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19 hours ago, mmiller3 said:

I can certainly agree with not giving chronic pain meds, benzos/narcotics combos, or ADHD meds to adults who "just can't concentrate".

Not filling out FMLA paperwork? I wish I had that luxury, but patient satisfaction is still a thing around here. In all honestly, if they take the time and spend the co-pay to come see me, I don't mind filling out reasonable FMLA documentation. It's not like society is any worse off if the call-center is missing an employee for a few days, regardless of the reason.

 

 

It has been my personal experience that the provider caring for the family member requiring the presence/assistance should be completing this form, not the requestors provider!

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Won't fill out an FLMA form...

I will not certify medical necessity for disability or disabled parking permits for most requests, especially things like arthritis which might benefit from exercise and weight loss and parking furthe

FMLA paperwork annoys me, but it is what it is. I am surprised about reluctance to write work/doctor's notes. I am more than happy to write those. People have shit jobs and often need a break for w

I work ER, I am tested every day what I will do.   

I used to not write work notes for "missed" days of school and work.  Now I do, if I think there was an illness, and within reason.  No writing for 7 days missed work excuse.  

I don't write for ambien or "sleeping pills".  

I don't write for erectile dysfunction meds.

I would not write for an emotional support animal.  

I don't do prior authorization for anything! I specifically say to the patient that we won't call the insurance company, if it is not covered then we can try to change meds/equipment or see your PCP. 

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On ‎3‎/‎25‎/‎2019 at 3:02 PM, Boatswain2PA said:

ould

 

On ‎3‎/‎25‎/‎2019 at 3:02 PM, Boatswain2PA said:

"No narcotics for chronic pain"...

This makes me think the pendulum is swinging too far again, and we are not practicing good medicine.

Example - pt with chronic back pain, treat a with daily mobic, stretches, and exercise.  Uses ibuprofen, lidoderm patches, and ice packs for flares, and 1-2 times a month takes a norco before bed so he sleeps better (pain frequently wakes him up).

Would you family practice guys turf him to pain mgmt??

 

I would not turf to pain management.  I have a few patients like that. 

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On ‎3‎/‎25‎/‎2019 at 6:28 PM, PAMEDIC said:

FMLA paperwork annoys me, but it is what it is.

I am surprised about reluctance to write work/doctor's notes. I am more than happy to write those. People have shit jobs and often need a break for whatever reason. I think it is crap that many employers actually require them. Maybe they were legitimately sick. Maybe not. What I do know is that if my little note can keep them employed and provide a small bit of relief from the brutal grind that many on the lower end of the socio-economic spectrum endure, that I am doing my job well.

 

I got snookered when I wrote a work note for a few days off due to my patient's shoulder pain and she was a CNA.  I faxed it over to her employer and sarcastically  said to my MA/RN team, I bet she will be on her snowmobile this weekend even tho she has shoulder pain.  Yup.  She rode her snowmobile, crashed it, hurt her back, went to ER 2 days later, got morphine (Only God knows why they gave her morphine), came to me in follow up and wanted a refill.  Nope, I asked her why on earth she felt she could get a note off of work and then get on her snowmobile????  She got red and flustered and that was the end of her asking me for anymore time off or refills of narcotics. 

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8 hours ago, CAdamsPAC said:

But, what would you do for a Klondike Bar?

I won't go into detail.  Let's just say I've done some things I'm not proud of but, we are talking about ice cream here.  

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On 3/25/2019 at 4:35 PM, JMPA said:

I will not tolerate anyone who is aggressive, belligerent, hostile towards my staff. i have zero tolerance for #&*@$^^holes/bags/ect

Which is your right, but entirely not the point of the thread.  Patients can request things that are legal and permissible, but arguably harmful to them.  Which of those requests would you do or not do?

