mlbarnes

In our practice we do not accept patients without documented medical evidence of chronic pain condition/s. Until the records are reviewed and we have made the decision to accept the patient they will not be seen much less given a prescription. We have established narcotic contracts that are specific and explicit with random Ameritox and in office drug screens. If a patient is diverting instead of taking the med, the drug screen is very helpful. We also have a strict policy of no second chances if the patient is diverting the medication or not adhering to their contract. We have found that patients with legitimate conditions do not have problems providing us with records and having a narcotics contract which many times includes agreeing to try different options such as non-opioids both as primary and as adjuncts, and other meds as indicated by assessment and by exhausting all other pain management options first. It is very difficult not to allow ourselves to be influenced by the poor behaviors of others, such as the MA to whom you refer. I have had one MA such as this and I finally had to speak with her about how her attitude was making it difficult for me to do the best job possible for my patients. I did include the clinic manager/HR in this conversation and it was well recieved. It is up to you as the educated professional that you are to set the example. Do not allow yourself to fall into this trap and have a zero tolerance for behaviors which demean the patient. Pain management is a legitimate discipline but because of the nature of the medications it is also very easily abused. Help your clinic develop a plan for patient intake and management if you can, this will help you maintain a positive attitude.