one like this 1st thing in the am it can ruin my day. My wife hears about it at night.
  3. knoxdoc

    knoxdoc New Member

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    I had a patient get right into my face about 3 years ago. When I told him to get out of my office he got right up in my grill, staring me down like Tyson before a prize fight, and gave me the old "you got a problem?" All this because I wouldn't prescribe .... you guessed it, Percocet.
    Last edited: 11.29.11
  4. ghost dog

    ghost dog

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    My pt wasn't that bad ; although when he Ieft the exam room, I was wondering if he might shove me / try to hit me from behind.

    On second thought ... maybe he was almost as bad!
  5. W222

    W222 2K Member

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    Are we allowed to or, better put, is it prudent to "carry" for protection from patients. I always fear someone will be waiting when I leave the hospital.
  6. clubdeac

    clubdeac

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    In fellowship I had a patient come in with his wife. He had just switched to the VA bc he lost his insurance and was due for his fentanyl fill. Last patient of the day and he was on day #3 of his LAST patch, of course. I agreed to fill and asked for a random UDS. Comes back positive for coke (the one drug you can't really get false positives with). Anyway, I bring him back a week later to discuss and collect his patches. When confronted he literally has a meltdown and throws his water bottled towards me, across the room hitting the wall behind me. He then proceeds to drop the f bomb innumerable times before storming out. Now that was a dousy :cool:
  7. ghost dog

    ghost dog

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    I'm not sure on the legality on the protection angle, but you read my mind !!

    I certainly took my time dictating that night , that's for sure. Checked to make sure the door on the office was locked too; he was a big fella - about 230 - 240 lbs.

    The pharmacist ( the one who was threatened ) made a good point: how much pain can this guy actually be in, if he can make the building shake when pounding down the stairs? He certainly made a swift ( final exit) !

    On the opposite end of the spectrum, I just discharged a high risk young(ish) pt who was on narcs for his low back pain. Opioid induced hyperalgesia, and his back pain dropped quite dramatically once I tapered him off . He actually thanked me for doing so; don't have that happen very often. He's going back to work in the new year. His PHQ-9 score dropped from
    20 points all the way down to 3.
    Last edited: 11.29.11
  8. Jcm800

    Jcm800

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    not nearly as bad, but yesterday had a guy who wanted to stand at the counter at the check in window and fill out paper work, new patient. Referred from one of my best PCPs. Usually no douches from this guy. We tell him he cannot stand there due to privacy issues. ask him to sit down with the clipboard. he rfuses and says he can't because his neck is fused he can't sit and look down. We tell him he can stand in the waiting area with the clipboard, he says he cannot becasue he cant support it with his bad arm. Says if he cant stand in front of the window, he wont fill it out. We offer to give him the paper work and let him re-schedule so he can fill out in his own comfy convenient environment and come back. Throws the clipboard at the window, not hard, and starts yelling and leaves. Knocks out a ceiling tile on his way...
    what a dick!


  9. SpineBound

    SpineBound Large Member

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    Do the pill mill guys ever have problems like this? You would think they would have less behavior problems because everyone who walks in knows you bring $50, see the doctor and get your script. Feel free to post guys, especially if you are one of the guys in Florida's 'Oxycontin Express'. Someday when I have my own practice I will have bullet proof glass which separates staff from patients. There will be a little hole for passing papers at check in and a little hole for the examiner to do an exam and stick needles. (And a little hole for pepper spray if a crazy patient captures someone's hand) It would be like a bank in a bad part of town :) I'm kidding of course...
  10. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    I have my own "Zero Tolerence" policy for these pts. I discharge at the first sign. The guy in the OP likely would not have made it to a second visit, certainly not a third.

    We just had a guy sexually harrassing our staff. We gave him warning in writing and verbally that this would not be tolerated. Any further similar behavior would result in automatic DC.

    I sometimes get in trouble with admin here for my quick pt firing trigger. I don't care. Fire me if you'd rather me have to deal with @$$holes like that.
  11. sblau001

    sblau001 yoyo1

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    Had a chronic pain patient come in drunk once for his med refills while I was in residency. He yelled and lifted his fist to punch me when I politely refused to renew his meds. Luckily my attending at the time heard the threats and came running into the room to stop him.

    I know a few docs down here who pack heat. They usually keep their gun somewhere in the office and not directly on their body while seeing patients. (Don't know how that would help though if a patient pulls a piece on them right then and there.)
  12. emd123

    emd123

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    You discharged him, I hope? Yes?
  13. emd123

    emd123

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    WTF? If a patient puts a gun to your head and demands an Rx, can you be faulted for writing a script and immediately calling the police when he leaves? I'm all for self defense within the bounds of state laws, and I would never contribute to diversion, but doesn't this seem like a better option than taking a bullet over a script or taking your chances in a gunfight with a sociopath with nothing to lose? I hope I never have to face the situation.
  14. knoxdoc

    knoxdoc New Member

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    I've thought about how I would handle that. I would write for Percocet #600000 ... and a refill.
  15. SSdoc33

    SSdoc33

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    but having a gun laying around "somewhere in the office" just sounds like a great idea. only place it would come in handy is on your person, and thats not practical. if you hide it and lock it up, its not useful.

    with all of the people milling around an office, you are safer to NOT have a gun
  16. 101N

    101N

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    For some reason Tim Deer comes to mind.
  17. ghost dog

    ghost dog

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    He discharged himself, after storming out.

