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Reality Check 2

Med use and DOT

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First disclaimer - yes, I really hate ambien.

 

Yes, I am a certified DOT examiner with lots of experience.

 

Today is a struggle with people's CHOICES versus their actual NEEDS and medical logic or reasoning.

 

I am in FP but do DOT certs here and manage the patient's general health.

 

Guy in his 50s. Drives HAZ MAT materials. Works 60+ hrs a week. Shifts are 12-14 hours long with only 8-10 off between shifts - BARELY skirting the DOT laws about driving.

 

He acts very privileged and I am supposed to be his Burger King drive thru for whatever he WANTS.

 

He has taken Ambien in the past. Then lied to me at an office visit and said that hypnosis helped him and he didn't need ambien anymore but kept requesting refills. Gut feeling - his wife kipes them.....

 

Wife calls furious that I won't give him ambien and gave him Belsomra samples. He is furious that I made him come in once a year. He says "I am a big guy and 5 mg just doesn't work so I ALWAYS take 10 mg". 

 

I go over Ambien issues and discuss FDA cutting the dose way back in 2011 and I am NOT going to write Ambien for him - period.

 

I give him Belsomra samples and a copay coupon. Wife calls less than a week later and rails us stating that I "don't understand his work responsibilities".  She is going to look up DOT and I WILL give him back his Ambien.

 

I left a voice mail for him on his phone stating that I will not be using ambien for reasons stated and if he feels that is a problem - he can seek another provider.

 

His CHOICE of job is not MY RESPONSIBILITY to chemically manage. Ambien is a bad drug with increased risks of dementia and early death. His decision to work a less than healthy work schedule while TRANSPORTING HAZARDOUS MATERIALS is his bad decision and I am not responsible for medicating him to sleep in the less than adequate 8-10 hours off work between shifts. 

 

SOOOOOO many red flags and privileged attitude and just flat PI&&ED that his guy acts like I am taking an order at a drive through instead of actually practicing safe and sound medicine.

 

I don't care if he leaves the practice. I stand by my decision but am so frustrated by this cavalier and arrogant attitude about dangerous drugs and stupid job choices.

 

Thanks for letting me vent........

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Guest UVAPAC

I am finding these DOT Physicals to become more and more exhausting.  The attending physicians that work amongst our clinic will no longer do DOT PE's and have asked them all to be put on my schedule or our nurse practitioners. 

 

I think you did the right thing in this instance, and "stuck to your guns." 

 

In my experience 99% of driver's believe they are right all of the time, that our decisions/rationale are "stupid" or "unwarranted" and they should be able to do/take whatever they want.

 

I have seen a huge influx of patients on benzo's, narcotics, antidepressants, and sedatives recently.  Many lie/omit information on their forms, and when looked up in the PMP, have all kinds of excuses as to why they did not disclose the information.

 

In my opinion if you lie on the form, it is an automatic disqualification.  If you are on Benzo's/Narcotics it is an automatic disqualification.  Patients who are rude/combative I simply ask to find another practice to obtain a second opinion or a "fair" examination.

 

I would not be able to sleep at night knowing I qualified a driver with "red flags" who was responsible for the death of others.

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Reading this, I'm realizing the gap by NOT running a PMP query by default on CDL applicants.  Just changed our office policy and we will now be doing it all the time.

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Being in a solo family practice - we only do DOTs for OUR patients.

No walks ins.

 

So, I have history to begin with.

 

If they start in on govt conspiracy or invasion of privacy etc - I have more ground and history to stand on. And I tell them they can go back to the doc-in-a-box. They usually straighten up and play nice.

 

Local doc-in-the-box DOT factory is FLUNKING EVERYONE - BMI over 33, neck over 16 inches - go get a sleep study. Might give a 3 month card, might not.

 

Some of those folks are trying to get into our practice knowing I am DOT certified. 

 

I am straight up - "you DO likely have sleep apnea and we aren't going to ignore it or lie about it. Get tested and we will see what happens."

 

A few have never come back.

 

The rules have existed for a long time, the DOT just never enforced them or monitored who did exams (chiropractors????) and now there are actual consequences. 

 

Safety always - my kids are driving out there

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Used.to do tons of DOT physicals in FM and urgent care. Stopped when the new certification requirements hit...I'm not remotely interested in doing these anymore for all of the reasons mentioned above. Just not satisfying and not an effective use of my intellect and energy.

 

Sent from my SAMSUNG-SM-N910A using Tapatalk

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Guest UVAPAC

Reading this, I'm realizing the gap by NOT running a PMP query by default on CDL applicants.  Just changed our office policy and we will now be doing it all the time.

Rev,

 

Out of curiosity would you allow a front office staff member or PCT to access the PMP under your name, or will you require that all of your providers individually look it up?  There are days where I can perform 7 or 8 DOT physicals and looking up each individual gets quite time consuming.  I typically do it for any patient who has admitted to currently using, or previously using any controlled substance (or if for some reason I am suspicious of them).  

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I have been in offices where MA/RN look up list, print it out and attach to chart for provider to see.

 

I am not in a clinic where I have an MA mentally capable of handling this ---- see other threads on office nursing. 

 

So, I am stuck doing it myself in order to know I looked up the right person and got the right info.

 

MA of mine vacating soon - she just doesn't know it yet.

 

Hopefully getting someone I can trust soon and take that off of me.

 

PS - I am still stranded in the state of Washington with their Prescription Look Up program. They are technologically deficient and have strangled my access for the 3rd time in eight months by failing to validate my application through their cloak and dagger 3 step cryptic email password process.

 

I can only look stuff up if they make the damn program work right.....................................

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Rev,

 

Out of curiosity would you allow a front office staff member or PCT to access the PMP under your name, or will you require that all of your providers individually look it up?  There are days where I can perform 7 or 8 DOT physicals and looking up each individual gets quite time consuming.  I typically do it for any patient who has admitted to currently using, or previously using any controlled substance (or if for some reason I am suspicious of them).  

Most of the office staff are delegates and can do queries on providers' behalf.  I do all my own, and find it takes very little time in my state.  It COULD be more streamlined, but there's also a multi-patient check feature.

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FINALLY, I got the State of Washington to fix my prescription drug monitoring access today and she even ran through it with me to make sure it worked.

 

We aren't delegating to anyone in our office out of sheer necessity of intelligence. Sorry - blunt kind of day.

 

My initial response to inquiries - THERE ARE A CRAPLOAD OF PEOPLE ON TONS OF CONTROLLED SUBSTANCES IN OUR SOCIETY.

 

And that isn't necessarily a good thing..............................

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