Am I at a pill mill for clinical??

[Quick Interlude]

I am an FNP student in my first semester following a Family Med doc in an very poor urban area. I have noticed some very innapropriate prescribing of many medications including antifungals antibiotics and opioid pain medicine. For example he has multiple patients on a regimen of Amoxicillin 500mg PO daily or penicillin vk 500mg PO daily for years at a time. Many patients have been taking daily antibiotics since the 90's (as far back as his paper charts go). Some are getting Fluconazole 150 mg PO monthly for years as well. There appears to be no compelling indication in his charts and the patients give vague reasons for being on the medications such as "you know, to clear things up" or "I've been on them forever". Others tell me the doctor told them they need to be on "antibiotics for life". When I questioned the doctor he tells me to just put in the refills- he doesn't like to talk about it and was also very reluctant to take students. I just kind of stopped asking him about it and I am just trying to make it through the semester but I feel like this is very wrong. Is there any medical indication what so ever for this type of long term antibiotic use??

He also is giving patients high dose OxyContin and Percocet together and very often patients are on "the holy trinity". Patients are prescribed muscle relaxers, benzodiazepines, and cough syrup with codeine without any diagnosis or cough. I'm just at a loss. Am I at a pill mill? Should I report this physician? What is going on here? I know this might sound naive and many people on this forum have very strong opinions about NPs but I don't really have anyone to talk to and I'm afraid to tell my teachers. I am just trying to learn what I can from the rotation and not rock the boat

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[cabinbuilder]

There is an anonymous tip line on the DEA website. I personally have had to use it. May consider that.

I have to say that you need to go with your gut here. I worked with a doc in Alaska who gave me the creeps and I couldn't put my finger on it. He was dealing suboxone out of the hospital pharmacy after hours. The DEA did a sting on him and he was caught. He is currently in prison for child pornography with possession and distribution. He also has a charge on him for rape in Louisiana where he came from originally. If it feels wrong than it just may be.

 

[JustPlainBill]

You may want to consider that perhaps these are long term patients that the physician has been with for a while --- some people have quirky physiology and require long term antibiotics for things that recur unless suppressed -- UTIs are one that immediately spring to mind -- know of more than a few patients on long term low dose macrobid for just such a reason. While not ideal, it is called practice for a reason.

As far as the narcotic medications -- I see your point -- but I also know of a physician that gives his patients a Phenergan/codeine mix -- his logic is that it's good for those virals that cause n/v/d/c -- Phenergan hits n/v, codeine hits cough and diarrhea --- could it just be that these are long term, chronic complaint patients that he's got on auto-pilot? I had a bunch of those in residency -- they were started on Norco for arthritic pain as a trial -- the trial turned into "I need my Norco for my knee pain" that propagated from resident to resident --- it took a new PD to do a study on that and we started weaning people off and moving towards EBM. It happens, people start things and in a busy practice forget what they were doing them for -- not right, not wrong, just is....for my practice, chronic pain goes to pain management, I write for enough to control the acute complaints and rarely write narcs -- I mean rarely. Too many people have lost their license and their freedom getting into pill mills.

No offense to your profession, but to my understanding, your training is very protocol driven, given the lack of depth of your education -- again, not throwing stones but just stating facts -- recognize that sometimes physicians do things as a trial understanding the physiology and considering the entire patient picture in that situation.

But then again, you may be at a pill mill --- quite often, that gut feeling is spot on --- be watchful. You may want to gently and circumspectly speak with your professors. I've had to do that once during 3rd and 4th year -- had a doc who was altering physical exams in the chart to support a billing level. I spoke to a trusted advisor in the FM department about it and two physicians met with him to ascertain what happened -- I've worked with the physician as a colleague much later and there was no perceived animosity.

Good luck to you with your training -- I hope it gets better.

 

[Merely]

You may want to consider that perhaps these are long term patients that the physician has been with for a while --- some people have quirky physiology and require long term antibiotics for things that recur unless suppressed -- UTIs are one that immediately spring to mind -- know of more than a few patients on long term low dose macrobid for just such a reason. While not ideal, it is called practice for a reason.

