Moderator ventana Posted June 27, 2011 Moderator Share Posted June 27, 2011 Maybe in your alternate universe... but this very notion is the antithesis of medical "CARE"... I guess they are teaching "Patient Focused and Centered Care" a bit different now-a-days... :sad: Personally, I couldn't give two $hits what "company" signs the checks... I work for and my responsibility is to THE PATIENT...!!!! Contrarian EDITED - I wrote this then RC "set me straight and I went and re-read the OP and realized I was wrong..... not an occ health visit but instead and urgent care visit wow - once again Contrarian throws outsomething that just does not make sense (see below where he advocatesdifferently) In Occupational Health you have a fiduciary responsibility the thecompany that is paying you – yes you still do have a provider/patientrelationship but there is a 3rd party to the equation that yousimply can not ignore. And in fact yourresponse shows a stark lack of insight that is startling from an experienced PA. When a company hires you to performpre-employment H&P and a drug screen your primary responsibility to the Company – while not the typical arrangement this is the standard in Occupational Health. If this were aurgent care clinic and her health insurance were paying it would be as you so clearly stated. "I couldn't give two $hits what company signs the checks" just shows a true dedication to your patients but a lack of understanding of Occupational Health - did you know that in Occ Health the company has full rights to all the medical records? Once again this is not primary care or psych and you can not merely apply your experiences to it - the one concerning thing is your loss open mindedness towards areas that you are clearly not an expert in. Slow down and realize you do not know every thing about every speciality As for your patient centered care remark - - you are merely hurling insults - Once again - this is Occ health and the OP WAS NOT a primary care provider or psych or ever ER provider. Possibly your years in psych have created a bias that you are unaware of as this is really basic occ health 101 topic and has nothing to do with patient centered care. It does have some relevance to doing the right thing as a patient has admitted to taking some one elses medications and I would think you all all people would understand the negtive of this. In fact you proport this in your follow up post where addicts will do just about anything to feed their addiction..... oh yes and as we all are aware what she did was illegal! Contrarian - before you unleash your torrent of rhetoric please do a little research in where the provider's responsibility is with Occuational health and then make an educated commented and please avoid the personal insults and taunts........ and to answer you question I am a strong patient centered advocate when it is appropriate and have numerous advanced degress on top of a decade of experience... by no means as I a newbie, young, or inexperienced..... and in my primary care position I am a strong patient advocate and focus on delivering exceptional care - as this is my place - But in none of my jobs will I personally lie, or break the law, to cover up a possible patient addiction as this is actually harming the patient. Yep... emergently for procedural medicine, but NOT to be taken home. Use Robaxin.... Flexeril... or Baclofen for outpatient muscle relaxation. Tooo easy to get into trouble with Benzos and Opioids individually and in combo. Also wouldn't want to contribute to the "entreprenurial exploits" of the Rx drug diverter/dealer. Lots of addicts trade Benzos for Opioids and also use them together since they have synergistic effects. Just something I learned from my time in Addiction Medicine Contrarian Link to comment Share on other sites More sharing options...
