Thursday, May 3, 2007

My favorite patients

When I started with my new call group I was surprised to receive one or two calls almost regularly every Friday late afternoon about 1-2 hours after taking over that sounded like this: "I am / my daughter is in excruciating pain, we have called the office (of the doctors I am covering for) severla times today and nobody has called us back. The pain medicine Dr....has prescribed is not helping / doesn't touch it. Is there nothing you can do?" and somehow the conversation would always turn to the perception that a narcotic prescription really would be the only acceptable solution to the caller's "excruciating" pain.

Initially I was annoyed at the negligence of my colleagues and attributed it simply being very busy. Sometimes prescriptions are forgotten, or not picked up by the pharmacist etc.
Then I collected the names and phone numbers of the callers and asked the "forgetful" colleagues about these callers. It turned out that they in fact had returned all those calls, but simply had not seen a good reason to prescribe the desired narcotics. And, as we all know, "Ibuprofen just doesn't touch it". Not only had my colleagues answered all these phonecalls, they had also informed their patients about their policy of "no narcotics on call or outside of office hours" - a policy that I now happily quote to those callers.

As it turned out, one patient was particularly tenacious in her requests for the comforting Vicodin. Her request was denied by my colleagues during office hours and, sicne she lives hours away, she was told to go to a local ER. So the ER calls me about this patient. All I could do is to relate my experience: She has called me multiple times after hours, she always requests Vicodin, I have never seen her nor examined her in person, and she either tells me she is about to have surgery for pelvic pain or she just had surgery for pelvic pain.

My hopes that this would be it for the evening were disappointed. The patient herself called me after receiving a prescription for ibuprofen, furiously reprimaning me about "giving the wrong information to the ER" " that made them not give her the right pain medicine" and that she "had to wait in the ER for hours with three children" and on and on. The next time I spoke to my colleagues I asked them to consider releasing them from their practice. The next time she called, I reminded her that restricted substances are restricted for a reason, that she should go to the local ER and that I could not do anything for her long distance over the phone (she lives hours away, God knows why she is still in my colleagues' practice, I can only suspect the reasons why she has not been able to find a local doc). I am waiting for her next call, for now it has been quiet.

I also love those prescriptions that are forgotten far away in the next state, where the patient did spend the weekend (apparently the "excruciating pain" does not prevent them from traveling for hours and hours).

I love the stories where prescriptions are forgotten on the bus, in a pub or in other public places. I personally would stash away such a valuable prescription in a very safe, deep pocket that I would never had a chance of loosing it. Strangely, narcotics precriptions seem to be the only ones that are teated with such neglect that they disappear, since I have never heard that an Ibuprofen prescription has suffered such a fate...

The patients that request those prescriptions usually tell you that you are the "best doctor in the world" and frequently mention that their last doctor "was just not a good doctor" who did not take good care" of them. I simply do not understand that they abruptly leave and never come back to the "best doctor in the world" once I explain that I do not prescribe narcotics more than once...

I also am surprised that those patients seem to lack the most simple and basic ability of foresight. You know that you need narcotics, you see that the bottle is almost empty for days, and you do not call your doctor's office during the day, but call me after hours??? As if you didn't see that coming?

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