Ethical delima????calling in or giving meds to drug seekers???

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i work part time in a family practice office. i work for all providers at one time or another. we have a doc (lets call hime smith) that is famous for giving pain meds. he'll switch them from lortab, to percocet, to methadone, to dilaudid, to whatever. we have a pt that filled her methadone then 2 days later siad they weren't working and he gave dilaudid. orders demerol 150mg im for obvious drug seekers.

the nurses know if the pt complains of pain in the hosp, he doesn't think twice about putting them on a pca. (even had a lap chole on a ms pca. 45 min after d/c of drugs pt felt good enough to leave. go figure!)

we had a surgeon admit a pt under dr. smith's care d/t lortab/percocet abuse post-op with dx of narc. addiction, even though we are not a rehab facility. the pt left with a script for lortab. she had been getting percocet #300 previous to surg.

my question for all of you is.....when does this become an ethical question for me? working in the hospital and/or working in the office. i have told the doc repeatedly my opinion that these are drug seekers and they need help. i have said......"they walked in here and joked around....then needed 150mg of demerol????????" he disagrees, and when he does defend the pt he simply says pain is subjective. uh, yeah, but can't you think for yourself? :uhoh3: i like the doc as person. very interesting company and good conversation, but don't i have a line where i am enabling these drug seeker too???? i might add no nurse at the hospital would let him be their doc. he is scary most of the time...and in difficult cases we know the pt would have a much better chance with another doc.

i have recently heard talk around the office that i might soon be offered a job working full time for this provider..(i'm full time right now med-surg) ethical delima or not....i know it sounds like i've made up my mind....but i would like your imput.

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Specializes in Utilization Management.

I'd find another job pronto. Docs who overprescribe narcs definitely make me nervous.

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Specializes in Med-Surg.

The doctor is correct. Pain is subjective. Many people need large doses of narcotics to control their pain. Especially if they've been in chronic pain. I'd rather have a doc that listens to me when I say I'm in pain than one who raises the red flag of drug seeker when I walk in the door. (I'm not on pain medicine, just being rhetorical.)

But you know the man, I don't. You work with the patients, I don't.

Ethically, it's a worse offense to undertreat pain. Ethically it's a worse offense not to believe a patient when they state pain.

Not there aren't drug addicts and drug seekers out there. It's a tough call.

Sounds like you've made up your mind already. Good luck in finding a position you're comfortable with.

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Specializes in Geriatrics/Oncology/Psych/College Health.

In a small to medium-sized town, working with the doc perceived as the local candyman (deserved reputation or not) generally doesn't reflect well on you when you look for other positions. Locally, a doc has run through numerous NP's and nurses (most of whom came from out of town and were unaware of his reputation) who after working there decided they weren't comfortable with his standard of care.

I don't know if your guy is satiating drug seekers, or whether he's a humanitarian. If it feels wrong to you, you probably won't last there full-time.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
The doctor is correct. Pain is subjective. Many people need large doses of narcotics to control their pain. Especially if they've been in chronic pain. I'd rather have a doc that listens to me when I say I'm in pain than one who raises the red flag of drug seeker when I walk in the door. (I'm not on pain medicine, just being rhetorical.)

But you know the man, I don't. You work with the patients, I don't.

Ethically, it's a worse offense to undertreat pain. Ethically it's a worse offense not to believe a patient when they state pain.

Not there aren't drug addicts and drug seekers out there. It's a tough call.

Sounds like you've made up your mind already. Good luck in finding a position you're comfortable with.

right on!

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It is a tough call.

There is a doctor in my town who is known to give out meds freely. A lot of our patients with abuse problems see him. Three of the patients died from OD last year. Each of them had hundreds of narcotics on them when they were found.One man had over 1000 pills in his apartment!!! Pain must be treated but not at any cost. Patients with abuse ploblems should be given meds in small frequent presciptions. Maybe one week at a time or even every other day for a while if needed. To not monitor how they are using the narcotics is just as poor care as under medicating them.

IMHO

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Wish I had this doctor for my Hospice Medical Director! Than I wouldn't have to fight so hard for pain meds for my patient!

