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referral for pre-procedure medications only

promethius

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    Hey just wanted to see what the general consensus is. We had a patient who called who wanted to be seen, as primary care physician wanted the patient to go to pain management for just pre-procedure pain medication and anxiolytic. Sounds like the patient only wants 1-2 tablets of each. Assuming you have room on your schedule, would you see this patient knowing that is all the patient wants and that the patient will not be following back up with you?
     
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    painfree23

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      Hey just wanted to see what the general consensus is. We had a patient who called who wanted to seen, as primary care physician wanted the patient to go to pain management for just pre-procedure pain medication and anxiolytic. Sounds like the patient only wants 1-2 tablets of each. Assuming you have room on your schedule, would you see this patient knowing that is all the patient wants and that the patient will not be following back up with you?
      Pre-what procedure??
       
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      RoloTomassi

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        I'm assuming the PCP will be doing the procedure? I don't know any other proceduralist who wouldn't write their own sedation.

        Assuming procedure and meds are reasonable, patient is reasonable, and PDMP checks out, I'd probably do it. Call the PCP to discuss and strengthen that referral relationship so you at least get some good referrals for doing them a solid.
         

        painfree23

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          I'm assuming the PCP will be doing the procedure? I don't know any other proceduralist who wouldn't write their own sedation.

          Assuming procedure and meds are reasonable, patient is reasonable, and PDMP checks out, I'd probably do it. Call the PCP to discuss and strengthen that referral relationship so you at least get some good referrals for doing them a solid.

          What pcp would b ok doing a procedure but not writing for 2 Valium’s? What procedure can u imagine it being??
           

          RoloTomassi

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            Just saw your post on another thread. Sounds like you are in solo PP in a still growing practice. It comes down to how much does this PCP relationship or potential relationship matter to you.

            From a medical perspective you would not be doing anything medically inappropriate if all checks out. What's worse case scenario, patient with no PDMP history, documented legit phobia, documented talk with PCP, ODs on one tramadol and Valium, and board or court finds you liable? Highly unlikely. Likelihood of benefit to your business? Up to you to gauge. This is much less risk than taking on new patients on chronic opioids.
             
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            dipriMAN

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              Why not, pretty low risk, I wouldn’t prescribe any opioids, no poly pharmacy, would just give a few tablets of lorazepam and instructions on when to take them, no driving, etc. if it’s truely a minor procedure they shouldn’t need opioids for postop pain anyways.
               

              promethius

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                Why not, pretty low risk, I wouldn’t prescribe any opioids, no poly pharmacy, would just give a few tablets of lorazepam and instructions on when to take them, no driving, etc. if it’s truely a minor procedure they shouldn’t need opioids for postop pain anyways.
                The patient specifically wanted Percocets for pain. I would imagine if you agree to see the patient, and you only prescribe anxiolytics without pain medications, both the referring physician and the patient would not be too happy. Sounds like some physicians are against seeing these types of patients and others would be okay with it.
                 

                dipriMAN

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                  The patient specifically wanted Percocets for pain. I would imagine if you agree to see the patient, and you only prescribe anxiolytics without pain medications, both the referring physician and the patient would not be too happy. Sounds like some physicians are against seeing these types of patients and others would be okay with it.
                  This sounds bizarre. What procedure was this? No proceduralist would ever give a preop Percocet or opioid for anything.

                  Did they want Percocet for post op pain?
                   

                  promethius

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                    Not sure. May have to call the patient back to get more information because it is not as straightforward as it first seemed. This may also apply to surgeons who refer their fresh post-op patients to you for pain management because they do not want to write for any pain medications either.
                     

                    lobelsteve

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                      The patient specifically wanted Percocets for pain. I would imagine if you agree to see the patient, and you only prescribe anxiolytics without pain medications, both the referring physician and the patient would not be too happy. Sounds like some physicians are against seeing these types of patients and others would be okay with it.
                      Hard pass. This went from assistance to ghost writer. If doc cannot rx or refuses rx for his patient undergoing whatever procedure, you MUST assume he is not competent.
                       
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                      VA Hopeful Dr

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                        Hard pass. This went from assistance to ghost writer. If doc cannot rx or refuses rx for his patient undergoing whatever procedure, you MUST assume he is not competent.
                        Yeah, I can't imagine doing a procedure as a PCP and needing someone else to write pre-op meds for it.

                        It's not like we're doing major surgery. He/she can write for 1-2 opioid and benzo pills themselves.
                         

                        Ducttape

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                          if this is an office based procedure, i find it unlikely that percocet is required post procedure. most procedures in office are local only and not significantly pain producing, and non-opioid therapy would be able to manage the pain.

                          in addition, i would not "write" for post op pain meds (exception - unless i am already prescribing them meds). if there is a complication from the procedure - for example, the pain pills masked infection from the incompetent surgeon - you will be liable.
                           
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                          Laryngospasm

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                            So the pcp doesn’t have a dea number? This is basically saying “I’m scared to write this because I feel like it’s high risk but want money from the procedure so will you pretty please take the risk for little compensation so I can do the procedure”
                             
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