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For everyon poo pooing on me...or simply disagreeing with my choice not to prescribe narcotics for chronic pain...I urge you all to remember that we are supposed to be lifetime learners. I direct you to barbellmedic.com. Dr. Baraki has compiled much of the emerging literature on pain science. Quite frankly if the patient is not willing to undergo pain management options Including pain psychology, then wht the F should I prescribe narcotics. I did not get into medicine to become a pill pusher of any sort and as a society I feel that is what Americans have come to expect... quick fix gimee a pill or a procedure so I dont have to put any effort into my own well being. And dont get me started on resiliance with our safe spaces.  

Oh, and I will gladly sign sick notes or FMLA...its not my paycheck.

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I wont certify pets or support animals. 

I wont (generally) do FMLA.

I wont give notes for time missed prior to seeing me unless they are obviously ill and they missed the last few days.

I wont do airfare refund paperwork unless they were under my care before their trip and mentioned it. 

I wont refill controlled drugs prescribed by another provider. 

I wont get bullied into giving antibiotics by patients or their doctor parents when it isnt warranted.

I wont order tests just because doctor dad/mom wanted to have them done. If they want it so bad they can order it. 

I wont order random "curiosity" labs that I would end up being responsible for should they be abnormal.

 

Edited by BruceBanner
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On 3/25/2019 at 2:09 PM, ArmyPA said:

No on emotional support animals...I've seen too many untrained ones piss/shit/bite where they shouldn't. 

No narcotics for chronic pain, they all go to pain management. 

I will not initiate stimulant treatment for adult ADHD without prior diagnosis from psychiatrist or psychologist, and I will request psych testing of some sort first if its an adult who has never been diagnosed as a child (MMPI , etc.). 

No benzos for anxiety. I will refill Klonopin if the patient is already maxed out on SSRI/SNRI. 

No stimulants for ADHD for someone who has a diagnosis of anxiety and is already taking benzos...pick one or the other...I dont care if a psychiatrist initiated treatment, he can follow up on it too. 

So what about someone with GAD and panic attacks who does well on daily SSRI but needs occasional PRN Ativan? What if having a bottle in the purse or bag makes them feel more confident going out and doing things? I also fear the pendulum is swinging way to far in the other direction and people are going to be missing out on effective management of their disease.

Edited by lemurcatta
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Guest Elpatodog

I am sort of shocked by our forum and stating all the things we won’t do for our patients 

Maybe we should think about all the things we can do to help our patients

I hope I don’t become callous and say because your diabetes is not controlled and it’s your fault.... ( if that’s what you are really thinking like posted above).....I am not going to fill out FMLA papers for you ..... How about talking with your patient and figuring out why things are not going well for them..... and help them with getting there DM under control...... and then tell them you will fill out the papers and make a goal with the patient to get things under better control or refer to someone that can help them more .......maybe you as a provider are not getting through to the patient...??

Filling out paperwork to help assist a patient get a parking placard for their OA that is so severe that the can barely walk and use a cane to help , which exercise will hopefully help them to maintain function   Because they are on their way to a knee replacement , and yes their family might use the placard to help drive the patient around , oh well, as providers we should try and not be so judgemental about what they are going to do with this after we fill it out. That’s on the patient 

Life is not perfect and we don’t know what patients are going through 

I hope I never look and say I am not doing these things .... whatever they may be... without considering everyone individually.

if you can’t do something for someone I hope you are asking another provider for ideas or asking yourself what can you do differently.

I have been in the medical field for 30 plus years. Twenty of it as a PA.

please do not insult me and start throwing daggers at me about how I feel 

i just felt I needed to speak up because I am shocked by all of this .... if I am the only one that feels this way I am okay with being the lone wolf or maybe I misunderstood what the purpose of this whole conversation was

Because of course there are the basic things I will not do like fraudulently chart or say I did a ROS when I didn’t,  etc.... and please do not insult me about general medical practice about when and when not to prescribe narcotics or what not to give them with.... Because we should all be educated on those issues and if one of our fellow providers is not maybe we can help them understand 

I understand the basics of safe medical care. 

