What do you do when you catch someone...

[Zanegray]

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What do you do when you catch someone lying to obtain opiods?

I caught a patient redhanded in a lie last shift. Not the first time that its happened, but I've been thinking about it a lot. I confronted him, he lied again, then had the nurse call me back in later to apologize for the lie. He didn't want it to cloud my "medical judgement." ha!

Just wondering what y'all do? Can you flag charts at your shop? Do you call cops? This guy had a legitimate medical issue.

Oh and any thoughts on the "ban" going into place in NY? Why can't we just get a national narcotic database?

 

[Arcan57]

What do you do when you catch someone lying to obtain opiods?

I caught a patient redhanded in a lie last shift. Not the first time that its happened, but I've been thinking about it a lot. I confronted him, he lied again, then had the nurse call me back in later to apologize for the lie. He didn't want it to cloud my "medical judgement." ha!

Just wondering what y'all do? Can you flag charts at your shop? Do you call cops? This guy had a legitimate medical issue.

Oh and any thoughts on the "ban" going into place in NY? Why can't we just get a national narcotic database?

Lying terminates the patient-doctor relationship. I inform them that I am aware of their lie. When I worked in TN, I would then inform them that I was contacting the appropriate law enforcement personnel. If they then chose to stay for their non-opioid issue I took care of them except for narcs. Hasn't come up in TX yet.

 

[southerndoc]

Patient came in once saying their oxycodone was stolen when someone smashed out the window of his car. I asked if they filed a police report and they said no. I told them the only way I would write for any oxycodone for them is if they bring in a police report. So the guy wants police called. They come and take a report. Then police go outside to examine his car and find the windows intact. He was arrested for filing a false report.

 

[medic25]

I've had a couple of patients continue to claim they aren't on any narcs, even after showing them a printout from the state narc database. After claiming that it must've been somebody else using their name, address and DOB I've offered to call the police for them to report an identity theft. Still waiting for someone to take me up on the offer.

 

[deleted109597]

In our old residency EMR we could make notes of it.
In my current paper system I write it on the T sheet, and put their sticker on the state database printout and make it part of the record. No way to flag charts though.

Oh, and I simply tell the patient that they're not going to get any narcotics from me. People with legitimate medical issues but have large amounts of narcotics prescribed obviously have other sources, and I let them obtain the meds from their other sources.

Never called the cops. I've offered to multiple times though.

 

[la gringa]

have caught a few in lies using the database or other info from the EMR... i tell them i cannot safely prescribe controlled substances to them if they cannot safely use them and tell the truth to me about their use.

most are not surprised and slink off w/o issue. one lady was so bat-**** crazy i had to get the nursing supervisor involved... who documented her erratic and bizarre behavior. gotta love the "my pain dr in another state told me to get my next pain meds from the ER the the state where i move" line...

 

[bulgethetwine]

What do you do when you catch someone lying to obtain opiods?

I caught a patient redhanded in a lie last shift. Not the first time that its happened, but I've been thinking about it a lot. I confronted him, he lied again, then had the nurse call me back in later to apologize for the lie. He didn't want it to cloud my "medical judgement." ha!

Just wondering what y'all do? Can you flag charts at your shop? Do you call cops? This guy had a legitimate medical issue.

Oh and any thoughts on the "ban" going into place in NY? Why can't we just get a national narcotic database?

5 years ago, I would do what one of the rational folks above suggested.

Now, I just fill the script.

My Press Gainey scores have never been better.

 

[Rendar5]

do they get a press ganey if you give them a diagnosis of medication seeking behavior?

 

[GeneralVeers]

do they get a press ganey if you give them a diagnosis of medication seeking behavior?

Yes. Thus it gives physicians incentive to give out narcotics.

 

[la gringa]

in 3.5 yrs of practice i have yet to have a pt who was a narc seeker:
1. fill out a P-G or the like (they are not anonymous and i read them all)
2. file a complaint about me, even if i denied their request

there is data out there about who does them - mostly middle aged women. always be good to the women in the room!!! they're gonna do the survey!

 

[southerndoc]

in 3.5 yrs of practice i have yet to have a pt who was a narc seeker:
1. fill out a P-G or the like (they are not anonymous and i read them all)
2. file a complaint about me, even if i denied their request

there is data out there about who does them - mostly middle aged women. always be good to the women in the room!!! they're gonna do the survey!

I had a suspected drug seeker give me all 1's, and I gave her Lortab 10's!

