Mister Mxyzptlk

10+ Year Member
May 16, 2006
5,082
1,215
Yewston, TX
Status
Attending Physician
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.
 
  • Like
Reactions: Ducttape

Ducttape

SDN Lifetime Donor
Lifetime Donor
7+ Year Member
Oct 7, 2011
8,472
2,125
Status
Attending Physician
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.
 

101N

Membership Revoked
Removed
Account on Hold
5+ Year Member
Apr 7, 2011
5,313
1,069
Middle of Oregon
Status
Attending Physician
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.
 
OP
Mister Mxyzptlk

Mister Mxyzptlk

10+ Year Member
May 16, 2006
5,082
1,215
Yewston, TX
Status
Attending Physician
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.
 
OP
Mister Mxyzptlk

Mister Mxyzptlk

10+ Year Member
May 16, 2006
5,082
1,215
Yewston, TX
Status
Attending Physician
You guys are my muse, which is really terrifying for all of us. I was inspired to write this up at authenticmedicine.com
 

lobelsteve

SDN Lifetime Donor
Lifetime Donor
10+ Year Member
May 30, 2005
13,841
3,734
Canton GA
www.stevenlobel.com
Status
Attending Physician
The kids give her 1 pill every 2 days and sell the rest for gambling money.