Re: drug screens
I tell my patients flat up that we do frequent and random UDSs at any time, and that if we call them in it's not to take it personally--it just means that their number was up. That helps smooth things out beforehand for most patients. Though I still have the odd patient that despite going long stretches between tests, still takes it as a personal affront. To them, I just say, "I'll have to let your doctor know you've refused; you and he/she can discuss it further." Half the time, that gets them to produce a sample. The rest of the time, it takes the doctor talking to them.
I also tell them I'd rather they refuse than provide a fake/tampered sample, as the latter doesn't go undetected for very long. Most of the time fakes are identified before they are put in the fridge.
As far as getting samples before they pick up meds/scripts...our facility policy is that I can't force them to give a sample for their meds. However, nothing stops me from saying, "I have to go pick them up. In the meanwhile, we need a sample from you; I'll let the doctor know you're taking care of that while I get your meds." No ultimatiums (sp) are made on my part, and they don't really need to know I already have the meds pulled and the pickup is not all the way in pharmacy but in the next room