rcdavis Posted June 27, 2011 Share Posted June 27, 2011 Wait a minute.. I just re-read the OP . He was in an urgent care, seeing her for her anxiety symptoms. I do not think he was/is working in an occ med position. The company required drugscreen seemed to be an historical background issue ( and arguably her true agenda), but , as I see it, HE WAS NOT BEING ASKED TO PROVIDE THE PRE-EMPLOYMENT PHYSICAL NOR THE URINE DRUG SCREEN. He was being asked to evaluate her anxiety, as a primary care provider. Did I miss something? If the purpose of her visit was a preemployment PE and uds, then all my original comments are wrong and do not apply. However, if I am correct in my reading and he was acting as a PCP to a patient presenting with a specific set of symptoms and complaints, then all these discussions about how controlled drugs should ge limited and how we should ge ever so wary about illicit drug abuse, and how she should face the music .. Blah blah, is simply blather. A young lady presents with a not uncommon set of symptoms consistent with acute situational anxiety. Not chronic anxiety or undifferentiated anxiety or anxiety masking underlying depression. There is no sense of drug abuse or impropriety that the OP picks up. Something ALL of us have seen. Benzos are the perfect drug for that. Low dose, short term ( less than a week, probably 3-4 days is what most people need) RAPID ACTING anxiolytic. She does not need a drug which will help her in 4-6 weeks as it achieves a therapeutic threshold, nor does she need counselling, nor does she need psychiatric referral. I am not a candy man. BUT If I am in the position of acting as a HCP, in an office where I am seeing her as a patient and am not acting as an agent for a third party ( eg occ med preemployment PE or UDS), And if I am seeing her in a traditional sense where I take a hx Do a PE and then make an assessment as to what I think is wrong, Then I make, as we all do, a value judgment as to treatment of what I think is wrong with the patient. ( does she have strep? Should I give an injection of bacillin Or give a prescription for pills? Does she need concurrent steroids?) While we are all on our respective high horses, I respectfully request my peers to review the OP. And ask yourselves: What about this case is it that kept the OP awake, and bothered him? And, Within the boundaries of being absolute fools about controlled drugs, are we self righteously straining the quality of mercy? Oh yeah, one last thing. OF COURSE it is wrong for ger to have taken her boyfriend's Valium. Just as it is WRONG for you to write a prescription for you neighbor without a written record of the hx PE and tx at you place of business, and Just as it is wrong for you to take ANY medication prescribed for someone else.. Even a motrin. But I gotta admit, even I have done it.. Taken a phenergan from a nurse's stash for vomiting... A large part of our job is evaluating the shades of grey as contrarian earlier said. All things being equal, I think I would have tried to help her by giving her the benzo. Primarily because in this case I believe it is the appropriate drug to address her immediate symptoms, The fact that it would give her " cover" is an added benefit. I am not prescribing the drug to do that, I am taking care of her as best I can. Humble, merciful, thoughtful, careful, and compassionate, gentlepeople. And maybe a whole lit less judgmental davis Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 27, 2011 Moderator Share Posted June 27, 2011 wow - I was way off!! went back and reread the OP and it does appear that this was a primary care/urgent care visit in that case all my babble about Occ health is purley wrong in this setting - if she went through her health insurance and this was a primary care visit then I agree with the above (and you contrarian) it would only boil down to rather to give her a script for a benzo so she might pass the drug screen - in fact most drug screens are Mass Spect confirmed these days so the only choice to "help" her keep her job is to give her the diazapam that she took - since I do not use this first line for anxiety I would not have given her any. Instead - CBT/DBT therapy, self help books, check a General Health Panel, refer to talk therapy (CBT/DBT) and............ EXERCISE!! I can't think of any 'new' patients that walked out of my office (that were not in obvious withdrawl with Tachy, diarrhea, sweets, htn......) that left my office on the first visit with a benzo script. I strongly beleive Anxiety is best managed with exercise, talk therapy, SSRI/SNRI then psych consult in that order - sorry just don't buy into chronic benzo's on a new patient for anxiety - a long standing patient that I can trust might get some xanax or valium but never on first visit....... sorry I misread the OP - don't flog me Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 27, 2011 Moderator Share Posted June 27, 2011 my take rereading the op was that this was an urgent care ctr, a place for episodic care, not a pcp appt. if I misread this then I'm sorry, but this does not sound like a pcp type of arrangement but a 1 time appt. Link to comment Share on other sites More sharing options...