 

[Doctor Bob]

I had a suspected drug seeker give me all 1's, and I gave her Lortab 10's!

I figure if I'm going to get low scores, then I might as well deserve it.
Ibuprofen for everyone.

 

[WilcoWorld]

in 3.5 yrs of practice i have yet to have a pt who was a narc seeker:
1. fill out a P-G or the like (they are not anonymous and i read them all)
2. file a complaint about me, even if i denied their request

there is data out there about who does them - mostly middle aged women. always be good to the women in the room!!! they're gonna do the survey!

That's odd, I've been told several times that PG makes these anonymous. Am I being lied to, or is there some detail I'm missing? Are your surveys tied to an MRN or the like that you're able to discover? I ask out of genuine curiosity.

 

[Arcan57]

That's odd, I've been told several times that PG makes these anonymous. Am I being lied to, or is there some detail I'm missing? Are your surveys tied to an MRN or the like that you're able to discover? I ask out of genuine curiosity.

Surveys are tied to MRNs. We do phone PGs, and not only listen to the survey but try and call the pt back in order to find out why they scored us like they did. Taking substance abuse and psych patients out of the mix actually didn't change our scores and this was true across the rest of the hospitals in the system (except one where there scores actually went up with the inclusion of these patients). The reason everyone (except for prisoners and SANE stuff) is eligible for a PG survey for us is timing. By the time the coding has been done which would flag them as excluded, the patient has already received the bill. And PG drops like a stone once the bill arrives. So it makes more sense for us to keep them in and take the potential hit on 5% of our patients then take the hit on everyone because of the bill.

 

[WilcoWorld]

Surveys are tied to MRNs. We do phone PGs, and not only listen to the survey but try and call the pt back in order to find out why they scored us like they did. Taking substance abuse and psych patients out of the mix actually didn't change our scores and this was true across the rest of the hospitals in the system (except one where there scores actually went up with the inclusion of these patients). The reason everyone (except for prisoners and SANE stuff) is eligible for a PG survey for us is timing. By the time the coding has been done which would flag them as excluded, the patient has already received the bill. And PG drops like a stone once the bill arrives. So it makes more sense for us to keep them in and take the potential hit on 5% of our patients then take the hit on everyone because of the bill.

Thanks. That was helpful.

I'm wondering when the first lawsuit will come of this. We have data that higher patient satisfaction scores correlate with higher mortality, and the surveys lack statistical significance. Yet admins continue to push for higher scores and hold docs up to this demonstrably faulty standard. It seems like only a matter of time before patients or docs sue over this.

 

[RustedFox]

Thanks. That was helpful.

I'm wondering when the first lawsuit will come of this. We have data that higher patient satisfaction scores correlate with higher mortality, and the surveys lack statistical significance. Yet admins continue to push for higher scores and hold docs up to this demonstrably faulty standard. It seems like only a matter of time before patients or docs sue over this.

Let that suit come soon. Its the only way to get Admin to do anything.

 

[Daiphon]

Let that suit come soon. Its the only way to get Admin to do anything.

I fear that suit, actually. Depending on how it is argued & decided, it might create a precedent for considering patient satisfaction as part of the "standard of care."

Ack!

But, I also agree the C-Suite yahoos won't pay heed to the issue without one... Joseph Heller would be proud.

Sent from my DROID BIONIC using Tapatalk

 

[la gringa]

That's odd, I've been told several times that PG makes these anonymous. Am I being lied to, or is there some detail I'm missing? Are your surveys tied to an MRN or the like that you're able to discover? I ask out of genuine curiosity.

mine come to me with a copy of the chart attached... electronically of course.

 

[RustedFox]

Depending on how it is argued & decided, it might create a precedent for considering patient satisfaction as part of the "standard of care."

Would never happen. There'd be huge backlash here. This is something that I'd leave the country over. Many would just close their doors to their shops. Cats and dogs living together. Mass hysteria.

 

[dotcb]

Realistically - if I catch the person lying - offer them tylenol or ibuprofen and a prescription for the same. Have our hospital police escort the person out of the ED if necessary.

Usually these people storm out when they realize their game is up.

What do you do when you catch someone lying to obtain opiods?

I caught a patient redhanded in a lie last shift. Not the first time that its happened, but I've been thinking about it a lot. I confronted him, he lied again, then had the nurse call me back in later to apologize for the lie. He didn't want it to cloud my "medical judgement." ha!

Just wondering what y'all do? Can you flag charts at your shop? Do you call cops? This guy had a legitimate medical issue.