If my patient needs to be referred to a chiropractor then I will do so.... I hear many patients have great pain relief and success with some of their modalities 

I will fill out fmla paperwork for my patients ( of course it goes without saying that it will be legit) 

My question is why would you Not fill it out?? , patients have surgeries, mental illnesses, family illness, sports injuries etc... and it’s a requirement by most all work places I know that patients have to get this filled out if they miss a specific amount of time .Please send them my way I will help.  I am qualified to do this as a PA. I will not add to making a patients life more stressful because I don’t like filling them out, I just do it , it’s part of my job and not everything is fun and I don’t agree with everything I have to do but patients need our service or they will get it somewhere else with someone  that is more qualified ? Or not or maybe another provider like an NP or an MD that is more willing to be open minded and helpful can do it 

I bet most PA’s can do functional capacity exams. Educate yourself on this it’s not rocket science. It may seem intimidating initially but ask someone more experienced for their guidance. You may learn something .

If they need a note off because they were sick the day before and their job is requesting it . I will do, I will be a reasonable provider that will give patients the benefit of the doubt most times....Yep I have been wrong and on more then one occasion.... but I will not crucify everyone else for one patient in the past that has  taken advantage of my good will

I could go on and on but I won’t......

i just want us all to think about what we are thinking and posting for our patients 

I hope my providers doesn’t come at me with “I am not doing this “

How about “Let’s try it this way “ instead 

These are just some thoughts after reading some of the posts 

 

please dont mistake this post  for being about getting a good survey or getting a pat on the back in front of others  to make myself or yourself feel good.  And it’s not about doing more just so the survey gets 5 stars. It’s truly about the simple fact of helping someone to the best of your trained abilities. As the old saying goes “ the more I know the more I realize what I don’t know”

My last thought is maybe you are the only person in the healthcare field that they have contact with  and hopefully you are sending them away with the help that is needed and not just the help you think they deserve 

thanks all for listening 

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22 hours ago, Paula said:

I got snookered when I wrote a work note for a few days off due to my patient's shoulder pain and she was a CNA.  I faxed it over to her employer and sarcastically  said to my MA/RN team, I bet she will be on her snowmobile this weekend even tho she has shoulder pain.  Yup.  She rode her snowmobile, crashed it, hurt her back, went to ER 2 days later, got morphine (Only God knows why they gave her morphine), came to me in follow up and wanted a refill.  Nope, I asked her why on earth she felt she could get a note off of work and then get on her snowmobile????  She got red and flustered and that was the end of her asking me for anymore time off or refills of narcotics. 

Yep that's been my experience more than a few times out in Alaskan villages

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23 hours ago, ral said:

I won't go into detail.  Let's just say I've done some things I'm not proud of but, we are talking about ice cream here.  

You're my favorite internet person of the day. You just reminded me I have half eaten ice cream cup in my freezer. Thank you. 

I work in ortho surgery. I often give work notes. I do not give pain meds >4-6 weeks after surgery. I have yet to write for temporary handicap pass. Our office handles all FMLA, disability stuff etc. 

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21 hours ago, rev ronin said:

Which is your right, but entirely not the point of the thread.  Patients can request things that are legal and permissible, but arguably harmful to them.  Which of those requests would you do or not do?

I will not mix orange juice and milk

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3 hours ago, Elpatodog said:

I am sort of shocked by our forum and stating all the things we won’t do for our patients 

Maybe we should think about all the things we can do to help our patients

I hope I don’t become callous and say because your diabetes is not controlled and it’s your fault.... ( if that’s what you are really thinking like posted above).....I am not going to fill out FMLA papers for you ..... How about talking with your patient and figuring out why things are not going well for them..... and help them with getting there DM under control...... and then tell them you will fill out the papers and make a goal with the patient to get things under better control or refer to someone that can help them more .......maybe you as a provider are not getting through to the patient...??

Life is not perfect and we don’t know what patients are going through 

I hope I never look and say I am not doing these things .... whatever they may be... without considering everyone individually.

if you can’t do something for someone I hope you are asking another provider for ideas or asking yourself what can you do differently.

