Question about prescriptions

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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?

Specializes in PICU.

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?

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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.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

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.

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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.

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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.

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Specializes in Community health.
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!

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I was told that Uber and Lyft are not an option. Since it was too far to walk, it took several hundred dollars for a plane ticket, car rental, and lost wages for a relative to fly in from out of state just to drive me to and from the surgery center. Relative told me not to ask them to do that again. Next time I will not schedule any procedure where I have to produce nonexistent transportation out of thin air.

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Maybe I'm biased, because I'm in primary care (as an LPN - NOT a clinician) but this kind of makes no sense. So the doctor doing the procedure says no to the pain med because he feels it's not safe for you to drive after taking it. Yet he is just fine with you driving off on that same pain med as long as he isn't on the hook if something happens because he didn't prescribe it?

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Specializes in ER.

CRAIGSLIST

Hire a "friend" to drive you home. Actually, I'd call an Uber and see if they have someone willing to be your friend for the time it takes to get home.

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sure it's "alright," as long as the primary is okay being responsible for the prescription & any negative consequences of prescribing. how would you, I mean the patient, know ahead of time if they aren't going to experience those side effects? ?

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On 5/3/2020 at 9:23 AM, 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.

The patient should not have the procedure if there is no one to drive him home. This should be made clear to the pt from the moment the procedure is scheduled. Usually a facility will have a nurse contact the pt and get the history, give instructions for prep, and explain the rules - like requiring that the driver be at the facility the whole time the pt is there. This interview with the nurse takes place before the day of the procedure so you can cancel or reschedule if no driver is available.

I think you ought to try talking to the surgeon about your concerns and if you don't get anywhere, you might want to report the surgeon to the licensing board for not giving you all of the rules prior to the procedure and for forcing you to suffer. It is surely immoral and unethical to not treat pain caused by some procedure that causes pain.

Try talking to your surgeon before he/she does any work on you. If you get nowhere, try to find someone who has a better way of handling pain produced by his or her procedures.

Doctors are very afraid these days to prescribe pain killers because people who abuse narcotics have made it bad for those who don't and for the doctors who operate on people. But to just refuse all pain med to every patient is not right.

I don't know that a doctor is responsible for side effects. If the doctor has asked you about allergies and if you have ever had a bad reaction to the pain killer, that's about all he/she can do. It is not possible to predict all side effects every pt will or might have.

For instance - I am able to take IV Toradol but taking the tablet made me anxious, itchy, and SOB. I think it must have been some filler, dye, coating, stabilizer, or some other component that is in the pills and not in the IV med. I had never taken it before, so had no idea. And there is no reason to expect that the prescriber

(or I) should have or could have known I would react that way to the pill. But I know now and make that known if I happen to be having a procedure that necessitates pain killer.

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On 5/3/2020 at 12:21 PM, KatieMI said:

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.

It's not the Primary's job. It's the surgeon's job.

On 5/6/2020 at 5:42 AM, caliotter3 said:

I was told that Uber and Lyft are not an option. Since it was too far to walk, it took several hundred dollars for a plane ticket, car rental, and lost wages for a relative to fly in from out of state just to drive me to and from the surgery center. Relative told me not to ask them to do that again. Next time I will not schedule any procedure where I have to produce nonexistent transportation out of thin air.

What will you do?

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