Oh and any thoughts on the "ban" going into place in NY? Why can't we just get a national narcotic database?

 

[EctopicFetus]

Ive sent 2 to jail. Its a felony.

Both with weird stories where they slipped up. Using false ID to try to get narcs.

If they just lie about their use of them etc (not breaking the law), I use the methods as above. They never get narcs. too bad for them.

 

[southerndoc]

That's odd, I've been told several times that PG makes these anonymous. Am I being lied to, or is there some detail I'm missing? Are your surveys tied to an MRN or the like that you're able to discover? I ask out of genuine curiosity.

We get copies of the actual survey (including their handwritten comments) along with a copy of the chart. They are not anonymous in any way.

Matter of fact, the same drug seeker than gave me all 1's came back. She played all nice saying "I saw you last time" and I called her on the Press-Ganey. F'her.

 

[southerndoc]

I'm wondering when the first lawsuit will come of this. We have data that higher patient satisfaction scores correlate with higher mortality, and the surveys lack statistical significance. Yet admins continue to push for higher scores and hold docs up to this demonstrably faulty standard. It seems like only a matter of time before patients or docs sue over this.

Very soon. An attorney friend is representing a physician who was fired for bad (customer service) scores. He will soon be suing the surveyor themselves for failing to provide statistically accurate score results. Some of his quarters had only 10 surveys returned. My friend said when they calculated, only 0.8% of the patients he saw had a survey sent to them and were actually returned.

He is also going to sue for selection bias since the happiest patients are often the ones who are admitted with a definitive diagnosis, yet they are not included in surveys.

When I talked to him last week, he plans to file as soon as he gets more opinion from an expert witness. He already has quite a few on statistics, selection bias, etc.

Definitely will be interesting to follow the outcome, and I'm quite sure the EM magazines/newsletters will start to cover it as soon as something is filed.

Things will definitely start to heat up for all of us now that CMS is tying payments to satisfaction scores. It's probably going to get much, much worse before it gets better. Surveys will fall out in 10 years.

 

[EctopicFetus]

Very soon. An attorney friend is representing a physician who was fired for bad Press-Ganey scores. He will soon be suing Press-Ganey themselves for failing to provide statistically accurate score results. Some of his quarters had only 10 surveys returned. My friend said when they calculated, only 0.8% of the patients he saw had a survey sent to them and were actually returned.

He is also going to sue for selection bias since the happiest patients are often the ones who are admitted with a definitive diagnosis, yet they are not included in surveys.

When I talked to him last week, he plans to file as soon as he gets more opinion from an expert witness. He already has quite a few on statistics, selection bias, etc.

Definitely will be interesting to follow the outcome, and I'm quite sure the EM magazines/newsletters will start to cover it as soon as something is filed.

Things will definitely start to heat up for all of us now that CMS is tying payments to satisfaction scores. It's probably going to get much, much worse before it gets better. Surveys will fall out in 10 years.

This is great news. I hope they sue the crap out of PG and whoever fired the guy. It will be ugly and messy though. They will try to crucify your friend. In the end while this sucks for your buddy it should start to make people notice.

 

[GeneralVeers]

This is great news. I hope they sue the crap out of PG and whoever fired the guy. It will be ugly and messy though. They will try to crucify your friend. In the end while this sucks for your buddy it should start to make people notice.

A win would be great for all of us, as it would establish legal precedent. Hospitals would be less likely to threaten groups and individual docs over Press-Ganey scores for fear of losing a wrongful termination suit.

 

[RustedFox]

A win would be great for all of us, as it would establish legal precedent. Hospitals would be less likely to threaten groups and individual docs over Press-Ganey scores for fear of losing a wrongful termination suit.

Hell, I'd contribute to the legal fund. How do we "pass around the hat" ?

 

[WilcoWorld]

This is heartening. Best of luck to your pal SD.

 

[Arcan57]

A win would be great for all of us, as it would establish legal precedent. Hospitals would be less likely to threaten groups and individual docs over Press-Ganey scores for fear of losing a wrongful termination suit.

Works if you're an employed physician. ICs will still be SOL.

