Going to the Doctor while in Monitoring Program- Need Advice!

Twoyearnurse · Mar 14, 2017

Hey hey! I've actually started bringing a copy of my contract a day or so before the appointment is scheduled. I tell the practitioner "I am in recovery and part of that is this contract from the BON. I wanted to make sure you had time to review it and get any questions you may have about my recovery and what this all means". Some practitioners are familiar with the process and others have been pleased that I afforded them the opportunity to ask questions. The deal is that not many folks are aware of this and I figured out early on that the negative reaction was related to them feeling tricked.

They have licenses to protect too and are likely freaked by hearing anything about monitoring agreements. They don't want to feel like maybe they took a misstep in the treatment they've given. I've had zero bad reactions since.

Id reconsider going back to the same practitioner, maybe they were just caught off guard.

KyBeagle, ASN · Mar 14, 2017

Stopping by the day before is a great idea. I've not heard of anyone doing this before. The only reason I waited until the end of my dental appointment is because I started out with the dental hygienist-- didn't meet the dentist until midway thru my visit, with my mouth already propped open & couldn't talk!

I've been focused on discussing this privately with the dentist. I never considered dropping this by the front desk and requesting the dentist (or any physician for that matter) review prior to my appointment. That does appear very proactive. Great idea! :)

amoLucia · Mar 14, 2017

I have no personal experience with recovery programs that so many of my peers struggle with. You all have my deepest admiration for all you face.

OP - as to your post, might your provider have felt like you 'blindsided' her when you hit her up with your contract at the END of your visit? Perhaps, there would have been better outcome if you had been upfront early, even before any exam was performed? That really took me by surprise that you delayed - might your dentist have felt you were using her???

I can understand your sense of shame as you no doubt have faced this dilemma many times over. But many HCPs have been 'snookered' before and will resist anything/anybody that appears to be taking advantage of them.

I really want to think that may have been the problem. For the future, just be forthright early.

Good luck to you. Holding good thoughts for you and all others.

KyBeagle, ASN · Mar 14, 2017

I have no personal experience with recovery programs that so many of my peers struggle with. You all have my deepest admiration for all you face.
OP - as to your post, might your provider have felt like you 'blindsided' her when you hit her up with your contract at the END of your visit? Perhaps, there would have been better outcome if you had been upfront early, even before any exam was performed? That really took me by surprise that you delayed - might your dentist have felt you were using her???
I can understand your sense of shame as you no doubt have faced this dilemma many times over. But many HCPs have been 'snookered' before and will resist anything/anybody that appears to be taking advantage of them.
I really want to think that may have been the problem. For the future, just be forthright early.
Good luck to you. Holding good thoughts for you and all others.

Thanks, amoLucia! I appreciate your support from someone that hasn't been in recovery. I had been a nurse for 22 years before I took that medication in my pocket that I needed to waste. I sincerely appreciate your acceptance because until THAT DAY ---I believe that I was one of "those nurses" that was somewhat disdainful of anyone with an addiction. That attitude developed after 20+ years of ED experience. My mistake has certainly caused me not to be so judgmental of others, regardless of what their mistakes or opinions might be.

In respect to my post- I had waited til the end of my visit to hand over my contract because I wanted to speak directly with the dentist. However, I was seen by the dental hygienist first, mouth propped open, then the dentist arrived & I couldn't speak! In retrospect, I should have clarified that I would see the dentist before proceeding or just discussed with the hygienist... Lessson learned! I have a new patient visit with a dentist next week. Thank you for your input!!

tarab333, BSN · Mar 14, 2017

KyBeagle, I am in the same monitoring program with you in Kentucky and I am also monitored in Ohio. I totally get where you are coming from, it's scary, somewhat humiliating, and just....sux....However, I actually found my MD by asking others in recovery who they see, and I ended up with a true gem of a physician in Ohio. He became my doctor about 10 years ago, so he was my doc thru 1st recovery and is still my doc thru my relapse. I cannot tell you how comforting and ego boosting it is to have a conversation with your doc about recovery and the disease of addiction. We had a long discussion this time around about the disease of addiction and he is completely supportive and encouraging. He is also familiar with the paperwork that the various boards require. If you can network a bit, you may be able to find a doc/dentist/endo, etc that is "recovery friendly." I also agree that it should be talked about BEFORE any procedure or even a formal appointment. It just ensures that everyone is on the same page. She may have been taken aback, because she was just that, taken aback, unsure of what to say, how to say it etc. Let's be honest here, there is still a huge stigma regarding addiction. I have found that being open, honest, humble and forthcoming always works. When I found my chiropractor and told him of my situation, the first thing he asked was "How long have you been clean?" and when I replied, he CONGRATULATED me. He had actually worked with another chiropractor who was in recovery and was his worksite monitor. The disease touches a lot of lives, once you put it out there, you will be surprised by the positives that come you way. Best of health, Tara

amoLucia · Mar 15, 2017

Thought of this as an afterthought - SOME providers charge a fee for client paperwork that they must complete. I never ever had an issue before, but just recently I needed an MD statement for my NJ handicap driver's license renewal. (State of NJ provides the document, the MD just completes it. And it's an easy peasy one.) My new provider charged me for completing it.

