Problem patient with controls. no one listens

[tobie]

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I will try to be as brief as possible, and am only looking for the most ethical solution.

I run a closed door pharmacy. I have a patient that moved to one of my homes. her MD had her on a CIII and CII med, 2 benzos, and a number of maintance meds. MD puts in his notes to dc 1 benzo and taper (over 2 weeks) the 2nd one to dc. stops the CII. patient doesnt like this and states that shes going to another md, "closer" to her residence. remarkably, a CII, a CIII and 2 benzo rx's make their way to me. I call the new md, and as professional as possible tell them what the other md did (with the taper/dc). they sort of ignore me. several months later, pat has major hip done. the ortho md gives her a long acting CII and short CII, a CIII and different dx on a benzo shes taking. after 2 months the ortho md trys to get her off by tapering her down (over ~4 weeks) to tylenol #3. she claims shes in pain, but according the the assisted living staff, she clock watches, and if the script says 1-2 po q4-6, she demands 2 q4 (thus the taper to tylenol #3). md says no more. remarkably (hours later) she has a new md thats "closer" to her residence. new md gives a scheduled high dose CIII, 2 benzos.

what am i to do. feel as if i am spinning my wheels here.

 

[J ROD]

I will try to be as brief as possible, and am only looking for the most ethical solution.

I run a closed door pharmacy. I have a patient that moved to one of my homes. her MD had her on a CIII and CII med, 2 benzos, and a number of maintance meds. MD puts in his notes to dc 1 benzo and taper (over 2 weeks) the 2nd one to dc. stops the CII. patient doesnt like this and states that shes going to another md, "closer" to her residence. remarkably, a CII, a CIII and 2 benzo rx's make their way to me. I call the new md, and as professional as possible tell them what the other md did (with the taper/dc). they sort of ignore me. several months later, pat has major hip done. the ortho md gives her a long acting CII and short CII, a CIII and different dx on a benzo shes taking. after 2 months the ortho md trys to get her off by tapering her down (over ~4 weeks) to tylenol #3. she claims shes in pain, but according the the assisted living staff, she clock watches, and if the script says 1-2 po q4-6, she demands 2 q4 (thus the taper to tylenol #3). md says no more. remarkably (hours later) she has a new md thats "closer" to her residence. new md gives a scheduled high dose CIII, 2 benzos.

what am i to do. feel as if i am spinning my wheels here.

enjoy the ride.....

that's how it goes with the professional drug seekers.

just follow teh law and learn to accept there are flaws......

 

[type b pharmD]

Best advice i could give is this : dont be super quick to judge her , and also protect your license.

Pain is subjective, perhaps her pain was significantly undertreated by doctors who either didnt understand its extent or its effect on her ADLs. Maybe she has a high tolerance and clock watches because she is in constant pain. If I was in severe pain, I know i would have constantly increasing anxiety as well. I know when I was in a pretty severe accident, i was ****ing clock watching every few hours to take that vicodin, and when it wasnt enough, I called the dr and asked for something stronger. Pain (mental and physical) is what it is. Fill the legal scripts, do whatever reporting you need to do, verify if there is a dr patient relationship, and maybe offer her a recommendation to a different or better pain doctor, or refer to a pain management center (offering many options besides drugs) since she seems to be having a hard time.

Source: some personal experience .. - I had a best friend who had a bad chronic condition, however the pain related to the condition was not well documented in the medical literature, and he had a hard time getting any pain meds, at times he was desperate and would not even be able to get out of the bed to see doctors to get meds. Half of his life revolved around waiting until he had enough of the weak (at that point) 5mg hydrocodones sitting around , he would spend days in pain waiting to have enough pills to take to go out of his house to see the dr, and then when somebody wouldnt give him what he needed, he would see other drs. Finally he saw an addiction specialist of all things who ended up prescribing him Oxy 80s, based solely on being understanding and not underestimating my friend's pain. At that point he was able to actually hold down a job.

You might find more interesting info in the pain management section of these boards. They have a lot of threads there about handling and distinguishing between real addiction, "pseudoaddiction" (a clinical phenomenon), and just plain old need for painkillers (dependence). That might give you some insight as to whether this patient is a user of pain meds or an abuser.

Hope this helps!! Just couldnt stay quiet on a thread like this after what my friend had to go through.