It begins

Discussion in 'Pain Medicine' started by Mister Mxyzptlk, 09.29.14.

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  1. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    Just saw a 90 yo today whose PCP has had her on Norco 10/325 TID for a long time for polyarthralgia. All I could really find was left knee pain with ROM. The indication for the referral was pretty much "please take over this C-II medication".

    Lives at home because the two daughters want their mother to spend her last days in her house. Since Mom lives alone and one daughter is in Austin and the other travels a lot they don't want to have to keep bringing her to the office and just want meds called in. If I needed to see her could I just do a house call?

    I said, "Your personal wishes have set up this scenario but your personal wishes don't obligate me in any way to practice substandard medicine. If she lived in assisted living or a nursing home she'd have supervision and transportation but she doesn't because it's what YOU want. So if that's what YOU want, then YOU have to figure out how to get to and from my office. You want me to prescribe without trying any other treatment. You want a 90 year old who lives alone to take narcotics. You don't want any meaningful followup. I can't do this."

    I guess that's the end of that guy's referrals.
     
    Ducttape likes this.
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  3. Ducttape

    Ducttape SDN Lifetime Donor Lifetime Donor 5+ Year Member

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    in this liberal bastion of a state, there are luxuries called Medicaid Cabs and Medical Motors. almost no excuse not to get in for an appointment.

    ive lucked out also, in one patient who really could not get here, in that case the PCP took over - and she started doing house calls on him once a month.
     
  4. 101N

    101N 5+ Year Member

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    Yes, so it does begin. I am getting a bunch of theses as well. The indignation of having to come in for a visit to get your refill of hydrocodone.
     
  5. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    In this case I sort of feel bad. This LOL is being kicked around like a football and I think she does hurt. Going back through the PMP she's been on this regimen for a long time. I just resent the PCP and the children putting me in this position.
     
  6. hyperalgesia

    hyperalgesia member 5+ Year Member

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    .
     
    Last edited: 09.29.14
  7. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    You guys are my muse, which is really terrifying for all of us. I was inspired to write this up at authenticmedicine.com
     
  8. lobelsteve

    lobelsteve SDN Lifetime Donor Lifetime Donor 10+ Year Member

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    The kids give her 1 pill every 2 days and sell the rest for gambling money.
     
  9. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    That definitely crossed my mind. I'm hoping that I was "difficult" enough that they will go haunt another practice.
     
    lobelsteve likes this.

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