Exam Room 4: School Bus Driver, Worker's Comp, Psuedo-seizures, PTSD

[drusso]

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50 y.o. female with litigated WC claim following bus vs bicycle MVC. Claimant alleges crash caused by new onset seizure d/o. Epileptologist IME says patient has psuedoseizures. WC claims adjuster requesting opioid taper for claim closure.

What's your next move?

 

[244913]

50 y.o. female with litigated WC claim following bus vs bicycle MVC. Claimant alleges crash caused by new onset seizure d/o. Epileptologist IME says patient has psuedoseizures. WC claims adjuster requesting opioid taper for claim closure.

What's your next move?

View attachment 230704

Staff with midlevel. Have staff member give her a "love tap" in the parking lot in order to reopen work comp claim. Fire said staff member. Once new WC claim open for business, begin injecting until endpoints of epidural lipomatosis, paralysis, or arachnoiditis are met. Then implant IT pump and keep on orals until staples are out. Once WC claim closed, have front desk staff ignore phone calls and recommend she go to the University. Defer requests for handicap parking tag to PCP.

 

[willabeast]

Pseudoseizures are a red flag for severe psych disturbances. Not that i am biased against anyone with those problems, but you need to avoid procedures and get psych evaluation.

 

[drusso]

Pseudoseizures are a red flag for severe psych disturbances. Not that i am biased against anyone with those problems, but you need to avoid procedures and get psych evaluation.

Anyone find it amusing that the workers comp claims adjuster thinks that they can order an opioid taper like a McDonald's Happy Meal? Like I'm just going to waltz in and say to a patient I've never met before and I didn't start on opioids, "Yeah, today we're going start tapering your meds," sans relationship, etc.

 

[willabeast]

Anyone find it amusing that the workers comp claims adjuster thinks that they can order an opioid taper like a McDonald's Happy Meal? Like I'm just going to waltz in and say to a patient I've never met before and I didn't start on opioids, "Yeah, today we're going start tapering your meds," sans relationship, etc.

I would try this gambit - narcotics make seizure disorders worse (show her in the PDR). Not that we think she does not have pain, but seizures can kill you, so the risks of the opioids are too great in this situation. But really, do not go into a room with her alone, figure she may be a victim of child abuse/molestation, you are a father figure, she may decide you have molested her and good luck after that.

 

[lobelsteve]

Anyone find it amusing that the workers comp claims adjuster thinks that they can order an opioid taper like a McDonald's Happy Meal? Like I'm just going to waltz in and say to a patient I've never met before and I didn't start on opioids, "Yeah, today we're going start tapering your meds," sans relationship, etc.

So why did she crash if she did not have a real seizure? Blame the meds as causing impairment? The lawyers will. Recommend taper. DO nothing, she won't come back. And you will not be part of the circus.

 

[SeniorWrangler]

Honestly, why does she need to see a pain specialist more than once for a taper from 50 MED? Some basic recommendations about taper schedule and adjunctive med use should be all they need. It's also possible, even probable, that the opioids are just a bandaid on her true source of pain which neither she nor the PCP may know anything about.

 

[drusso]

Honestly, why does she need to see a pain specialist more than once for a taper from 50 MED? Some basic recommendations about taper schedule and adjunctive med use should be all they need. It's also possible, even probable, that the opioids are just a bandaid on her true source of pain which neither she nor the PCP may know anything about.

No one wants to see these patients...