I know I did the right thing

[perfexion, ASN, RN]

When I was an outpatient OB nurse, I had a patient who confided in me that she used Marijuana to combat her morning sickness. She told me that the doctor wrote her a prescription for anti - nausea medication but her insurance didn't cover it and she couldn't afford the monthly cost, (both Reglan and Diclegis go for anywhere from $500-$750 a month without insurance). She had tried ginger, sea bands, unisom, and peppermint tea to no avail. The Marijuana, she said, worked wonders.

She wasn't what we envisioned a typical user to look like. She wasn't a pothead. She was highly educated, upper middle class, had a good job and was very well kept, (well according to Weeds, I guess that is how we envision Marijuana users). She knew it was wrong, and she said she only smoked in the morning to get through the day. She had the type of job where she couldn't call in sick and she couldn't function at all with the morning sickness.

I told her I would work with her doctor to get a more affordable medication if she promised to stop smoking. She agreed but she didn't want me to tell the doctor that she was using drugs. I was so torn. Was my legal obligation to the patient to keep her secret, or to her unborn baby? I got the patient a prescription for generic zofran and very reluctantly told the doctor about her Marijuana use. The doctor flipped out, lectured the patient and immediately called the social worker in to talk to her. The social worker requested a urine toxicology and started a case on her. I knew she felt so betrayed and I was felt so guilty.

Today I question whether I should've told the doctor. The patient never returned. She never answered our phone calls or our telegrams. We never heard from her again. I figured she and her baby are all right now but to this day I think about her. I know I did the right thing but it just felt so wrong. What would you have done?

[BSNbeauty, BSN, RN]

You did the right thing in notifying the doc. Dont ever doubt that.

[klone, MSN, RN]

You did the right thing. The physician is the one who handled it VERY poorly.

[SmilingBluEyes]

there was nothing else you could do. The doctor is the one handling it wrongly. Let it go.

[Elvish, BSN, DNP, RN, NP]

A few things come to mind here:

1) I absolutely agree with the other posters that the MD needed to know this, and s/he did a ****-poor job of handling the situation. If a pt is having morning sickness so severe that MJ is the only thing that works, a doctor definitely needs to be in the loop AND able to work with the pt.

2) I have had many a hyperemesis pt tell me that MJ is the only thing that remotely touched their symptoms....and that was in the hospital with IVF, Compazine, Reglan, Zofran, Phenergan, and even Droperidol back in the day. I'm willing to believe it considering what it does for other conditions.

3) It is protocol in most places to do a drug test on someone who admits to using illicit drugs (even though MJ is not high on my personal list of priorities) and for the SW to get involved, though the pt has the right to refuse both. However, the point is not - or at least, should not be - to punish. It should be to work with the pt to find other possible resources and/or ensure the baby's health.

I guess I'm fortunate to work with the docs I work with. I've never seen anyone lecture a pt about their drug use regardless of the pt's background or whether they look like the 'typical' user. Nurses, yes. Doctors, no.