Just a quick question...I've been getting a lot of referrals from pcps saying, "will provide last norco script, after this has to see pain management provider for more scripts". I hate these referrals because patients just get frustrated , my office does a good job informing them that no precriptions will be provided on the first visit...only will prescribe if indicated...etc. but still have frustrated patients. How should I address this?
The biggest thing is having your scheduler tell them "No Rx on the first visit, no exceptions." Then when you see them, you can decide if an Rx on the second visit is even an option. If not, don't accept them as a patient, and don't schedule them for a second visit. A patient is not yours until you accept them as a patient, review their records, evaluate them, review UDS, etc. Upon walking in your door, you never told them they needed an opiate to live, or that they needed one at all. The one that did was their PCP who referred them, because he wrote for it, not you. So if that doc told them they need an opiate, and prescribed it, they can continue it, until you have the information you need to decide whether or not you agree.
So, if they're frustrated, you make it clear to them, that it's between them and their doctor who has been prescribing the medicine to them. He's the one that told them it's good for them, not you. You've not started them on it, nor prescribed it to them, nor told them they needed it, ever. Make it clear if they're frustrated, then it's the referring doctor who's responsible for the frustration, not you. I don't play this, "I could prescribe it once just fine, but I can't ever prescribe it again" nonsense. If they felt the opiate was good enough for the patient last month to prescribe it to them, then it's good enough for the patient to prescribe it one more time, or until the expert decides if its right or not.
For them to say, "This patient is so complicated, they need an expert" then claim that once the patient gets to the expert (you) that all of a sudden they know more about the problem that you, know what prescription you need to write, how much and when and are so smart on the issue that they can essentially bully you into prescribing it, is garbage. It's an abuse of a consultant. They'd never do this to any other specialist or consultant. Stick to your guns, hold the line until you are confident you're doing the right thing, and after either talking to the pcp's or after enough patients go back to them angry at them, asking for more Rx's, they'll either stop abusing you, or they'll start sending their abusive dumps to someone else.
I've found, that nearly 100% of the time, when the PCP tells a patient, "You get one more Rx an no more from me" that translates to, "You don't need this medicine. I think this medicine is not good for you. You shouldn't be on it. I'm writing one more prescription for it even though I don't agree with it, just to get you out the door, until you find someone else who'll prescribe this medicine I think you don't need."
That's not how it's supposed to work, and that's not what a doctor who cares about his/her patients or who advocates for his or her patients does. If they really were trying to help such patients they'd either try to help them until they find someone who can help them long term if they think they legitimately need the medication, or refer the for detox if they had the guts to do what's right for the people they feel shouldn't be on opiates.
