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Question about prescriptions

Posted

Specializes in nursing ethics.

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?

Sour Lemon

Has 9 years experience.

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.

CharleeFoxtrot, BSN, RN

Has 10 years experience.

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.

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 8 years experience.

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

Mywords1

Specializes in nursing ethics.

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

Sour Lemon

Has 9 years experience.

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?

CharleeFoxtrot, BSN, RN

Has 10 years experience.

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

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 8 years experience.

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.

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

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?

CharleeFoxtrot, BSN, RN

Has 10 years experience.

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.

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

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.

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.

RNNPICU, BSN, RN

Specializes in PICU. Has 13 years experience.

I think the concern is that the patient wants a specific medication that does have side-effects. Just because the patient does not feel that they are groggy, altered, etc, does not mean that they are altered. Why didn't the patient want to try something less sedating. And yes, in an outpatient setting, if the doctor had prescribed a medication that caused an alteration in mental status of any kind, and that patient drove a car and crashed, the doctor could be liable.

Nowdays, there is a much heightened control over controlled substances and the realization of over-prescribing of pain medications likely had a relationship to the opiod addiction crisis.

What was the pos-op plan? What were the pos-op instructions if pain did not subside or increased?

Mywords1

Specializes in nursing ethics.

I don't have anyone to drive me, at all. The hospital is strict--they won't permit a taxi ride or a bus either. The procedure is done in the doctor's office/clinic. It is very short but nasty pain. Doctor offered to do it in the hospital with staff and anesthesia as I did first time 2 years ago when small cancer was found. It took much longer, a production. I am happy because he enabled me to beat the odds of the cancer returning. Chances are small now.

I still think my PCP should prescribe it. I have HMO insurance, so there aren't so many suitable PCPs nearby.I have been a patient of both docs for about 2 years. It took me a long time to find the PCP.

I appreciate your answers. You are the only people I told this to.

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Is UBER or LIFT transport in your area -- you can call your UBER or LIFT "friend" to pick you up thus having safe transport post procedure.

CharleeFoxtrot, BSN, RN

Has 10 years experience.

36 minutes ago, NRSKarenRN said:

Is UBER or LIFT transport in your area -- you can call your UBER or LIFT "friend" to pick you up thus having safe transport post procedure.

Also OP check for a branch of Jewish family Services, or Catholic Social Services (you don't need to have a specific faith to use their services BTW) in your area. Some branches offer volunteer drivers/sitters for procedures. The volunteers who have been background checked drive, wait through the procedure and take you home again. We use them all the time for folks needing procedures like colonoscopy that have no one to drive them home afterwards.

DextersDisciple, BSN, RN

Has 8 years experience.

12 hours ago, Mywords1 said:

I don't have anyone to drive me, at all. The hospital is strict--they won't permit a taxi ride or a bus either. The procedure is done in the doctor's office..

this is not strict this is policy at the vast majority (if not all) hospitals. I work in a procedural area and if you don’t have a ride then you get nothing via IV. Doesn’t matter how you personally tolerate it, it’s a safety and liability issue for the hospital.

Bus or Uber is fine BUT you need a friend to basically chaperone you as you leave the Dept and during the ride home.

or just get anesthesia. All good options.

CommunityRNBSN, BSN, RN

Specializes in Community health. Has 3 years experience.

On 5/4/2020 at 2:29 PM, CharleeFoxtrot said:

Also OP check for a branch of Jewish family Services, or Catholic Social Services (you don't need to have a specific faith to use their services BTW) in your area. Some branches offer volunteer drivers/sitters for procedures. The volunteers who have been background checked drive, wait through the procedure and take you home again. We use them all the time for folks needing procedures like colonoscopy that have no one to drive them home afterwards.

That’s a great idea!