What's your "gut check" reaction to this?
Started by drusso
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I like that it wasn’t written with AI but wish someone would have proofread it a little more carefully.
A confluence of events may have come together for this outcome. Seems rather broad but does keep away the seekers that ultimately clog up the days workflow with running over appointment time, threats, and outbursts.
We took every single consult and could forsee who and what would take an inordinate amount of time to address and the fires that needed putting out.
Is this the best care for all comers? Absolutely not
We took every single consult and could forsee who and what would take an inordinate amount of time to address and the fires that needed putting out.
Is this the best care for all comers? Absolutely not
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I like it. My practice sort of evolved this way when two internists under the umbrella of CDRP took over all chronic opioid patients in my service area. We had our disagreements but nothing we could not resolve peacefully. Made my life quite a bit easier. Not my idea BTW.
Nothing like being threatened for trying to do the right thing at your own financial expense.. it’s a special kind of reward.
We have something similar, no signature but just a notice before first visit. It filters out many of the opioid seekers. I still write low dose in appropriate patients, but they are on average lower risk and more reasonable because they weren't specifically seeking opioids.
I do zero COT and that is the well known word on the street. I've had literally one patient in the last year come in specifically asking that I take over an Rx from their old PCP.
If I ever started getting any sort of volume of patients who came in asking for opioids, I'd probably post something similar, minus the signature line and the typos.
If I ever started getting any sort of volume of patients who came in asking for opioids, I'd probably post something similar, minus the signature line and the typos.
I manage a lot of opiate patients.
I enjoy the challenges.
I enjoy the benefits.
Frustrated waiting for my CAGE code to get reactivated after the alleged 12 day TAT, Submitted 8/19/26 and still pending.
I enjoy the challenges.
I enjoy the benefits.
Frustrated waiting for my CAGE code to get reactivated after the alleged 12 day TAT, Submitted 8/19/26 and still pending.
Why are you trying to do business with the government?
Keeping people alive.
Helping bad doctors stop prescribing.
This is likely a necessary evil. My fellowship program, many years prior to when I was there, stopped rxing all opiates. Prior to that the fellows were not getting the procedural volume they really needed prior to graduating.
I once had a letter like that I included in my new patient paperwork. Mine dictated the how I approached opioids in more detail than this. It didn't do a thing to reduce opioid patients or even to set expectations before walking in. Nobody thought it actually applied to THEM, just the other people who are drug seeking.
Also, the grammar is terrible.
Also, the grammar is terrible.
I don't mind expectation setting. I do mind training programs that don't train fellows on how to write/manage medications (opioids or not). Supplements and first line agents aren't what you come to a specialist for normally.
That's a failure of the fellowship and field
That's a failure of the fellowship and field
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i have concerns about the ethics of that approach.
it got a lot of people in trouble.
it got a lot of people in trouble.
the APPs don’t care enough to vet patients carefully. A local doctor ended up investigated by the DA after a few patient overdoses were linked to his cadre of NPs and that was the beginning of the end of his practice
I think you guys missed the part about MEQ <60. Assuming that low MEQ in conjunction with a strict rule of no concurrent opioids+benzos in any patient, and things become dramatically safer.
The doc does need to be available for questions from APPs on tougher cases and APPs should understand the doc will intermittently do random chart reviews.
What's wrong with following guidelines-based care?
okay.... show me the guidelines that state that we are supposed to be prescribing opioids.
yep i saw that.
i am also aware of something called tolerance and dependence; over time, <60 doesnt stay that way.
if you give the patient whatever they ask for, then no it doesn't stay that way. We talked about this a while ago on this forum and that patients on MEQ 20 or less, had much less tolerance, and could frequently stay on the same dose for years, but patient written for more than 20 MEQ/day, have increasing issues with tolerance. I have found that to be true. In the very rare circumstances that I write a patient for chronic opioids, 30 MEQ is the upper limit I would offer.
