Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, May 12, 2008


I'm not sure why, but my traffic seems to have picked up lately. What that also means is that people are reading and commenting on old posts. (Thanks, folks.) Here's a recent comment by Dr. Sissy (no blog link; start one and I'd be happy to send you some linky-love) on my post about identifying drug seekers in the primary care setting:
Any advice for a new FP? The narkies are coming out of the woodwork. I offer referral for counseling, hospitalization, pain management and physical therapy, along with NSAIDs, tramadol and other lower risk meds and watch them leave in a huff.
Yes, I do have some advice: keep it up; you're doing exactly the right thing. Here's why:

After I'd been in practice for only a few years, I saw a patient for a non-drug-related problem (bronchitis or something like that) who mentioned as part of her medical history that she was an active heroin addict. I looked up at her and told her point-blank I wouldn't prescribe any narcotics for her. Here's what she said:
Oh, I know. The word is out on the street: don't call Dr. Dino. No drugs to be had there.
My honest reaction was to swell with pride! That's obviously why the narkies were leaving me alone. Stick to your guns; once you establish your reputation, you're home free. By the way, I told the patient it was the nicest thing anyone had ever said about me. She didn't leave in a huff, either. Maybe someday, when she's ready, I'll be the one she comes back to. In the meantime, I treasure the reputation I worked so hard to achieve.


At Mon May 12, 08:28:00 AM, Blogger Margaret Polaneczky, MD (aka TBTAM) said...

Darn! I was about to ask you to write me some percocet....

At Mon May 12, 10:40:00 AM, Blogger Cathy said...

Dr. Dino, I think part of the reason your readership has picked up, is because Kevin has been linking to you alot.

Hope you have been well?

At Mon May 12, 01:27:00 PM, Blogger Joe said...

I am a family physician workng the past 4 years in urgent care. I, too, have made the decision not to prescribe narcotics. You're right, word gets out "on the street" quickly, and the drug seekers stay away for their chronic back pain or tooth pain.

Unfortunately, I have experienced an unexpected consequence. Due to the decreased volume in our urgent care due to lack of drug seekers, the hospital administrator, my employer, is now threatening to fire me due to the fact that it is "(my) fault" that volume and revenue is down. In addition, he is upset that I am not giving antibiotics to all the people with viruses, and, according to him, that is causing a further decrease is volume because patients aren't getting what they want.

So, at age 55, I may be forced to find another job because of the fact that I've practiced what I consider good medicine.

It's very discouraging.

I'd be interested in hearing from any other readers who may have experienced similar problems.

At Mon May 12, 06:58:00 PM, Anonymous Anonymous said...

>>Oh, I know. The word is out on the street: don't call Dr. Dino. No drugs to be had there.

I knew it !!

There's a Web site or discussion board out there, I swear it's true.

At Mon May 12, 08:16:00 PM, Anonymous Anonymous said...

You did the right thing. That way word gets around that "Dr. Dino is a hard-*&%". If you don't, and believe me I've seen it happen (not, however, to me, I did what you did) every addict in the KNOWN WORLD will show up at your door. And when you're not there your partners will have to deal with them, and trust me, they don't like it one bit.

At Tue May 13, 07:15:00 AM, Anonymous Anonymous said...

i'm in a group practice and have had it happen. I will not give narcoitcs out easily (or at all pre-op) whereas my partners are more liberal. I've heard patients (that fit the profile) at the front say -- I don't want to see Dr. .... and I just have a small smile inside. There is no-one that I won't see/treat but i'm stingy with narcotics. BTW my favorite line for them when they as for "you know...that starts with a p.... perca-something" is to say "oh - that, sorry I don't give that out -- do you know how many people are just after drugs out there?" Love to leave my name but the college may come after me. Brave new world!

At Tue May 13, 08:59:00 AM, Anonymous Anonymous said...

So, do you ALL think everyone who complains of pain must just really be a seeker? My concern is with the comment directly above this one (anon 7:15am). He states that he never gives pain medictaion "at all" for pre-op pain. if you are getting ready to operate on someone that sounds like a situation where there may be real pain that requires medical attention. if you don't believe they have any pains, with whatever it is you are taking them to surgery for, then why are you taking them to surgery?

There is a difference between seekers and REAL pain that needs to have some kind of pain control. if you are medical doctors and totally refusing to acknowledge this aspect of medicine then where does that leave your patients? Are you sending them to the streets to comntrol chronic pain?

At Tue May 13, 04:26:00 PM, Blogger Neumed said...

It's funny, you have people on one side accusing doctors of just being drug pushers and on the other hand people complaining when we refuse to supply the junkies. Whatcha gonna do?

At Tue May 13, 08:41:00 PM, Anonymous Anonymous said...

My father was a PA in the federal prison system for over 20yrs. He had a reputation, too. Word in the yard was, if you're sick and PA My Dad is on call, go in and he'll take good care of you. If you're not, don't bother, he won't put up with your bullsh*t. He was incredibly well respected not only among the inmates, but also among his colleagues.

At Thu May 15, 02:33:00 AM, Anonymous Anonymous said...

Advice from the pharmacist: Do not EVER EVER authorize coverage for brand-name narcotics. In fact, just put right on the Rx--GENERIC ONLY. This will keep the drug-seekers away, especially the ones who sell their pills. But please don't screw around with Darvocet (generic) either. If a patient needs a narcotic (arthritis, broken bones--real stuff) then give them a few of something that works. Also warn your patient that narcotics can cause euphoria, and when taken for such, as opposed to SEVERE pain, then life-long addiction can ensue, and it will ruin their life as they watch their dignity circle the drain. Don't ever prescribe narcotics for migraines. Don't prescribe fiorinal/fioricet, either, for that matter, EVER, or you will end up with the biggest pain in the ass patient who will take up all your time. Don't prescribe narcotics for "fibromyalgia" for reasons outlined above. How about a narcotic contract for each new narcotic regimen you start? For SURE this will keep the druggies away; they'll know you mean business. It'll be so great to be able to spend your time helping MANY people instead of banging your head against the wall over a handful of incessant people. Don't be a sucker. If you suspect a patient of drug-seeking behavior, get a CURES printout on them. Mention to new patients that you've had to do this a few times. That'll drive the druggies away, too. Don't punish those who are truly in pain (but don't forget the NSAIDs, either--my favorite drugs personally. I <3 Advil!) Remember, even patients with chronic conditions can become addicts. Proceed with caution.


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