Procedure Room: "I took some THC gummies and had a beer before my MBB..."

[drusso]

37 year old mechanic with axial low back after being struck on the back by a tractor tire. Exam concordant for lumbar facet pain generator. He arrives at the appointed time for diagnostic MBB in the accompaniment of his girlfriend. He appears sedated, giggles, and demonstrates inappropriate jocularity toward office staff. Girlfriend admits to giving him THC gummies. He desires to proceed with MBB's.

What's your next move?

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[lobelsteve]

Adios MF. No shot no rx no further care.

 

[nvrsumr]

I think this happens all the time in CO. I would reschedule. Wouldn't fire patient.

 

[Ferrismonk]

If high, he cannot legally sign consent. Reschedule.

 

[TIVAndy]

reschedule. educate on THC. if he really desires, then try CBD.

 

[lobelsteve]

And if he came in piss drunk? Because I see no difference.

 

[drusso]

And if he came in piss drunk? Because I see no difference.

...it's an herb, man...

 

[DOctorJay]

ensure she drives home, staff to witness, call cops if he's DUI

 

[Biohazard685]

Can't consent if he's under the influence of mind altering substances. Then the door opens, do we consider our long term opioid users to be consentable? What if consent is signed beforehand?

 

[unchockey21]

Agree with cancelling procedure. I also wouldn’t fire him for this alone. He’d get a stern warning that if he came in like that again he’d be gone. I’ll give him the benefit of the doubt that he was anxious for the procedure and made a poor decision. If someone came into clinic like that, probably just fire them on the spot. Besides consentability (if that’s a word) and obviously moving during the procedure being concerns, I doubt he’d be able to give a fair assessment of a diagnostic block in that state. Of course, you could just ask the pink elephant next to him.

 

[SommeRiver]

If drunk it is GTFO forever.

 

[PainMD23]

I would reschedule the patient because he cannot sign consent. Agree with not driving home, making sure gf drives home, calling police if he drives.

Could the patient be anxious about the procedure? He admits to pregaming before the procedure, likely treating his own anxiety and providing his own sedation. Most on this forum do not sedate for procedures. We have valium po in our office for patients who are anxious, and offer IV sedation as well.