Has anyone had a similiar experience ?

[ghost dog]

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I had an unusual experience today.

My secretary tells me there was a police officer on the phone, and he wanted to speak with me. Bit worrisome.

Anyways, it turns out that a 55 year old patient of mine had passed away in his sleep, and this cop wanted some medical information from me.

I had never encountered this scenario before, and was unfamiliar with how the doctor / patient relationship should be handled ( in regards to confidentialty). I told him as much.

The officer indicated that there were no signs of foul play, and he called me as one of my prescriptions ( the NSAID Meloxicam) had been found in the pt's house. I eventually told him that I had prescribed 30 tabs of percocet 5 months ago. This guy then asks me " how many tabs can be prescribed at once." I wasn't sure if this was a real question or not, and told him that this wasn't a question that could be answered. In this patient's case, I had only prescribed this medication on 2-3 occasions in total.

At this point, he seemed to get pushy, stating that he had no idea how a "55 year old man could just die". I got the distinct impression that he was implying that this was somehow my fault. I then informed him that people will sometimes experience MI / sudden cardiac death while sleeping, although there are any number of reasons why a person of 55 years could die in their sleep. Of course, he will be receiving an autopsy.

I then informed him that we had reached the natural stopping point in our conversation. I believe he grunted his agreement, and hung up.

This is why police officers get a bad rap- jerks like this. The police are accustomed to being in a position of power, and as such, believe they can treat anyone as they wish.

This interaction pissed me off.

Anyone had a similiar experience?

 

[deleted87716]

I've received calls from police officers when a patient dies at home of natural causes. The main thing they usually want to know is if I'll sign the death certificate. If it's a suspicious death, or obvious foul play, they typically call the medical examiner instead.

I've never had one inquire as to the manner of death, aside from perhaps asking if the patient had any underlying medical conditions which could explain their demise. Most of the time, they've already gotten this information from the patient's family. It's pretty much just a guess, anyway. Natural deaths rarely go to autopsy these days, unless it's an M.E. case.

Maybe the cop who called you was around the same age as the patient, and didn't like being reminded of his own mortality. Who knows? Maybe he was just having a bad night. I wouldn't worry about it.

 

[newdude2009]

I had an unusual experience today.

My secretary tells me there was a police officer on the phone, and he wanted to speak with me. Bit worrisome.

Anyways, it turns out that a 55 year old patient of mine had passed away in his sleep, and this cop wanted some medical information from me.

I had never encountered this scenario before, and was unfamiliar with how the doctor / patient relationship should be handled ( in regards to confidentialty). I told him as much.

The officer indicated that there were no signs of foul play, and he called me as one of my prescriptions ( the NSAID Meloxicam) had been found in the pt's house. I eventually told him that I had prescribed 30 tabs of percocet 5 months ago. This guy then asks me " how many tabs can be prescribed at once." I wasn't sure if this was a real question or not, and told him that this wasn't a question that could be answered. In this patient's case, I had only prescribed this medication on 2-3 occasions in total.

At this point, he seemed to get pushy, stating that he had no idea how a "55 year old man could just die". I got the distinct impression that he was implying that this was somehow my fault. I then informed him that people will sometimes experience MI / sudden cardiac death while sleeping, although there are any number of reasons why a person of 55 years could die in their sleep. Of course, he will be receiving an autopsy.

I then informed him that we had reached the natural stopping point in our conversation. I believe he grunted his agreement, and hung up.

This is why police officers get a bad rap- jerks like this. The police are accustomed to being in a position of power, and as such, believe they can treat anyone as they wish.

This interaction pissed me off.

Anyone had a similiar experience?

Yes!!!!!!
I never trust the police. They are the worst of the worst. Some may think my opinion is too strong, but if you have gone through what I have you will see cops can really be quite worst than the criminals they are supposed to go after.

I've never had a good experience with a cop and especially as a physician you have to
extra careful.

 

[ghost dog]

I've received calls from police officers when a patient dies at home of natural causes. The main thing they usually want to know is if I'll sign the death certificate. If it's a suspicious death, or obvious foul play, they typically call the medical examiner instead.

I've never had one inquire as to the manner of death, aside from perhaps asking if the patient had any underlying medical conditions which could explain their demise. Most of the time, they've already gotten this information from the patient's family. It's pretty much just a guess, anyway. Natural deaths rarely go to autopsy these days, unless it's an M.E. case.

Maybe the cop who called you was around the same age as the patient, and didn't like being reminded of his own mortality. Who knows? Maybe he was just having a bad night. I wouldn't worry about it.

I imagine this could be the case, but I didn't appreciate the stupid "Haiwaii 5-0" question in regards to prescribing percocet.

It was both the context, and the manner in which he phrased his questions and statements that really grinded my gears.

I am (somewhat) in a position of power all the time in my interaction with medical students, residents, my RN and administrator. I consciously make an effort to be nice, so the office is a reasonable place to work.

Again, it appears that it is just in some people's nature to act like a douche bag when they perceive that they are in a position of power.

