How to refuse to Rx narcotics to chronic pain patients?

[Colorado]

On 12/7/2017 at 9:19 PM, camoman1234 said:

Why do ED providers not do referrals. If you did a full work up, why pawn them back off on me (PCP) for me to just write out a referral? I see this a lot and still not sure why waste the patient time/money to come in for a referral. 

Some more urgent referrals are ER generated (ie: to ortho for f/u after an ortho injury/fracture for those that can wait a few days comes to mind) but for non-urgent referrals such as this patient in question (referral to neurology for recurrent migraines apparently not responding to typical 1st/2nd line treatments who has repeat ER visits).... this referral should appropriately come from the PCP (not urgent ergo not the ER providers responsibility. Not to mention if insurance/CMS is involved, which typically always requires PCP generated referrals).

I understand your frustrations.....I'm currently working in Family Practice/am a PCP for many.

Now.... if the ER providers get sick and tired of seeing this person and the pt refuses to go back to their PCP, maybe an ER provider with time on their hands (not likely) would spend the time to get the patient seen by neurology either by arranging OP follow-up or convincing some poor soul in neuro to see them in the ER briefly. However....no guarantees that the pt will go to that outpatient neurology visit either (which also reflects poorly on the ER provider for wasting their time and the neuro's time on a referral/consult and the pt will likely be back in the ER again)

And round the world goes.....

[mgriffiths]

4 hours ago, Colorado said:

Some more urgent referrals are ER generated (ie: to ortho for f/u after an ortho injury/fracture for those that can wait a few days comes to mind) but for non-urgent referrals such as this patient in question (referral to neurology for recurrent migraines apparently not responding to typical 1st/2nd line treatments who has repeat ER visits).... this referral should appropriately come from the PCP (not urgent ergo not the ER providers responsibility. Not to mention if insurance/CMS is involved, which typically always requires PCP generated referrals).

I understand your frustrations.....I'm currently working in Family Practice/am a PCP for many.

Now.... if the ER providers get sick and tired of seeing this person and the pt refuses to go back to their PCP, maybe an ER provider with time on their hands (not likely) would spend the time to get the patient seen by neurology either by arranging OP follow-up or convincing some poor soul in neuro to see them in the ER briefly. However....no guarantees that the pt will go to that outpatient neurology visit either (which also reflects poorly on the ER provider for wasting their time and the neuro's time on a referral/consult and the pt will likely be back in the ER again)

And round the world goes.....

You do realize you're responding to a post from almost 2 years ago...