winterallsummer Posted June 27, 2011 Share Posted June 27, 2011 Really...?? Lets come back and try again after a few days/months/yrs without the "Pre" as a prefix to the PA... BEFORE you start spouting off to someone who is where YOU are trying to get to... what THEIR job is. Simply put... Lets get a license to practice medicine before telling those with one... how to do so..! Thanks My point was that he treated her on the grounds of her symptoms and not based on her needing an excuse to get past a drug screening. And telling me to keep my opinion to myself, really, how ignorant is that? Last time I checked you don't need a license to engage in a conversation on-line regarding ethics. His question was did he do the right thing on an ethical ground, I am not pretending to tell him I know what medication was or was not appropriate based on physical or psychological symptoms. I also have worked in health care and largely in psych for three years and like it or not I am just as entitled to my opinion as you are. I mean seriously, come on. This forum should cultivate respect among PAs, PA students and pre-PAs. Especially considering how some people feel PAs don't get enough respect from the outside community, we should at least try to foster respect within our own community. You weren't born with a license and just because you have one now doesn't give you some right to devalue other peoples comments. Link to comment Share on other sites More sharing options...
Contrarian Posted June 27, 2011 Share Posted June 27, 2011 wow - I was way off!! ... I agree with the above (and you contrarian) ... sorry I misread the OP - don't flog me Please consider that the "company" can have you lose your job" which you can always get another one... but the patient can have you lose you career/credentials and freedom.... therefore: The patient always comes first regardless of who signs the check or who "owns" the documentation... If you always do right by the patient... the rest will take care of itself... Sometimes... I do know what I'm talking about... :wink: My point was that he treated her on the grounds of her symptoms and not based on her needing an excuse to get past a drug screening. Then you should have made your point... and NOT stated this: "Your job was to"... This doesn't change... YOU have NO idea what his/her job is. And telling me to keep my opinion to myself, really, how ignorant is that? Last time I checked you don't need a license to engage in a conversation on-line regarding ethics. Your opinion wasn't the problem here... it was your strongly asserted post starting out telling someone with a license... that YOU are seeking to obtain... what THEIR job is... As stated above... YOU don't know WHAT their job is... This is akin to me entering the cockpit of the next plane I'm on and asserting to the pilot "what their job is"... regardless of the fact that I don't even have a ground school chit... I mean seriously, come on. This forum should cultivate respect among PAs, PA students and pre-PAs. Especially considering how some people feel PAs don't get enough respect from the outside community, we should at least try to foster respect within our own community. You weren't born with a license and just because you have one now doesn't give you some right to devalue other peoples comments. Yep... I AGREE... and that RESPECT starts HERE with respecting those who are... where YOU want to be... and respecting what they know and had to do to get there. Not by telling them "what their job is"... when in reality... you haven't a real clue until you are standing there with the credentials and licenses and the responsibilities. Like it or not... The "opinion" about the practice of medicine as a PA-C ... DOES have different value based upon where one is in the process. If you can't see why this is so... its sad ...because in essence you are saying that the 16yr old kid, custodial engineer, legal clerk, ceramics designer, etc... who just found this site today... caN OPINIONATE about our profession and their "opinion" is JUST as valid and carries as much weight as the opinions about our profession expressed by the PA student who has been up for days studying, or the PA-C who has been practicing for decades. It just isn't so... no matter how hard, or bad you and others want it to be... PA-Cs... daily, weekly, monthly in clinical practice have folks with SOME HCE or health care training attempting to dictate "what their job is"... without the benefit of PA school (or any formal training that teaches the "practice of medicine")... If/When you become a PA-C... you WILL have nurses, techs, aids, social workers, family members, pharmacists, chiropractors, pilots, engineers, teachers, taxi drivers, etc... ALL trying to direct YOUR practice of medicine without them having completed the required training to even have a clue as to the minimum standards and principles at play... Part of the reason we have little professional respect is because EVERYONE who has ever touched a patient thinks they can tell us how to do our jobs without them having completed the required training to even have a clue as to the minimum standards and principles at play... That RESPECT starts HERE with the members on THIS board... Respecting those who are... where YOU want to be... and respecting what they know and had to do to get there. Thinking that simply because you have a computer... and can join a free public forum... means you know as much about what is being discussed here... as the people who are deep within the process or have been through the process... ISN'T respectful. So give some... if you want to get some My $1.50 worth... Contrarian Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 28, 2011 Moderator Share Posted June 28, 2011 ever notice contrarian seems to thrive off long posts and banter??? Link to comment Share on other sites More sharing options...
