Insanity is relative...

[katmandu]

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I am trying to figure out if I just need a vacation or if my patient population is more special than average. What percentage of your patient population is crazy and/or drug seeking?

 

[Pinner Doc]

Love the use of the term 'special.'

Maybe I'll consider tonight's shift a random sampling of the population and get back to you. Although it's a Monday, so it may be heavily skewed.

 

[tkim]

my shop has a locked unit. if you build it they will come.

 

[deleted6669]

my shop has a locked unit. if you build it they will come.

mine too so all the outlying hospitals send those folks to us.
as far as the op's question:
crazy: 10%
drug seeking 15-20%
obviously some overlap in those groups.
our drug seeking population has gone way down in the last yr since we started a no oxycontin/methadone policy. we also do not ever refill lost/stolen narcotics or provide narcs for chronic pain pts who "just need a few days worth" until they can get into the pain clinic. we also no longer have take home packs of narcotics for those who show up at 2 am with dental pain/back pain, etc x 6 months.
we have a big poster at the triage desk informing folks of these things. we have taken a hit on pt volume though down from 250 to 210 pts/day or so.

 

[docB]

Downtown Vegas: "Special" = ~35%

 

[deleted65604]

I'd echo about 1/3 of patients

 

[ohiovolffemtp]

Emedpa,
Has that 15-20% drop in patient visits caused a corresponding drop in collections - or were most of the drug seekers non-payers?

 

[deleted6669]

Emedpa,
Has that 15-20% drop in patient visits caused a corresponding drop in collections - or were most of the drug seekers non-payers?

about half were non-payers so we are taking a hit but on the bright side it let us shorten some of our shifts...I view that as a good thing but some of my colleagues are upset because they feel that now they need to work more shifts. I just work a few hrs less/mo and I'm ok with that.
I think working shifts longer than 8 hrs in a busy trauma ctr is a recipe for burnout so I welcomed the shorter shifts.

 

[katmandu]

emedpa, we have a similar narcotics policy. Unfortunately, with ~30 providers, the enforcement is variable. So, it hasn't really done anything to deter drug-seeking pts from visiting our ED.

I estimated our percentage around a third too. Looks like I need to start planning a vacation....

 

[GeneralVeers]

emedpa, we have a similar narcotics policy. Unfortunately, with ~30 providers, the enforcement is variable. So, it hasn't really done anything to deter drug-seeking pts from visiting our ED.

I estimated our percentage around a third too. Looks like I need to start planning a vacation....

We have the same problem. We have 35 doctors and about 2/3 are on-board with the narcotics policy. While the number of problem patients has noticeably dropped, many of them just doctor shop with repeated visits until they get what they want from one of our pushovers.

I've found that the narc-giving docs fall into two categories:

1. Kind people who don't want others to be in pain, so give narcotics with the hope of making people feel better.

2. Cynical *******s who don't want to "get into a fight" with patients, or are trying to gerrymander the Press-Ganey system.

 

[deleted6669]

fortunately our medical director is on board with the narcs policy and "offenders" are being "counseled" to conform to dept norms. it seems to be working.

 

[med2UCC]

Our "special" population is probably around 15-20% on any given day. We also seem to do a lot of informal dentistry. We have a similar narc policy in that we don't refill lost or stolen meds, nor do we fill chronic pain meds that have run out. I rarely write pain meds for anything other than broken bones. However, I have recently been landed with a college complaint for unprofessional behaviour for following our ED policy - politely I may add - and am just waiting to see which way this particular cat will jump. To add insult to injury, the college says it supports our policy and encourages us not to write narcs, as we have a huge problem in my province with diversion and prescription drug abuse. Oh well.
M