Narcotics Specialist vs. Primary Care

[mgriffiths]

I work in family medicine and have a pregnant patient who used to be on chronic pain medication for chronic back issues (verified by MRI, but still not good use of chronic narcotics).  She tried to get me to prescribe her narcotics by saying her OB/GYN had okayed it.  I told her I would not prescribe the med unless I had in writing from her OB/GYN that he/she supported the prescription - in reality I was never going to actually prescribe the medication.  Later that day I get a note clearly stating the OB/GYN does not clear patient for narcotics.

Fast forward approximately 4-6 weeks and patient was seen in ED 10 days ago for abdominal pain and found to have hydronephrosis on US secondary to either pyelonephritis or kidney stone.  Three days ago I received an office visit note from a new OB/GYN stating that chronic narcotics are okayed due to patient's diagnosis and he wants me to prescribe them (he did provide her with a short course).  Yesterday she had followup US showing complete resolution of hydronephrosis with no stone.  OB/GYN again states narcotics warranted due to patient's pain even though she is pregnant.

I have absolutely no plans to provide this patient with narcotics, regardless of her drug seeking behavior, as she is pregnant - but curious other's thoughts given the "directions" from the specialist.

[camoman1234]

HAHA!!! That is great! The OB/GYN has a DEA just as you do so he/she can use it. I have had a OB/GYN do that to me as well last year with the exact same story minus her's was always chronic lumbago. I laughed out loud and called the OB/GYNs office, spoke with the MA/RN and told her to relay the message of "If you think it is important/of sound mind to have a pregnant patient that was once deemed non-compliant and abusive with her pain medication a script of hydros or percs than please write it yourself." I got a call back the next day stating that Dr. OB/GYN does NOT write for narcs on any pregnant patient. I thought to myself if you do not do it then why should I? The patient then came back in a few days later wanting her pain medications as the OB/GYN stated it was "fine" for her to have her pain medication. I told her to her face, "I will NOT be given you any pain medication due to X/Y/Z  and if she feels like she needs pain medication then she must go elsewhere. 

[sas5814]

^What he said. I get people fairly often who say "my specialist said I should come here and get you to prescribe blah blah blah". Most recently I had a RA patient come in because she had a sinus infection and couldn't get her infusion that day. No biggie. I'll deal with the sinus infection. Then she tags with "my rheumatologist said you should give me a Medrol dose pack while I'm here because my hands hurt." Nope.... "If he would like for you to have one all he has to do is prescribe it."