Hemegroup Posted September 22, 2010 Share Posted September 22, 2010 I'm currently on my last rotation, at a clinic which has a high turnover of patients, mostly employment and injury related. They see a lot of pain management, a lot. The thing that's difficult is seeing so many of these people come in for nothing other than *drum roll* their fix. I have no problem with a patient receiving continued scrip refills if there's a legit need, and to be sure there is (spinal surgery cases and the like), but there are patients who have been coming there for years to receive nothing but their continued refills when in my eyes they should be back at their Orthos and PTs for follow-up eval. And I've yet to see anyone receive a block or injection, I don't think they even do that there. It's just opiate after opiate after opiate, benzos also. Anything the patient wants, they get. One case in point, this guy had a history of "low back pain". He's on oxycontin, percocets, and xanax, all at maxed dosages. He's been on this stuff for years, and yesterday he came in asking for an increase in dosages! When the Doc asked him where the pain was, he replied, "oh, everywhere!" The dude is seriously hooked and is in need of rehab, in my opinion, not more refills of his 'heroin'! But yet they write and write and write, not once have I seen anyone tapered off. Granted, this is only my second day, but I've already been battered with enough of these observations to become really disheartened. What's the deal? Is there something I'm missing? I'm sure these patients bring in revenue, but it just all feels so wrong and it really bothers me. Obviously I can't speak my mind, but ... I really needed to vent, at least I can here. Link to comment Share on other sites More sharing options...
outennisboi Posted September 22, 2010 Share Posted September 22, 2010 unfortunately, there are many docs out there that are desperate for revenue because in this economy, the patient load may seem lighter and they need to put food on the table too. If you are concerned, i would certainly ask your preceptor his reasoning for prescribing those meds. Remember, you are paying good money to learn, so ask questions! I took a pain rotation and learned lots. And i thought the exact same thing as you after the first week, but as i asked more questions, things made more since ....SURPRISE! lol However, there are lots of docs out there that are pill-pushers, if you realize that you are not learning anything on that rotation and they have questionable morale, i would notify the program director and get switched to another preceptor immediately. Hope that helps! Link to comment Share on other sites More sharing options...
jmj11 Posted September 22, 2010 Share Posted September 22, 2010 I see the same. I call it medical professional laziness and apathy. It is very draining having and intervention over Rx narc abuse. I have to at least once a day and it can get ugly. The lazy, apathetic professional would rather not do that. Link to comment Share on other sites More sharing options...
Hemegroup Posted September 22, 2010 Author Share Posted September 22, 2010 i'm learning tons, that's the easy part ... it's just the pain mgmt cases like the ones i mentioned that are tough ... thanks for listening. at least i'm developing my own clinical sense in that area, i.e. what i would and would not do once i'm for real. Link to comment Share on other sites More sharing options...
Hemegroup Posted September 23, 2010 Author Share Posted September 23, 2010 They called the cops on a seeker today, who was taken away in handcuffs. Maybe I misjudged, although I do think there are some who are just as guilty but are just seen as 'legit'. I'm gonna grin and bear it, and keep my eyes and ears open. Link to comment Share on other sites More sharing options...
Hemegroup Posted September 24, 2010 Author Share Posted September 24, 2010 -*deleted*- Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 24, 2010 Moderator Share Posted September 24, 2010 . I'm gonna grin and bear it, and keep my eyes and ears open. excellent idea. keep it cool and just finish. don't rock the boat this close to your goal. Link to comment Share on other sites More sharing options...
meaux Posted September 24, 2010 Share Posted September 24, 2010 There is a good article in PA Professional Sept. 2010 issue. How to Identify Drug-Seeking Patients. p. 36 Whether or not it will help I dont know but def worth a read. Good luck with PANCE, and finding a job etc. Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 24, 2010 Moderator Share Posted September 24, 2010 10-15 yrs ago it was okay to do chronic opiates for non CA pain... and the floodgates opened... easy practice model to get about 800 patients on chronic opiates, see them every 3 months for check ups, write scripts and make a good living with very little challenge..... problem is that it is easy and people are doing it Hang in there - you can not change the system in a practice till the doc decides to change (ie you recomend a drug holiday and the patient complains to the doc and if they over turn you you are nothing) So learn about testing/monitoring, appropriate use, alternatives and the like and enjoy the experience for what it is... BTW I think these types of practices are on borrowed time as the new databases come out for opiates and the Gov't looks into script drug abuse... Link to comment Share on other sites More sharing options...
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