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Discussion

Is it fair..

First of all, let me start off then I believe patients when they come in and tell me they have pain. I always believe them and give them the benefit off the doubt, even if they don't appear to be in pain. I can't feel what they feel or read minds.

However, is it fair to label a patient as "drug-seeking" when they doctor hop, have narc reports from 5 pharmacies and 20 doctors, visit the er 4 times a month, have urine tox screens come up with 5 things they aren't prescribed and won't admit to taking, (including illegal substances) call for narcs and not follow refill rules, always run out early, etc.? If you can't leave a urine sample when you came in knowing you were getting a drug screen urine test and get angry because you have to wait until you go to get your prescription.. I mean...

I know that it's difficult and I know what pain is like. But if a patient follows the rules they can count on us to provide what they need and respect them. But if they don't follow the rules, which are there for everyone's safety, they get labelled as drug-seekers. Fair judgment or not?

Any thoughts?

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    • Featured Replies

    Fair Observation with evidence listed! No judgement needed; the evidence already sealed the deal. You are only judging that they are seeking drugs; thats fine - clearly it is what they are coming to the doctor for.

    No one can judge if they are in pain or not. Only they know.

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    IMHO These are "drug seeking" behaviors, you are right..... But...Are you labeling the behavior or the person? I have to make myself not label a patient. I ask myself...What un-meet needs are the behaviors are trying to meet? In this case could it be tolerance, dependency unrelieved chronic pain or addiction, depression maybe even other MI?

    This sounds condescending, I know, but this is the only way I can practice in the field of addiction, and not be judgmental. I have to say this to myself many times a week. I do not consider it fair to label, though I find it very hard not to and often donot play fair :scrying:

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    • Author

    I just get frustrated when the patient who wants/is prescribed pain meds refuses to follow the rules. If we call you in for a urine test, it's not personal, it's because something happened, something is wrong, or it's random. Don't waste 40 minutes of my time arguing about why I'm picking on you. The doctor said to call you and get a specimen. I didn't pick you out specifically for harassment. Although you are being awfully harassing and awful to me right now...

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    • Experts

    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 ;)

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    • Author

    We make patients sign a contract they states we can call for random UDS anytime or even call them in for a pill count. I don't know why they don't get this. They think they can "call and request refills too" even though we tell them it's only done at appointments and they sign a form that we explicitly read and give them a copy of at the time of first prescription. I think they just are seeking and want to put up a fight if they may get caught doing something wrong.

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    • Experts
    I think they just are seeking and want to put up a fight if they may get caught doing something wrong.

    Or to have an excuse to use again...because after all, whatever happens it'll be OUR fault in their eyes. Even if they're outright guilty of trying to pull a fast one, it'll still be our fault. Sadly, for some patients, a problem at the clinic is all the excuse they need.

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    • Author

    I feel for them but I am not gonna be involved in a controlled substance issue that can get me in trouble. :/

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    I think a pt can both be a drug seeker AND be in pain. Which is an unfortunate set of circumstances for everyone involved, and probably not a lot of fun to manage medically.

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