Jump to content

Question about prescriptions

Nurses   (1,212 Views | 25 Replies)

Mywords1 specializes in nursing ethics.

806 Profile Views; 50 Posts

If the  patient wants a strong pain reliever (such as vicodin) for a painful procedure and the doctor refuses it because of possible side effects--though the patient does not experience that ,and the doctor says he is responsible for any after effects--,

is it all right or customary for the primary doctor to prescribe a few tablets

for the patient. Only two times a year?

Share this post


Link to post
Share on other sites

Sour Lemon has 9 years experience.

3 Followers; 4,444 Posts; 33,496 Profile Views

2 hours ago, Mywords1 said:

If the  patient wants a strong pain reliever (such as vicodin) for a painful procedure and the doctor refuses it because of possible side effects--though the patient does not experience that ,and the doctor says he is responsible for any after effects--,

is it all right or customary for the primary doctor to prescribe a few tablets

for the patient. Only two times a year?

Are these two different doctors? I can't tell.

I'm not sure anything is "customary" to the point where it should be expected. Each situation is different. Each patient is different.

The doctor doing the procedure should be the one to decide what drugs are in the patient when the procedure is done. The doctor providing follow-up care would be the one to decide what follow-up care was needed.

I'm been prescribed one tablet of a specific medication on two different occasions, so "small" prescriptions are not unheard of.

Share this post


Link to post
Share on other sites

CharleeFoxtrot has 7 years experience as a ADN, RN.

657 Posts; 8,558 Profile Views

5 hours ago, Mywords1 said:

If the  patient wants a strong pain reliever (such as vicodin) for a painful procedure and the doctor refuses it because of possible side effects--though the patient does not experience that ,and the doctor says he is responsible for any after effects--,

is it all right or customary for the primary doctor to prescribe a few tablets

for the patient. Only two times a year?

 

Is it all right? You'd have to pose that question to your PCP. 

But IMO it's not the PCP's job to prescribe narcotics for pain caused by another doctor's procedure. In fact, in our office it is the rule to refer the patient back to doctor that did the procedure. This is in part due to the prescribing laws in the state where I practice. 

Share this post


Link to post
Share on other sites

KatieMI has 6 years experience as a BSN, MSN, RN and specializes in ICU, LTACH, Internal Medicine.

2 Followers; 1 Article; 2,564 Posts; 43,473 Profile Views

4 hours ago, Sour Lemon said:

 

I'm not sure anything is "customary" to the point where it should be expected. Each situation is different. Each patient is different

The doctor doing the procedure should be the one to decide what drugs are in the patient when the procedure is done. The doctor providing follow-up care would be the one to decide what follow-up care was needed.

It might be so in the book, but oversight rules are so strict nowadays that it is very common for PCPs to prescribe short term courses of controlled substances after (and before as well) procedures. In fact, many surgeons do not even have DEA numbers, preferring to stay out of trouble. Of course, by this they put PCPs into the hot pot, but who cares. 

Also, if a patient needs chronic controlled substance and has "controls agreement" paperwork signed with the provider A, then it is illegal for that patient to obtain and fill scripts for controlled substances from anyone else but the said provider A. Such scripts are immediately "flagged" by pharmacists, can be denied, provider who signed the script can be reported directly to authorities, etc. The exclusions are possible, but rules are so awfully complicated and restrictive that no one in right mind will do a step in that direction. The rules were developed to stop "docs shopping", but in reality they just make lives of many patients literally not much worthy of continuing them. I followed quite a few buprenorphine or methadone "supported" patients (I.e. opioid addicts who already fought addiction itself and now are on possibly life long "pharmacologic support" for prevention of recurrence) in hospice because enrolling them there was the only way to give them additional  pain killers and anxyolitics they needed for, say, going through cancer treatment with >90% chance to cure them completely. 

 

 

 

Edited by KatieMI

Share this post


Link to post
Share on other sites

Mywords1 specializes in nursing ethics.