    But yes, he's gone for good. Thank god.
  18. Jitter Bug

    Jitter Bug

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    I think the best offense is a good defense. I kick them out at the first visit, because the behavior will only get worse if they think I will take it.

    I document the patient became verbally abusive and I asked them to leave. Then I call the referring doc and apologize, and they usually apologize to me since the patient is a jerk to them too. This only applies to the aggressive patient who is starting to escalate by using tone of voice, the stare down and starts verbally trashing my skills, my judgement, my clear lack of understanding of the emptiness of their vicodin bottle.

    For all other high maintenance patients: the needy, the clingy, the whiny, the mistrustful, the hyperanalytical, the edgy antisocial, I breath deeply and try to be as empathetic as possible.
  19. Jcm800

    Jcm800

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    this is why i am so reluctant to prescribe any narcs at all...

    i never had a patient threaten me because i wouldnt renew his Mobic or wouldnt give him 2 more weeks of PT...

    Thats why my staff tells all new patients (except the little old ladies and the ones referred by PCPs we know, etc...even those we probably should also tel...) we do not renew or write any opiates that we did not start, and we rarely start them...

    this opiate thing is an epidemic...
  20. PGY2

    PGY2 Member

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    I have been in private practice now for about 7 years. I've had my share of crazy patients. The police have been to our office at least a dozen times to help remove them from the premises. My office is now a fortress. I have a loaded 12 gauge Mossberg 500 shotgun by my desk, an AR-15 near the procedure room, and carry a compact 9mm with hollowpoint rounds everywhere I go (legal concealed weapons permit). I never owned a firearm until three years ago. See what this profession does to you?
  21. PinchandBurn

    PinchandBurn

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    exactly my policy.

    Absolutely NO opioids on first visit. patients are all aware of that when they are schedule.

    Only time I go against this is the lil ol lady or someone w/ a fx.
  22. SSdoc33

    SSdoc33

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    great idea! what could possibly go wrong with a loaded shotgun under your desk? if you feel you need to go to work like you are getting ready for some black-ops mission, then perhaps its time to re-evaluate your practice style
  23. lobelsteve

    lobelsteve www.stevenlobel.com Lifetime Donor

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  24. SSdoc33

    SSdoc33

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  25. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    I'd turn the guns on myself before I would practice somewhere where I felt I needed them.

    The worst I normally get is patients bitching because I won't contribute to their madness of opioid prescribing. If I feel they are indicated, I prescribe what I feel is appropriate. I feel most patients are not appropriate for long-term opioids. The elderly do well on them, the rest make me regret starting them.
  26. giddyup

    giddyup

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    i had a good one yesterday. pt scheduled for impar. go in the room to consent and she went off on me because she thought she was scheduled for something else. told me "you are ****ing lying to me. i waited for 2 months for this ****ing appointment" blah blah blah. for 10 minutes the cussing continued. told her we do not cuss here. her response, "what are you gonna ****ing do, make me leave?"

    i leave room, tell my attending that she was using profanity for the last 10 minutes etc etc. we go back in, she is nice as can be, attending leaves and i am getting ready to get consent form signed and she calls me a "tattletale."

    um, goodbye. PEACE OUT, SISTER!
  27. ghost dog

    ghost dog

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    Trailer park special.
  28. Jcm800

    Jcm800

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    i agree, in practice for 6 years, and the cops have NEVER come to my office (yet)...

    but it depends on the type of clientele you attract... the lines out of some the guys practices down the block is crazy. sketchy characters to say the least. We get sketchy people now and then like everyone, but we only see them once...
  29. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    And let me guess... She was on Medicaid?
  30. Tenesma

    Tenesma Senior Member

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    past behavior is the best predictor for future behavior... that's why all for all new patients we get their drug history from PMP and their criminal history (online google your states judiciary and do case searches - some states are more transparent than others)...

    It is safe to say anybody coming out of jail, multiple arrests for controlled substances, etc... is only going to be looking for one thing...
  31. PinchandBurn

    PinchandBurn

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    Do you document stuff that you found 'online' on these patients in their charts? Is there anything wrong in doing this?
  32. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    What? You don't believe him when he says he "found Jesus" while in the Pen? That he has "turned over a new leaf", but just needs "a few" (translation 120/mo) Vicodins to get through his day?
  33. foxtrot

    foxtrot Member

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    This is the funniest thing I have read all day:laugh::laugh:
  34. emd123

    emd123

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    There's nothing wrong with taking information that is publicly accessible by anyone and placing in a private medical chart. It's when you do it backwards that you have a problem (taking private info from a patient chart and making it publicly accessible). I think you're okay here.
  35. emd123

    emd123

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    Yeah, something's wrong here. It shouldn't be this terrible. Why the armed fortress?
  36. ghost dog

    ghost dog

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    The only time I ever had to call the police was at my old location (not my practice) - what a dump. The owner was a real sleaze - they cleaned the place once a week (whether it needed it or not :thumbdown: ).

    This pt made a death threat against her neighbour, and since she had a psych Hx, I felt compelled to take it seriously. I called the police and they showed up - 3 hours later. What a headache.

    I'm sure glad I moved to my own place.

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