Drug-seeking patients in the clinic

JZ_RN · Nov 24, 2012

And we do terminate patients, but the doctor usually just tells me "tell them no more narcotics" and that goes over really well. We have agreements they sign and everything but the patients do not care. I forward messages to the doctors but since they don't have to talk to the patient on the phone or when they show up they don't seem to understand how difficult it is. I get cursed, threatened, harassed, called names, and my time is wasted daily now by some of these patients. The doctors initiate termination at their follow-ups when the patient comes in and gets rude but what can I do in the meantime to spare my sanity? I can't write prescriptions and I don't deserve to be treated this way by patients over pain pills!

LuckyDevil2020, BSN · Nov 25, 2012

I know what you mean. I honestly thought (though I am not sure WHY) that once I left the ED I would get away from the med seeking patients, but addiction knows no bounds. We typically adhere to the rules established by the clinic. If we think we see trends in a patient (going to every provider in the clinic looking for meds, or calling for refills of narcs over the phone) we put them on a one provider contract where they can only see that one provider. We tell them that the MUST be seen for a narc refill. Then if things progress negitively we refer them to a pain clinic, if they come back or get kicked out then we make an appointment for them at another pain clinic and give them a refill for enough to last from then to that appointment and tell them that they will not get anymore. If they come back we refuse citing the documentation from the last visit.

What have their providers told them?

JZ_RN · Nov 25, 2012

We have the one provider agreements with no over the phone refills as well. They get kicked out of pain management and we agree to give them a refill until they get into a new one but when all the ones in town are exhausted or refuse/kick out the patients they have nowhere left to go. The docs feel bad and write some more but it's me caught arguing with belligerent patients who want pain medicine. I truly feel bad for the patients with pain but that is no excuse to call me names and say I don't know what I'm talking about or threaten to sue me when I tell you that the doctor isn't refilling your prescription. We're not allowed to just say "go to the ER" because that's not good customer service and the patient doesn't want to pay to go there if they think they can get a walk-in refill or phone refill or just pay sliding scale to see another MD or DO or NP in the clinic and get their fix. I feel it will only get worse when the ERs stop writing. Patients expect me to stay 1/2 hour late at the clinic so they can drive up and pick up their prescriptions... UH NO. Patients expect me to get them an appointment with a provider who is already double and triple booked... UH NO. I just am at my wit's end with the pain medicine patients.

RxOnly · Nov 27, 2012

Are all the docs in clinic on the same page about prescribing? It's irritating at my clinic when one doc follows our narcotic contract to the letter and another hands out scripts here and there when he feels bad.

I feel like when all the docs get on the same page it makes things easier. People tend to back down a little more when you can throw the words "It's our clinic policy and we can't make any exceptions" at them.

Our manager is great in the sense that she won't let patients verbally abuse us. If a patient is getting belligerent over the phone, we are allowed to say "John, things have escalated too far and I am going to have to end this call now." and then hang up. Of course we have to document our butts off when we do that. Is there a policy in place that would allow you to end a call like that? I know it doesn't help much when they show up in person, but at least it helps get them off the phone, if only until they call back!

JZ_RN · Nov 29, 2012

Not that I know of, but I can discuss with management. I frequently hang up on callers who cal me names, are belligerent, and swear and threaten me. I document everything they said, including the point where I said, do not swear at me or call me names or whatever again or I will hang up the phone. But I don't know if there's rules or anything. When they show up in the clinic they are always nasty and it's always the nurse who gets stuck trying to reason with them and they never accept, the doctor is with patients or the doctor says no. I am lost, I have no other options. What should I be saying to these people because the simple facts are not getting though. I can repeat myself until I am blue in the face and they keep arguing. Most of our doctors follow rules but any time an exception is made it turns into this. I can't control the providers though. =/

mclennan, BSN, RN · Nov 29, 2012

I worked for a year at a free/low cost/sliding fee clinic that was staffed by resident/student docs. It was basically a Vicodin/Norco/Oxy factory. It was a satellite of a large and well respected Magnet hospital system so we had to follow their rules and protocols, and you all know how THAT goes - "customer service" and "patient satisfaction" took priority over "basic safety" and "competency." We REGULARLY called security to escort out belligerent patients screaming for their Soma/Ultram/dilaudid, and after a while even Security gave up, and we had to call the local cops to come and drag patients out.

I finally quit after an addicted patient in withdrawal grabbed my wrist, whipped out a Zippo lighter and threatened to set my clothes/hair on fire if I didn't get him his pills. It wasn't so much the actual incident that bothered me as much as how little support I got from my supervisor about it. "Oh, make sure you write an incident report," and she walked away. I did just that and turned it in along with my 2 week notice.

As hospitals try to cut costs, insurance companies try to limit benefits and ERs are overflowing, ambulatory clinics are going to take the brunt of the fallout. It's where the patients who fall thru the cracks land. I got out before I got physically hurt or went nuts.

JZ_RN · Nov 30, 2012

I've never been physically threatened but I have been verbally threatened. That sounds scary. Anyone belligerent gets security called stat and security has guns. (yeah it's that kind of place.. sadly) but never have I been physically involved with an angry patient. When they come in angry no one buzzes them back. sounds scary!