Contrarian Posted June 28, 2011 Share Posted June 28, 2011 ever notice contrarian seems to thrive off long posts and banter??? Ever notice Ventana can't stand to be called on his BS... and stumbles when trying to "backslide"... ??? Go ahead... admit that "banter" is expressly what DISCUSSION forums are for ... and that it stings a bit when I'm right... especially after YOU wrote a long-A$$ed rebuttal... only to find that the entire premise of your response was severly FLAWED... Link to comment Share on other sites More sharing options...
andersenpa Posted June 28, 2011 Share Posted June 28, 2011 So...forgive my ignorace, folks, as an (almost) exclusively inpatient provider. I've been following this colorful thread. If the patient c/o anxiety..... And BZDs are an indicated tx for anxiety.... And there is little suspicion for substance abuse (as much as you can glean from a one time drop in appt)..... The only questions to me are: Are you required to document the pt taking an unprescribed controlled substance that you are subsequently writing for? Are you required to document that the pt has an upcoming drug screen which will test for the drug you are about to prescribe which the pt took, unauthorized? this big theme seems to be liability. if you got deposed about this, the truth might look ugly even though you did the "right" thing...... Link to comment Share on other sites More sharing options...
winterallsummer Posted June 28, 2011 Share Posted June 28, 2011 Then you should have made your point... and NOT stated this... [excess colors, font size, underlines, etc] Contrarian You completely misinterpreted my language. I am not telling this guy how to do his job or what drug to prescribe. He openly asked if we thought he did the right thing on an ethical ground considering the situation. To relate to your trivial airplane example (try not to take this one so literally), no, I am not telling this pilot which levels to pull and buttons to push or pretending to know how to fly an airplane, but if he asks me, "Hey guy, is it okay to let this girl on the airplane even though she's drunk?", I am just as entitled as you are to say yes or no. If you disagree with my opinion, fine, then present your own, which all us pre-PAs wait for in great grandeur for you to bestow upon us lesser medical providers. And next time try not to internalize things so much. My meager $0.00000002 cents worth. Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 28, 2011 Moderator Share Posted June 28, 2011 Welcome winterallsummer!! See you are getting to know Contrarian...... good job on standing up for yourself - sometimes everyone forgets that everyone is entitled to an opinion..... You completely misinterpreted my language. I am not telling this guy how to do his job or what drug to prescribe. He openly asked if we thought he did the right thing on an ethical ground considering the situation. To relate to your trivial airplane example (try not to take this one so literally), no, I am not telling this pilot which levels to pull and buttons to push or pretending to know how to fly an airplane, but if he asks me, "Hey guy, is it okay to let this girl on the airplane even though she's drunk?", I am just as entitled as you are to say yes or no. If you disagree with my opinion, fine, then present your own, which all us pre-PAs wait for in great grandeur for you to bestow upon us lesser medical providers. And next time try not to internalize things so much. My meager $0.00000002 cents worth. Really...?? Lets come back and try again after a few days/months/yrs without the "Pre" as a prefix to the PA... BEFORE you start spouting off to someone who is where YOU are trying to get to... what THEIR job is. Simply put... Lets get a license to practice medicine before telling those with one... how to do so..! Thanks Contrarian Contrarian really goes the extra mile to make people feel worthless - must be all those years in psych.. There is a reason he choose the name CONTRARIAN..... he really likes to post long post and talk about how much he knows and how smart he is.... Good post and don't let the grumbly old psych bear scare you off..... Ever notice Ventana can't stand to be called on his BS... and stumbles when trying to "backslide"... ??? Go ahead... admit that "banter" is expressly what DISCUSSION forums are for ... and that it stings a bit when I'm right... especially after YOU wrote a long-A$$ed rebuttal... only to find that the entire premise of your response was severly FLAWED... more banter...... typical.... now you beat me up for appologizing and admitting you were right - no problem with me admitting that and I certainly did not stumble - in fact I left a previous post up which RC saw and corrected me on - I have only a little pride, but I know when I was wrong and admitted it - you? Link to comment Share on other sites More sharing options...