 

[Apollyon]

There could be some disparity in that you are in Canada, and I am guessing in the Maritimes. I don't know how rural you are, so I don't know if you would have RCMP or the local police service (and, if you are in ON or PQ, apologies to the OPP and the locals), and, as such, if your police officer was from the prairie, he might be a little short.

I'm just guessing. There are several suppositions in my post.

 

[ghost dog]

There could be some disparity in that you are in Canada, and I am guessing in the Maritimes. I don't know how rural you are, so I don't know if you would have RCMP or the local police service (and, if you are in ON or PQ, apologies to the OPP and the locals), and, as such, if your police officer was from the prairie, he might be a little short.

I'm just guessing. There are several suppositions in my post.

I live and practice in Toronto ( Ontario). Metro Toronto.

A little short, like " short man syndrome " - or short like : short bus ?

Apollyon, I ask you: how many percocet is it possible to prescribe at once ?

1 million ( holding pinky finger thusly ) ?

 

[Apollyon]

I live and practice in Toronto ( Ontario). Metro Toronto.

A little short, like " short man syndrome " - or short like : short bus ?

Apollyon, I ask you: how many percocet is it possible to prescribe at once ?

1 million ( holding pinky finger thusly ) ?

When I was an intern (IM - prelim), I rotated at Mount Sinai in Manhattan. I mathed out 56 Percocet for a guy who had a fracture. I didn't have a lot of prescribing experience at that time.

It made logical sense, but my attending pointed to the bigger picture - that it was just too many from the ED.

It's possible to write for a large amount. Some docs believe that it is their solemn duty to do the PMD's job and give the pt 240 tabs at once. However, the big push in EM education is 20 or less tabs; if it for a person with a chronic problem and a PMD, unwritten or written (which is great) policies is one or two days (whichever gets you to Monday).

Having grown up in Buffalo, and knowing a LOT about Canada in general, and Ontario in specific, it's generally more liberal. I don't know about the EM program at U of T, though (either the CCFP or FRCP programs); TGH and TWH might be much more on the liberal bandwagon.

When I was a med student, there was a doc in the ED in Buffalo that was CCFP. He didn't remember me from when I was EMS, and he was a total ass towards me when I was a paramedic. His perspective totally changed when I was there as a med student. With an N of 1, he was pretty liberal. However, I don't know from where he came in Canadia. (Joke, it's a joke!)

 

[ghost dog]

When I was an intern (IM - prelim), I rotated at Mount Sinai in Manhattan. I mathed out 56 Percocet for a guy who had a fracture. I didn't have a lot of prescribing experience at that time.

It made logical sense, but my attending pointed to the bigger picture - that it was just too many from the ED.

It's possible to write for a large amount. Some docs believe that it is their solemn duty to do the PMD's job and give the pt 240 tabs at once. However, the big push in EM education is 20 or less tabs; if it for a person with a chronic problem and a PMD, unwritten or written (which is great) policies is one or two days (whichever gets you to Monday).

Having grown up in Buffalo, and knowing a LOT about Canada in general, and Ontario in specific, it's generally more liberal. I don't know about the EM program at U of T, though (either the CCFP or FRCP programs); TGH and TWH might be much more on the liberal bandwagon.

When I was a med student, there was a doc in the ED in Buffalo that was CCFP. He didn't remember me from when I was EMS, and he was a total ass towards me when I was a paramedic. His perspective totally changed when I was there as a med student. With an N of 1, he was pretty liberal. However, I don't know from where he came in Canadia. (Joke, it's a joke!)

As a general rule, I'm not a big fan of the short acting opioids for managing chronic non cancer pain.

If a pt has constant 24 / 7 pain, and is a candidate for opioids ( an important consideration where a lot of family MDs miss the boat), then they can undertake a trial of long acting opioids. If they are low risk, I will typically give 2 doses / day of a short acting opioid for BTP. If they are at higher risk ( as measured by way of the opioid risk tool), I will not prescribe short actings.

Patients taking mondo doses of short actings a day ( whether on their own or in conjunction with LA opioids ), doesn't make a heck of a lotta sense to me. Either there is a substance abuse problem, the pt has an insufficient LA opioid on board, or they are not a good opioid candidate. In my experience, it is typically the first issue.

The more I prescribe opioids, the less I believe in them. However, they do have their place in the right population.

Having spent a fair amount of time in the ER as a resident, I have found that paramedics are pretty cool dudes. I've never run into one yet that has been on a power trip. 👍

 

[Apollyon]

I've never run into one yet that has been on a power trip. 👍

You have yet to see a "paragod"? Those that "don't know what they don't know"? You're in for a treat once you do.

Just like CRNAs that become anesthesiologists, paramedics that become emergency physicians really become aware of the gaps in knowledge that were there prior to further education.

As for the narcs, what always amazed me was the people that would take 20 Lortabs or Percocets in one day. So what about the opiate - that's a lethal dose of Tylenol! Then again, the law of inverse value, or, these aren't people but cockroaches...