painconfidential
Full Member
- Joined
- Oct 8, 2018
- Messages
- 15
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- 2
Hey guys more questions here:
How can I avoid any issues with the DEA in the busy private practice I joined? I honestly can't do a full proper exam on every patient and honestly most of the times its pointless especially if they are follow ups or just here for refills. My clinic has started to wean all people <90 PO morphine equivalents as a rule so thats a good positive step. One issue I have is my clinic does a ton of Personal Injury and on occasion these patients will be prescribed narcotics (albeit rare) and we are not testing Urine because the attorney doesn't want urine tested or something like that or they won't pay for the UA. So sometimes I just have to spot test. Does that even make sense?
What are other things that a good ethical pain doctor can do to avoid the eye or the DEA or some under cover agent? Honestly because I inherited some pretty high dose opioid patients I feel uncomfortable writing them anything but so far I've been sticking to my instincts and tapering everyone down to <90 PO Morphine equivalents. I usually do a brief exam when they come in for the first time : See them walk, walk on toes, heels, palpate back, quick straight leg/Faber/Spurlings/ Reflexes brief strength test. Is that enough?
Now that Im out of fellowship Im kind of paranoid the DEA will have some undercover agent and like the 1 patient out of the 30-40 I saw that day I didn't do a full exam will be an agent and will write me up even though Im weaning them off of an already high dose narcotic.
Also Im being put in a position where Im seeing these PI patients and they are requesting narcotic and I never have any urine sample on them. Im not sure how to handle that. I think Im just going to refuse to give them any narcotics unless they have a urine from now on. I don't care how expensive it is. The only problem is this will probably piss off my boss and office manager because they tend to cave in to whatever that attorney wants.
How can I avoid any issues with the DEA in the busy private practice I joined? I honestly can't do a full proper exam on every patient and honestly most of the times its pointless especially if they are follow ups or just here for refills. My clinic has started to wean all people <90 PO morphine equivalents as a rule so thats a good positive step. One issue I have is my clinic does a ton of Personal Injury and on occasion these patients will be prescribed narcotics (albeit rare) and we are not testing Urine because the attorney doesn't want urine tested or something like that or they won't pay for the UA. So sometimes I just have to spot test. Does that even make sense?
What are other things that a good ethical pain doctor can do to avoid the eye or the DEA or some under cover agent? Honestly because I inherited some pretty high dose opioid patients I feel uncomfortable writing them anything but so far I've been sticking to my instincts and tapering everyone down to <90 PO Morphine equivalents. I usually do a brief exam when they come in for the first time : See them walk, walk on toes, heels, palpate back, quick straight leg/Faber/Spurlings/ Reflexes brief strength test. Is that enough?
Now that Im out of fellowship Im kind of paranoid the DEA will have some undercover agent and like the 1 patient out of the 30-40 I saw that day I didn't do a full exam will be an agent and will write me up even though Im weaning them off of an already high dose narcotic.
Also Im being put in a position where Im seeing these PI patients and they are requesting narcotic and I never have any urine sample on them. Im not sure how to handle that. I think Im just going to refuse to give them any narcotics unless they have a urine from now on. I don't care how expensive it is. The only problem is this will probably piss off my boss and office manager because they tend to cave in to whatever that attorney wants.