Hemegroup Posted June 28, 2011 Share Posted June 28, 2011 =winterallsummer;301056 I like you :) You'll make a great provider. It's a tough path, but hang in there and best of luck! Link to comment Share on other sites More sharing options...
just_me Posted June 28, 2011 Share Posted June 28, 2011 well of course in the ER but if this is an ongoing patient/provider PCP type deal then not so simple... that's even easier. "sorry, we don't refill narcotics in the er, you need to get these from your regular dr". Link to comment Share on other sites More sharing options...
vaston Posted June 28, 2011 Share Posted June 28, 2011 Oooh, this one is getting juicy. Contrarian, winterallsummer just broke your serve. Can you break back? (Forgive the tennis reference, I've been watching Wimbledon....) Link to comment Share on other sites More sharing options...
Contrarian Posted June 29, 2011 Share Posted June 29, 2011 You completely misinterpreted my language. I am not telling this guy how to do his job or what drug to prescribe... Nope... I didn't "misinterprete" anything... simply read what YOU wrote... Your job was to treat her symptoms, which you did, not give her a get out of jail card for her future employer. Had you considered that your poorly framed point could have been worded better and a bit more respectful to the OP who happens to have credentials YOU are trying to get...??? Probably not huh...??? Anywho.... YOU still aren't qualified to tell the OP or any other PA-C what their job is... regardless of how many silly rebuttals you type...:wink: Ventana... I didn't "beat you up" when you tried to apologize... (See post # 31) I was intentionally humble in that particular response because YOU were good enough to admit that your silly tangent about Occupational Med was misplaced. You were beat about the head and torso when you apologized and couldn't stand to leave it there... so then came BACK and made the remark about the length of my responses... (see post # 32 then #33) Now you are seeking some sympathy from your fan club... and playing victiim... Maybe if you slow d-o-w-n a bit and focus on what I write... and the spirit of what I type... versus simply trying to bicker, fight, and win... you may do a bit better. After all of this back and forth... YOU still haven't convinced ANYone who practices "patient CAre"... that the/a/any patient is NOT the primary interest/concern in any/all interactions that occur during the "practice of medicine." This is becoming a fairly typical FAIL for you...!!! Btw... ban·ter (bntr) n. Good-humored, playful conversation. v. ban·tered, ban·ter·ing, ban·ters v.tr. To speak to in a playful or teasing way. v.intr. To exchange mildly teasing remarks. Verb: Talk or exchange remarks in a good-humored teasing way: an exchange of light, playful, teasing remarks; good-natured raillery. to speak to or address in a witty and teasing manner. As for the rest of you foks... Ha..ha... you guys and gals sure are funny... :heheh: Contrarian Link to comment Share on other sites More sharing options...