I have been in the medical field for 30 plus years. Twenty of it as a PA.

please do not insult me and start throwing daggers at me about how I feel 

i just felt I needed to speak up because I am shocked by all of this .... if I am the only one that feels this way I am okay with being the lone wolf or maybe I misunderstood what the purpose of this whole conversation was

Because of course there are the basic things I will not do like fraudulently chart or say I did a ROS when I didn’t,  etc.... and please do not insult me about general medical practice about when and when not to prescribe narcotics or what not to give them with.... Because we should all be educated on those issues and if one of our fellow providers is not maybe we can help them understand 

I understand the basics of safe medical care. 

If my patient needs to be referred to a chiropractor then I will do so.... I hear many patients have great pain relief and success with some of their modalities 

I will fill out fmla paperwork for my patients ( of course it goes without saying that it will be legit) 

My question is why would you Not fill it out?? , patients have surgeries, mental illnesses, family illness, sports injuries etc... and it’s a requirement by most all work places I know that have to get this filled out if they miss a specific amount of time .Please send them my way I will help.  I am qualified to do this as a PA. I will not add to making a patients life more stressful because I don’t like filling them out, I just do it , it’s part of my job and not everything is fun and I don’t agree with everything I have to do but patients need our service or they will get it somewhere else with someone  that is more qualified ? Or not or maybe another provider like an NP or an MD that is more willing to be open minded and helpful can do it 

I bet most PA’s can do functional capacity exams. Educate yourself on this it’s not rocket science. It may seem intimidating initially but ask someone more experienced for their guidance. You may learn something .

If they need a note off because they were sick the day before and their job is requesting it . I will do, I will be a reasonable provider that will give patients the benefit of the doubt most times....Yep I have been wrong and on more then one occasion.... but I will not crucify everyone else for one patient in the past that has  taken advantage of my good will

I could go on and on but I won’t......

i just want us all to think about what we are thinking and posting for our patients 

I hope my providers doesn’t come at me with “I am not doing this “

How about “Let’s try it this way “ instead 

These are just some thoughts after reading some of the posts 

I agree with much of what you said, and I think most of the people here do as well.

However, I think the original gist of the op was "in view of helping a person give another person a head injury (boxing), would you help.". Lots of sports have risks, but very few is the goal to deliberately knock someone out.

Also, it's a shame that the FMLA laws are used the way they are; however, it is a facet of my job and I will fill it out.  To the best of my ability, which means I'm not going to stretch the truth.

Parking placards are similar.  Reasonable evidence will get a reasonable response.

On the other hand, I am a medically trained scientist, and while I will certainly work with someone, and enable them to do it on their own, I prefer to put the impetus on the patient for self responsibility.  This means asking questions, and contacting the clinic if the plan goes awry.  

Through shifting of medicine to be a retail industry driven by customer satisfaction scores means that more and more I am being called upon for unreasonable demands, because the customer is always right.

This is where I draw the line.  

Forms will get filled out, but as a scientist, I can only use objectivity and base my decisions on data.

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7 hours ago, Elpatodog said:

I am sort of shocked by our forum and stating all the things we won’t do for our patients

I tend to agree.  I thought I was pretty clear about framing the question in terms of us refusing to do things on an ETHICAL basis, looking at (potential) harm to the patients, and a lot of the answers had to do with things that were inconvenient, annoying, or otherwise onerous for the providers. Not what I had been expecting.

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I also think there was a fair amount of "dagger" throwing in that post.

I'm will to bet a large portion of those refusing to fill out FMLA forms or disability placards are individuals NOT working in primary care, and no, as an ED or UC provider you should NOT be filling those out.

I also think that some individuals explained themselves quite well in their decisions to not write for handicap placards for individuals who would benefit from exercise over a more sedentary lifestyle.

Oftentimes uncontrolled diabetes, HTN, obesity etc are due to patient non-compliance (duh). 

I think this post was a good outlet for folks to vent, while I do agree it kind of moved away from the original intent.

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On 3/28/2019 at 2:48 AM, rev ronin said:

I tend to agree.  I thought I was pretty clear about framing the question in terms of us refusing to do things on an ETHICAL basis, looking at (potential) harm to the patients, and a lot of the answers had to do with things that were inconvenient, annoying, or otherwise onerous for the providers. Not what I had been expecting.

