I had a patient today, who admittedly has some serious but old spinal problems, tell me he is almost out of his pain meds that were prescribed by another provider a week ago. " I maybe have 2 days of meds left" he tells me. This fella had seen me for his initial visit and subsequent visit but then his claim was denied. So he had to go to the ER for his pain meds. I had to dig but he fessed up to going to the ED on several occasions while his worker's comp claim was adjudicated to get pain meds for his train wreck of a neck. So, since he told about all the visits I had dug up and investigated so I gave him an Rx for #60 oxycodone and put him on a narc contract. He new what it was before I even mentioned it. He signs it and went off to fill the Rx. I get a call from the pharmacist telling me that this fine gentleman just had an Rx filled 2 days ago for #120 oxycodone. I told the pharmacist to rip up my Rx and to tell the patient I asked to do so. The patient just called as I type this telling me he went back and counted all of his pills and he 68 left and that the pharmacist is wrong and that he got the Rx filled 4 days ago. These are the kind of patients that make me question what I am doing. I am sure it isn't as bad as I feel it is, but it seems so many of patients don't want to get better. It seems so many of them lie. Shit, I wish I didn't care but I do.
2 comments:
I'm a paramedic in NYC working my tail off to get into PA school. I completely understand the essential frustration of this post. However, if it's any consolation I've treated many pill poppers addicted to opiate analgesics like oxycodone, as well as innumerable methadone and heroine junkies. All I can provide as an opinion is many of these people are seriously ill, mentally and psychologically, because of their addiction. They never start on the path, but they get sucked in, and once they do, it's very difficult to wean them off. For some the addiction is so indomitable the thought of being freed from their addiction isn't feasible whatsoever. I've encountered methadone junkies who overdose on their "weekend dose", agonally breathing at 4bpm, some even in cardiac arrest, and when I counter the opiate effects with Naloxone all they want to do is beat the living shit out of me!!! So much for saving a life! Hang in there, continue writing and continue with your passion. For a person like me ur a tremendous motivation.
Yes, wow. After reading J's comment also, I can only say "wow." I have to wonder how good I may be at discerning these patients in an ER situation without beaucoup experience under my belt.
I have a dangerous tendency to believe what people tell me.
Note to self: Question this more.
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