As far as the narcotic medications -- I see your point -- but I also know of a physician that gives his patients a Phenergan/codeine mix -- his logic is that it's good for those virals that cause n/v/d/c -- Phenergan hits n/v, codeine hits cough and diarrhea --- could it just be that these are long term, chronic complaint patients that he's got on auto-pilot? I had a bunch of those in residency -- they were started on Norco for arthritic pain as a trial -- the trial turned into "I need my Norco for my knee pain" that propagated from resident to resident --- it took a new PD to do a study on that and we started weaning people off and moving towards EBM. It happens, people start things and in a busy practice forget what they were doing them for -- not right, not wrong, just is....for my practice, chronic pain goes to pain management, I write for enough to control the acute complaints and rarely write narcs -- I mean rarely. Too many people have lost their license and their freedom getting into pill mills.

No offense to your profession, but to my understanding, your training is very protocol driven, given the lack of depth of your education -- again, not throwing stones but just stating facts -- recognize that sometimes physicians do things as a trial understanding the physiology and considering the entire patient picture in that situation.

But then again, you may be at a pill mill --- quite often, that gut feeling is spot on --- be watchful. You may want to gently and circumspectly speak with your professors. I've had to do that once during 3rd and 4th year -- had a doc who was altering physical exams in the chart to support a billing level. I spoke to a trusted advisor in the FM department about it and two physicians met with him to ascertain what happened -- I've worked with the physician as a colleague much later and there was no perceived animosity.

Good luck to you with your training -- I hope it gets better.

What ended up happening to that physician altering charts?

 

[JustPlainBill]

What ended up happening to that physician altering charts?

No idea -- I had turned it over to the appropriate school authorities and left it in their capable hands -- I trusted them to be people of integrity and conduct their inquiries accordingly --- as I said, the physician was still in practice when I ran into them after graduating residency --

 

[deleted87716]

I am just trying to learn what I can from the rotation and not rock the boat

You aren't going to learn anything good from that guy. Run away.

 

[smq123]

I am an FNP student in my first semester following a Family Med doc in an very poor urban area. I have noticed some very innapropriate prescribing of many medications including antifungals antibiotics and opioid pain medicine. For example he has multiple patients on a regimen of Amoxicillin 500mg PO daily or penicillin vk 500mg PO daily for years at a time. Many patients have been taking daily antibiotics since the 90's (as far back as his paper charts go). Some are getting Fluconazole 150 mg PO monthly for years as well. There appears to be no compelling indication in his charts and the patients give vague reasons for being on the medications such as "you know, to clear things up" or "I've been on them forever". Others tell me the doctor told them they need to be on "antibiotics for life". When I questioned the doctor he tells me to just put in the refills- he doesn't like to talk about it and was also very reluctant to take students. I just kind of stopped asking him about it and I am just trying to make it through the semester but I feel like this is very wrong. Is there any medical indication what so ever for this type of long term antibiotic use??

He also is giving patients high dose OxyContin and Percocet together and very often patients are on "the holy trinity". Patients are prescribed muscle relaxers, benzodiazepines, and cough syrup with codeine without any diagnosis or cough. I'm just at a loss. Am I at a pill mill? Should I report this physician? What is going on here? I know this might sound naive and many people on this forum have very strong opinions about NPs but I don't really have anyone to talk to and I'm afraid to tell my teachers. I am just trying to learn what I can from the rotation and not rock the boat

I agree with @Blue Dog that you are unlikely to learn anything good from this physician, and should try to get another rotation (if possible). If nothing else, look out for your own education.

I think that @cabinbuilder has a good suggestion with an anonymous tip to the DEA. Don't report this physician unless you are willing to all-in - i.e. go to court to testify against this guy, etc.

I am sorry that you do not feel comfortable confiding in your teachers - because I would suggest that you tell your school or program that they should NOT be sending any students to this guy. At worst, future students will learn bad habits; at best, they will learn nothing of value and it will be a waste of time.

You may not be at a pill mill, but you are certainly rotating with a poor physician. Best of luck to you and your studies.

 

[K31]

I am sorry that you do not feel comfortable confiding in your teachers - because I would suggest that you tell your school or program that they should NOT be sending any students to this guy. At worst, future students will learn bad habits; at best, they will learn nothing of value and it will be a waste of time.

This is NP school we're talking about. Usually they're responsible for finding their own preceptors/rotations.

 

[cabinbuilder]

https://www.dea.gov/ops/submit.php . The link for the tip. They do have you submit your name and they will call you if they have questions (I did do a phone interview) but it doesn't ever go further than that.

 

[Quick Interlude]

Thank you for your replies. It seems like the general consensus is to leave and or report. I'm going to have to really think about this...