So when their time is their money, it could have been a MAJOR annoyance for your provider to have to STOP and READ and then COMPLETE the documentation. Your paperwork sounded like it could take some time to complete and that you really weren't able to just leave it with the office to complete. Another reason to NOT have just sprung it on her.

I know there are some doctors out there who are very selective about pts needing Workman's Comp, Disability, and/or insurance paperwork. It can be quite time consuming.

I'm guessing there's a CPT code in there somewhere.

Meriwhen, ASN, BSN, MSN, RN · Mar 15, 2017

IMO, if you haven't already, get a new dentist. This one clearly has already passed judgment on you, and you know that once a person has done that, it's incredibly hard to change their perceptions.

(ah, I see you've already done that. Good.)

Second, I agree with stopping in/calling in the day before to let them know about the monitoring program and the paperwork. That way they know up front what you're dealing with and can start working with you to get the best possible care while making sure you stick to your contract. And it also gives them time to get the paperwork done and ready for you.

Hope your tooth feels better soon!

allnurses Guide · Mar 15, 2017

In the 5 years I was always very open with my doctors and dentists. I would tell them up front that I was in recovery and from what substances and that I was in a monitoring program. They always treated me with great kindness researching alternative pain management and even going to bat when they felt that limited opiate use was justified and under what conditions.

Except for the initial shame in the beginning - I never felt a lot of shame once I fully embraced my recovery. I took all the necessary steps to recovery and now 15 years later I still feel the pull of ETOH from time to time - but I turn it all over to the God of my understanding and keep trudging.

Hppy

TexasNurse2014 · Apr 13, 2017

In February I got a really bad sinus infection and cold with a really bad cough. I went to my PCP and he gave me antibiotics and Cheritussen with codeine. I explained to him that I was in a monitoring program for nursing because I had history of prescription drug addiction and I had to have him sign my paper and list all prescriptions that were prescribed. No big deal at all. It can be kind of embarrassing but they know that things like this happen.

IrishCMSRN, BSN, RN · Apr 14, 2017

You know it is very embarrassing revealing the need for the extra paperwork etc. and explaining the monitoring programs . I actually avoided going to doctor appointments for exacerbations because of this reason. My experience in recovery as a nurse has only showed me that I have been judged the most harshest by others who are in the healthcare professions. I don't know what advice to give you I could not overcome the embarrassment and reliving the judgment over and over again every time I had to re-explain it to another nurse or another doctor but please know that I understand your situation and I feel exactly how you do !

Recovering_RN · Apr 14, 2017

I'm with Irish on this one! I've never gotten over the embarrassment and I avoided doctors appointments when I first got into monitoring. I put off my annual obgyn exam for almost a year! But I finally broke down and went. I ended up not telling him anything about my monitoring program at all. I figured if my case manager somehow found out and called me on it, I'd go back and get it signed. I'd tell my case manager that I was sorry, I should've already faxed in the form, but the doctor's office had been busy so I'd left it with them to fill out later, and I needed to go and pick it up.

But seriously, how would they ever find out I had gone for a routine doctor's appointment? As long as no narcotic prescription was written and picked up. After that, I did the same thing with my dentist. No script for narcotics so there's no way my monitoring program would ever know I had gone!

I even had a colonoscopy done, and for that, because of the sedation, I went in prepared to suck it up and admit I was in monitoring and needed these forms signed. But in the end there was never an opportunity to talk to the doctor about it, everything was such a hustle and bustle! And the nurse preparing me for the procedure gave me a request form to take with me (without me asking, it's standard for all patients) that was a request for records to show an explanation of the need for the sedation for any monitoring agency that may need it. Like they got that request so often they finally added it to their standard procedure! Anyway, I went through the colonoscopy and figured if I got selected to test within a few days where I'd test positive, I'd get that paperwork submitted right away, but I didn't have to test for at least a week or more, and by that time my urine was clean again.

So I'm not saying you should do what I've done, but seriously, how are they gonna know? I was always prepared to suck it up and go to my doctor and ask for them to fill out the paperwork if I was asked for it, but in 20 months it hasn't happened.