winterallsummer Posted June 29, 2011 Share Posted June 29, 2011 Nope... I didn't "misinterprete" anything... simply read what YOU wrote... [more large text, underlines, and, oh my, even a quote from the dictionary, class-y!] As for the rest of you foks... Ha..ha... you guys and gals sure are funny... :heheh: Contrarian Man, I really should stop. Not only have I contributed to this thread hopelessly steering off topic, but I seem to be causing you considerable emotional damage. And as much entertainment as it offers me, and a much needed break from studying, to see how easily I can elicit an emotional response from you, I really should be the bigger person, as I clearly am the only one capable of it. I mean, really, you "attacking" me in other threads, you clearly are being bothered by this throughout the day. So here I am, a meager pre-PA, and I am going to try to give you some advice (oops! I'm not supposed to offer advice to PAs, oh well!) 1. The next time you get this frustrated, take ten deep breaths. You'll be surprised how much better you can feel after this simple exercise! 2. Write down your feelings. No, not on a message board where everyone else can see you make a fool of yourself by trying to get even with someone who is CLEARLY beneath you as a human being (I mean not only am I a PRE-PA, but I can't even emphasize my points with bold and underlines or spell correctly!). You'd be surprised what a healthy exercise journaling is! 3. When you disagree with someone, try to tell them why you actually disagree with them, instead of uselessly launching into a series of arguments when the only thing you have against them is that you have a title they haven't obtained yet. 4. Find someone close to talk to about your deep rooted anger problems and passive aggressive nature. A friend is a person who you can trust with your feelings. If you can't seem to find one of those, consider buying a dog. After all, they won't even bother to disagree with you! Super! 5. Try to keep the arguments on topic instead of veering off into personal attacks. Oh wait, did I contradict myself? Sorry, maybe once I get a title, my brain will be able to keep track of all this stuff. Nah in all honesty man, as much fun as this has been, I will let you come in and get your next last word, because you clearly need it more than me. But on some real stuff, try to take a day off (or maybe off the forums at least) and relax. There is a lot more to life than trying (failing) to demean someone online. You obviously do have a passion for what you do and seem to have taken time to develop a number of opinions on health care, which I commend you for, as I have met far too many MDs and PAs who lack this luster. Best of luck to you bud. Link to comment Share on other sites More sharing options...
Contrarian Posted June 29, 2011 Share Posted June 29, 2011 ... BLAH.. BLah...Blah..blah... [silly juvenile attempts at witty/snaarky combacks then] BLAH.. BLah...Blah..blah.... Ha... ha... ha... "emotional"... ha..ha.. ha.... "frustrated"... ha..ha...ha... this is "sport." After ALL of the drivel above... like the MA in the other thread... YOU still aren't qualified to tell the OP or any other PA-C or even PA-S what their job is... regardless of how many silly rebuttals you type... In case you forgot: Really...?? Lets come back and try again after a few days/months/yrs without the "Pre" as a prefix to the PA... BEFORE you start spouting off to someone who is where YOU are trying to get to... what THEIR job is. Simply put... Lets get a license to practice medicine before telling those with one... how to do so..! Thanks ____________________________________ The REALLY humorus part is that YOU won't be able to resist... and will post more nonsense that has nothing to do with the fact that YOU still aren't qualified to tell the OP or any other PA-C or even PA-S what their job is... If you were a NP/MD/DO or PA then yeah... but you are none of the above. Which means you have NO training in the "practice of medicine" which is the qualification needed to tell someone who has that qualificaton "what their job is"... Link to comment Share on other sites More sharing options...
Hemegroup Posted June 30, 2011 Share Posted June 30, 2011 Your job was to treat her symptoms, which you did, not give her a get out of jail card for her future employer. She's a college educated adult who must've known she had a drug screen coming up and she took the pill knowing the consequences. Plus what if her story is bogus and she just wants more pills since she enjoyed her boyfriend's? What she was asking you to do was unethical IMO. Besides, she can go to her employer and explain the situation just like she did to you, telling her employer "look I even went for a consult right after" and then it is up to THEM if they fault her for it or not. AGREED. Sound words, very sound. I had a similar situation a few weeks ago, with a patient who got a few Norcos from me after I excised a cyst from their knee, and they took that as license to go HOG WILD with street narcotics, and then came to me asking me to lie for them when they came up positive with their probation officer. I wrote a letter to the officer with the dosage, quantity and dates of what had been prescribed by me ... it's up to them to decide what to do with that information. I will NOT lie for a patient to pass a tox screen. I'm not going to put my personal reputation and license on the line for someone who, quite honestly, wanted to use me. I don't like being used, and I don't like being manipulated. Link to comment Share on other sites More sharing options...
Vulgatus Posted June 30, 2011 Share Posted June 30, 2011 Winterallsummer: excellent posts/contributions Link to comment Share on other sites More sharing options...
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