If you're a resident reading this discussion, please don't take the wrong message away from it. PG is almost completely BS, but it doesn't matter. Generating patient satisfaction as a core competency in EM is here to stay. Regardless of how statistically flawed the methodology may be, your ability to continue earning a paycheck is going to depend on your ability to satisfy your patients. Excellent patient care isn't remarkable anymore, it's expected. It's your ability to "Wow" your patients that's going to be the differentiator in terms of ED docs. Like Greg Henry says, "Medicine is show business for ugly people." When you're on shift then you're also on stage. Whether it's PG or CMS, the metrics are only going to get tougher to meet as the gap between the lowest performing hospitals and the highest shrink. Neglecting patient sat skills is going to be crippling in terms of where you can practice, similar to the way not being board-certified is now. There will be shops that don't or can't care about it, but they're not going to be in places you want to live.

And SD, I hope your friend wins millions.

 

[dotcb]

If your friend wins - we need to BLOW IT UP all over the EM news.

 

[southerndoc]

And SD, I hope your friend wins millions.

Plan is to sue the health system for $2.5 million, the physician's employer for $2.5 million, and the surveyor for $5 million for future lost wages, emotional distress, and punitive damages.

I will post it when it's filed. Until it's actually filed, I can't post the name of the health system, employer, or his name. The physician was offered a decent amount to settle but is refusing to do so. Wants it to go to trial to be made public.

 

[JacobMcCandles]

I will post it when it's filed. Until it's actually filed, I can't post the name of the health system, employer, or his name. The physician was offered a decent amount to settle but is refusing to do so. Wants it to go to trial to be made public.

This man is a hero. If this goes through, there needs to be a statue of him outside of every ED.

 

[deleted6669]

I figure if I'm going to get low scores, then I might as well deserve it.
Ibuprofen for everyone.

PERCOGESIC. each tab is apap 325 and benadryl 12.5.
dose just like vicodin and write it out to look like a narc script. advise will cause drowsiness, not to drive, etc
Percogesic #15(fifteen) 1-2 po q 6 hrs prn pain. no refill.
by the time they figure it out they are out of the dept.
I only write it for drug seekers so if asked about the rx I know they are full of crap.

 

[dotcb]

Love it! Gotta try writing this...

http://www.amazon.com/Percogesic-Backache-Maximum-Strength-48-Count/dp/B001G7QWY4/ref=pd_sbs_hpc_3

 

[deleted6669]

Love it! Gotta try writing this...

http://www.amazon.com/Percogesic-Backache-Maximum-Strength-48-Count/dp/B001G7QWY4/ref=pd_sbs_hpc_3

Actually this one:
http://www.amazon.com/Percogesic-As...01G7QRN0/ref=pd_sim_hpc_3/176-4788237-8801047

the maximum strength is a different formula with magnesium salicylate, basically doans pills, also good, but for all those "allergic to every nsaid" it doesn't fly. the original formula does.

 

[WilcoWorld]

The physician was offered a decent amount to settle but is refusing to do so. Wants it to go to trial to be made public.

Three cheers for this doc!

 

[Arcan57]

Plan is to sue the health system for $2.5 million, the physician's employer for $2.5 million, and the surveyor for $5 million for future lost wages, emotional distress, and punitive damages.

I will post it when it's filed. Until it's actually filed, I can't post the name of the health system, employer, or his name. The physician was offered a decent amount to settle but is refusing to do so. Wants it to go to trial to be made public.

Does your friend's hospital call or mail surveys? If they call, get them to subpoena the actual calls. You'd be amazed how many times the patient either siding understand the question or the surveyor didn't record the answer correctly. Especially for Spanish speaking patients we've had multiple surveys where they said very good for eveything but is was recorded as good.

 

[Birdstrike]

Plan is to sue the health system for $2.5 million, the physician's employer for $2.5 million, and the surveyor for $5 million for future lost wages, emotional distress, and punitive damages.

I will post it when it's filed. Until it's actually filed, I can't post the name of the health system, employer, or his name. The physician was offered a decent amount to settle but is refusing to do so. Wants it to go to trial to be made public.

Amen to this. For centuries, Medicine was about making people healthy and doing what is "right". Now, that is secondary to profit. "Patient sat" is just a way to circumvent what's "best for the patient" and replace it with what is most immediately gratifying, which is often what's "worst" for the patient (antibiotics where not needed, narcotics for people with addiction, CT scans and harmful radiation where not needed) for one purpose and one purpose alone:

To increase profits for the businessmen that run the hospital.

It's one thing to give everyone a smile, handshake and "thanks for coming," but it is a slippery slope to punish a doctor for doing what's right. Only we who have been tortured by this know how much it is used to warp the purpose of what Emergency Physicians were placed on Earth to do.

I support legal action 100%.