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Specializes in Operating Room.
The doctor is correct. Pain is subjective. Many people need large doses of narcotics to control their pain. Especially if they've been in chronic pain. I'd rather have a doc that listens to me when I say I'm in pain than one who raises the red flag of drug seeker when I walk in the door. (I'm not on pain medicine, just being rhetorical.)

But you know the man, I don't. You work with the patients, I don't.

Ethically, it's a worse offense to undertreat pain. Ethically it's a worse offense not to believe a patient when they state pain.

Not there aren't drug addicts and drug seekers out there. It's a tough call.

Sounds like you've made up your mind already. Good luck in finding a position you're comfortable with.

Exactly, 3rdShiftGuy. I know that in one family practice where I worked we knew which ones were obvious drug seekers. Eventually they would come in after a 30 day Rx at 29 days, next time at 28 days, next time at 27 days...etc. The Dr. would make them wait the full 30 days if he thought it was an addiction problem, and not a pain problem.

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Specializes in Med-Surg.
To not monitor how they are using the narcotics is just as poor care as under medicating them.

IMHO

I agree 100%. Any doctor that would prescribe to the point a patient had 1000 pills on him that were narcotics (considering a typical script is what 40? 50?) should be investigated.

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Specializes in OB, M/S, HH, Medical Imaging RN.
I agree 100%. Any doctor that would prescribe to the point a patient had 1000 pills on him that were narcotics (considering a typical script is what 40? 50?) should be investigated.

If you don't feel comfortable working for this doc then you shouldn't. Plain and simple.

I agree with Twitty that pain can be subjective and it's the doc who should decide but it does sound like this particular doc is the candy man. We have a frequent flyer at the hospital that everyone knows comes in for drugs and he gets them. Last week he was caught shooting up in his room. His doc finally saw him for what he is and threw his butt out of the hospital, Pronto.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Actually...you proably will not do this, but I would advise it! NO, I am not going to tell you to report him or quit...something far more productive and proactive that will really help you in the long run!

Oregon is about to require a one time 7 hours of CME in Pain Management for all re-newal of licenses! I was pretty well bummed about that...and my first response was...I will take it if Doctor's take it! LOL!

Well..that isn't going to happen, so best I get up to date and be able to refresh my knowledge of alternative ways and newer assessments for pain! I would look into this (and btw other states are going to follow suit, already the buzz!!!!) and brush up on your skills so that when issues like this come around, you maybe can speak with your patients and that doc to suggest alternatives to narcotics!

Reasonable alternatives mind you...I mean most folks won't do 'sit in a quiet calm room, breath, use aromatherapy or heat/cold therapies' nor will they accept 'lets try tylenol first..and go from there!'...no, folks may seem like they are drug seeking when in fact they are looking for what other people or what they have experienced as working best! And lets face it folks...lots of couch docs out there watching ER and I don't see too many pain victims on those shows getting Ibuprofen or heat therapy now...nope..always a narc! Go figure they think that is the only thing that works!

Just recently I had a guy that had a shattered clavical from an auto ped accident (yeah..he was the ped!). They had him on vicodin 1-2 Q6 and believe me..wasn't working. But I knew this patient, he has already been on several narcotics for pain managment and on a heavy routine of antiseizure meds! I came up with a silly idea...suggest Toridol IM next time you go into the MD's! Sure enough the MD went for it..and for some reason that worked better than the vicodin! I knew about that med personally, and that I have suggested it in the ED for various things and people really responded well with it! And it is non-narcotic! :). WOW..shocker huh...a narcotic didn't work well, but a non did!!!!! Imagine that huh?

Now, we won't get over Doc's prescribing pain meds liberally since many law suits have really jumped on the "pain managment neglect' wagon (another case of law suits swinging the medical practice pendulum to the opposite side...it use to be DON'T because they can sue you for addiction or misuse...uhgggg!). Docs will do what they feel is right for the patient as much as we do...it is just helpful to have some nurses in the trenches so to speak helping them with other options to use they may have forgotten (and us too..when was the last time anyone went to a pain management class for the latest interventions or studies???).

Good luck to you...hope this is a helpful more proactive idea for all of us nurses that deal with this time and time again!

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Specializes in Critical Care/ICU.

I agree with Twitty ....

LOL!! :rotfl: Sorry, I couldn't help it, but isn't is Tweety!!

Thanks for the laugh, and I hope you don't mind it being at your expense 3rdShiftGuy!

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