I agree as well, based on that I see VERY few reasons to be on chronic opiods or benzos and feel the risk of addiction as well as side effects...most patients do not hesitate to drive after taking them (I’m good, I’ve been taking this for years and I know how it affects me) outweigh any potential benefit to the patient. If their case is so outside of the norm then they need to be seen by a specialist. I see these as short term use medications.

If I wanted to push pills for quick fixes I would have been a drug rep...

Edited by ArmyPA
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Came up today... I won't clear someone for a work physical if I don't see you accomplish everything on the physical. Physical asks for immunization status and you don't provide vaccinations? Show me the vaccs or you're getting titers drawn. Physical asks you to lift 50 lbs? You're lifting 50 lbs. So many people try to talk us into things at my UC and say "oh just cross that out" but our legal dept actually said absolutely dont cross something out and sign it because it won't hold up in court. 

Edited by kadiah
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On 3/25/2019 at 3:02 PM, Boatswain2PA said:

"No narcotics for chronic pain"...

This makes me think the pendulum is swinging too far again, and we are not practicing good medicine.

Example - pt with chronic back pain, treat a with daily mobic, stretches, and exercise.  Uses ibuprofen, lidoderm patches, and ice packs for flares, and 1-2 times a month takes a norco before bed so he sleeps better (pain frequently wakes him up).

Would you family practice guys turf him to pain mgmt??

 

When I did FM, depends on the usage, how well established they are, how good the local pain management is, and why they have LBP ( better managed by ESI, radio frequency ablation, ect). Probably 70% of low back pain I sent to pain management. If they needed something for break through pain, okay. Not asking for escalating dosages or frequency, adhering to opioid plan, okay. Most people do not fall into this category. It’s not about inconvenience, but my practice and office being equipped to manage people with high levels of chronic pain. 

 

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I also will not give antibiotics for viral illnesses. 

As a prior PCP, I won’t draw a bunch of labs that your specialist thinks is indicated. Tricare paid him a bunch of money. He can order it, but I warn that the labs were a shotgun approach and likely to led to unnecessary and possible detrimental further testing/treatments.

i won’t write for window tint for headaches that would impair night driving. Just wear sunglasses.

i won’t allow unvaccinated children in my clinic in the event they would expose my patients who could not be vaccinated who were too young to vaccinate, at least not after I explained the risks of not vaccinating and they still refused. You can think I’m being hard nosed and “these people need care to”, but I will not abide endangering the safety of others. 

I won’t use AMA paperwork or sign people out AMA. We have a shared decision making and you refused my highest recommendation, so instead of kicking you out I gave you my next highest recommendation, because some treatment is better for you than no treatment.

i won’t place IUD in nulliparous women unless they are on their menses when the cervix is slightly dilated, and I would accept last minute appointments to be accommodating. I’ve seen too many cry and scream, and so many do amazingly well when placed during menses.

i won’t send wife for a BTL until husband comes to visit to listen to my vasectomy spiel, because it’s safer and much less invasive. He can have his own visit, come to yours, call on the phone. Whatever.

 

 

 

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On 3/25/2019 at 3:14 PM, Cideous said:

Won't fill out an FLMA form...

All these years on these boards I'm not sure I've had two down votes on any one post.  I had to laugh at these though.

 

So, for the record, I don't do FLMA forms because I do Urgent Care, not because I don't think they are valid.  Just fyi LOL.  Oh sooo angry you guys are....!  LOL

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17 hours ago, LT_Oneal_PAC said:

i won’t write for window tint for headaches that would impair night driving. Just wear sunglasses.

I've never even heard of this.  Oh, wait, I practice in (the western half of) Washington State where sunshine is an occasional treat.

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4 hours ago, rev ronin said:

I've never even heard of this.  Oh, wait, I practice in (the western half of) Washington State where sunshine is an occasional treat.

Happened several times on base. Said headaches trigger their migraines and want a letter stating such and they should have greater than x % tint, so that when they are pulled over they don’t get a ticket. No one could ever explain to me why sunglasses weren’t a better solution.

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