50 Posts; 806 Profile Views

The doctor doing the short procedure  will not permit  the drug because it makes some patients groggy and cannot drive, but NOT me. My primary doctor refuses because it is a narcotic and its not her procedure.  I feel they are both insensitive to the pain.  I scream. There is no followup.

Edited by Mywords1
clarity

Share this post


Link to post
Share on other sites

Sour Lemon has 9 years experience.

3 Followers; 4,444 Posts; 33,496 Profile Views

1 hour ago, Mywords1 said:

The doctor doing the short procedure  will not permit  the drug because it makes some patients groggy and cannot drive, but NOT me. My primary doctor refuses because it is a narcotic and its not her procedure.  I feel they are both insensitive to the pain.  I scream. There is no followup.

Maybe you should seek alternate care providers?

Share this post


Link to post
Share on other sites

CharleeFoxtrot has 7 years experience as a ADN, RN.

657 Posts; 8,558 Profile Views

Can you have someone else drive you back and forth from the procedure? That is a solution.

Share this post


Link to post
Share on other sites

KatieMI has 6 years experience as a BSN, MSN, RN and specializes in ICU, LTACH, Internal Medicine.

2 Followers; 1 Article; 2,564 Posts; 43,473 Profile Views

2 hours ago, Mywords1 said:

The doctor doing the short procedure  will not permit  the drug because it makes some patients groggy and cannot drive, but NOT me. My primary doctor refuses because it is a narcotic and its not her procedure.  I feel they are both insensitive to the pain.  I scream. There is no followup.

If you are in pain NOW, go to ER. Not in urgent, but in ER.  

If the situation is just prospective and you are afraid of what might happen, politely tell your PCP once that the procedure can be "not hers" but you as a patient still "hers" and would she please do her job. If that doesn't work, fire her immediately.  

Share this post


Link to post
Share on other sites

JadedCPN has 13 years experience as a BSN, RN and specializes in Pediatrics, Pediatric Float, PICU, NICU.

1 Follower; 991 Posts; 8,636 Profile Views

3 hours ago, Mywords1 said:

The doctor doing the short procedure  will not permit  the drug because it makes some patients groggy and cannot drive, but NOT me. My primary doctor refuses because it is a narcotic and its not her procedure.  I feel they are both insensitive to the pain.  I scream. There is no followup.

So the issue isn’t that the procedural doctor will not prescribe you meds, it’s that they won’t prescribe them if you plan on driving? 

Share this post


Link to post
Share on other sites

CharleeFoxtrot has 7 years experience as a ADN, RN.

657 Posts; 8,558 Profile Views

7 minutes ago, JadedCPN said:

So the issue isn’t that the procedural doctor will not prescribe you meds, it’s that they won’t prescribe them if you plan on driving? 

That's my take on it, which is why I suggested having someone else drive so that the procedural doctor can give her pain management.

Share this post


Link to post
Share on other sites

JadedCPN has 13 years experience as a BSN, RN and specializes in Pediatrics, Pediatric Float, PICU, NICU.

1 Follower; 991 Posts; 8,636 Profile Views

5 minutes ago, CharleeFoxtrot said:

That's my take on it, which is why I suggested having someone else drive so that the procedural doctor can give her pain management.

Agreed. And that’s actually extremely common and I feel reasonable for the procedural doctor to ask that. 

Share this post


Link to post
Share on other sites

13 Followers; 4,117 Posts; 32,245 Profile Views

Regardless who should be on the hook for this, there is another underlying issue: The patient's word that the medication doesn't affect him/her in a certain way. The patient wants someone to prescribe the controlled substance without regard for published warnings and cautions, it seems. (?)

The patient needs a driver/ride or another pain control plan.

Share this post


Link to post
Share on other sites
×

This site uses cookies. By using this site, you consent to the placement of these cookies. Read our Privacy, Cookies, and Terms of Service Policies to learn more.