Negative urine

[SommeRiver]

Inherited a pt on opiates, and I got two back to back negative urine samples. I will no longer Rx for her, but I offered her baclofen and gabapentin. Obviously she is angry with me, but she has no legit excuse. First negative urine she was hoarding for an upcoming surgery but second one (one month after the first) there is no excuse. Said she ran out. What do yall do in this situation? My first negative urine.

Edit - Lemme add that she has an SCS unit implanted by some outside MD in Feb of this year. I inherited her like two months later, when she is still complaining of IPG pain. In fact, she still has IPG pain now, and asked if I can revise it.

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[pastafan]

Two negative UDT and you prescribe may equal prosecution for drug trafficking.

 

[NJPAIN]

Curious. How did you “inherit” her? She came to you because she wasn’t happy with the doc that put the SCS in?


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[244913]

violated contract, withdrawal meds, substance abuse referral if appropriate. Have a nice life.

Don't revise the ipg because she'll use that against you as a bludgeon to get back/cont. opioids

 

[SommeRiver]

I accepted her for some stupid reason without thinking about it. She moved from a different state.

 

[SommeRiver]

Her IPG is low and midline in a thin buttock. Not what I would have done but with these urines being negative there is a zero percent chance I would do something interventional. Zero. Then she gets mad at me for not telling her over the phone and sparing her gas mileage to come in for a face to face. Sorry ma'am, we have to talk about this eye to eye.

 

[BobBarker]

I send certified letters.

 

[NJPAIN]

I accepted her for some stupid reason without thinking about it. She moved from a different state.

I get it. You think - well I will do the IPG site revision, pain will improve, off opioids and poof I have turned a bad patient into a good one. Been there, done that. In reality and in the words of DRusso “ you can’t polish a turd”.


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[painfree23]

I send certified letters.

Stating what?

 

[Ducttape]

I would let her know no more scripts. All done. Do not adjust ipg unless you and her have a viable working relationship in 2021.

 

[DODOCSS]

99214, then letter

 

[BobBarker]

“I can no longer prescribe you opioids due to xxxxxx “

 

[swamprat]

I bring patients back in. I have some guy who missed like 3 injections sent to me after a pain clinic closed on high dose oxy I de-escalated from the getgo but when he no showed to all injections but always shows up to his fu I switched him to belbuca. Now when I checked the cup at his last visit it had powder in it. I confirmed today he had all oxy no metabolite so the dude is diverting. He is act scheduled for an injection he may show up he may not. Regardless when he comes back he’s getting DC. I work in an area with a ton of diversion powder in the cup high oxy no metabolite etc. it sucks

 

[lobelsteve]

I dont fire the patient, I fire the drug. They can leave me or come in for talking, exercise counseling, or procedures.

But they go elsewhere.

 

[Aether2000]

"I am not 'firing' you, I am changing your therapy."

 

[SommeRiver]

Yeah, I offered nonopiate management but she's like, "If I go somewhere else they won't know about this right?"

"Well, you have a stim implanted and are on opiates so I'm sure they'll want my notes..."

 

[Agast]

Sometimes if I don't catch a bad utox before the patient arrives (positive cocaine, etc) I have my MA tell the patient they can either leave nicely and keep their copay, or they pay the copay and get a scolding lecture from me about why I'm not going to prescribe them anything any more. 100% choose to keep their copay and don't come back, I get a breather in between my other patients, and stress load is reduced.

 

[painfree23]

Sometimes if I don't catch a bad utox before the patient arrives (positive cocaine, etc) I have my MA tell the patient they can either leave nicely and keep their copay, or they pay the copay and get a scolding lecture from me about why I'm not going to prescribe them anything any more. 100% choose to keep their copay and don't come back, I get a breather in between my other patients, and stress load is reduced.

But but but but 99214

 

[Ducttape]

the amount of $$ you make from 99214 is similar to what you would pay for a 1/2 hour high quality massage therapy.

for Agast, id guess not seeing the patient is worth a massage...

 

[painfree23]

the amount of $$ you make from 99214 is similar to what you would pay for a 1/2 hour high quality massage therapy.

for Agast, id guess not seeing the patient is worth a massage...

Probably will need the 1/2 hour massage after dealing with this type of patient