Saturday, October 17, 2009

Naughty and Nice

One of our long-term Oxycontin/Vicodin regulars, who we've long suspected of some funny business (early refills, lots of 'trips out of town', insurance rejects cause it's filled somewhere else, etc.) gets his refills denied by the doctor. Apparently they learned he had been supplementing his prescriptions with some alternate source, or in the words of someone at the doctor's office, "He's been naughty."

"Naughty?" Really. That's a funny way to put it. I really don't understand why some prescribers are so slow to put the hammer down. They accept excuse after excuse from these people. The pharmacy howls and they don't want to hear it. It's not being 'naughty.'
It's WASTING the time of the people who are trying to treat you. It's lying. It's breaking a contract. Maybe I'm not able to look at it from the viewpoint of the medical practitioner, but I don't think 'naughty' is quite the right word. I think "no more prescriptions, buh-bye" at the first sign of trouble, is the way to go. And without guilt, too --- these people want to get it, they'll find a way.

And then there are the 'nice' people. Friday afternoon is full of last-minute calls. A customer calls and asks me to look up some medications he got in the past for excessive sweating. I find Drysol and generic Robinul in his file. He sounds really happy and excited and tells me he has an interview next week and would like to refill them. I tell him the Robinul is out of refills and I can request more from the doctor, if it's still a few days from the interview. He apologizes for the last-minute request, says he'd rather start it right away --- but don't bother, he'll work something out and check to see if he may have some left somewhere. The guy was so nice about it and if he had really pushed I probably would have told him to come in and get a few tablets.

I hope he gets the job, I truly do.


Lorne from Toronto said...

To me, that 'nice' guy sounds a bit But it's all about knowing people. You're probably better at it than I am since you interact with loads of them daily. People like the 'naughty' guy should be seriously punished. It's sad that pharmacies don't do much to stop stuff like that. Anyways, check out my article on weird insurance if you want ;) Thanks for your post,

take care, Lorne

Guzzo said...

I really don't understand why some prescribers are so slow to put the hammer down. They accept excuse after excuse from these people.

I feel the same way.

The other night I asked one of the ER docs why he was writing a C-II script for someone presenting with a non-specific ailment, frequently documented as an abuser, and had a note written "NO NARCOTICS FROM THIS HOSPITAL"?

His response? Liability.

He just didn't want to be put in charge of being the "narcotic police" and was worried about a "what if" situation. He decided to fill an overnight quantity and defer authority to the primary care provider for follow up.

I didn't agree with him, but I could understand where he was coming from and filled the Rx.

Anonymous said...

I'm my opinion the ones who are usually the 'nicest' are the ones trying to pull a fast one.

Grumpy, M.D. said...

I try to put the hammer down- when I catch them. Some of them are better than others.

Phathead said...

hehe naughty... that's spectacular.

We have entire patient profiles of people who will get 2 day supplies of hydrocodone or oxy or what have you. They just go from ER to ER to ER.

Sad thing is when we ask them if there is someway to flag their profile so this doesn't happen we're told no. Now who's being naughty?

Anonymous said...

My husband has been unemployed for a year, and will probably never work in his field (civil engineering) again. The story about the sweaty guy made me realize just how saddened I now am by that peculiarly giddy happiness of people who have a job interview lined up. Really. It's heartbreaking.