Guest guest Posted November 4, 2011 Report Share Posted November 4, 2011 why are you letting the patient go? you dont like her anymore? grace > > Hi Everyone, > > I need to let a patient go from my practice. > Any expereince with this? Advice? > She has psych issues, see a psychiatrist ( I have read his report) > Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication. > The pharmacy just called to tell me she is a pt at a drug rehab on suboxone. > Thanks > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2011 Report Share Posted November 4, 2011 She never informed me she was beening treated for opiate addiction and requesting opiate pain medication. She has been manipulating me. I don't feel I have a theraputic relationship with someone who is manipulating why are you letting the patient go? you dont like her anymore?grace >> Hi Everyone, > > I need to let a patient go from my practice. > Any expereince with this? Advice?> She has psych issues, see a psychiatrist ( I have read his report)> Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication. > The pharmacy just called to tell me she is a pt at a drug rehab on suboxone.> Thanks> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2011 Report Share Posted November 4, 2011 If your state has a prescription monitoring program run it before you give pain meds or at least later so you know and do not continue why not care for her just don;t give narcotics? How does it benefit either of you to throw her away? She will self select out if that is all she wants and she could surpise you and let you take care of her. Addicts lie That is what they do It's the disease. You can stil ltake care of then with boundaries and rules that are clear but be kind. I say the same thing all the time, though I am in a minority This is my approach though other than that, the rules to dismiss are to sned a letter acc. to the advice of your medical association usually ceritfied ,offering 30 days emergency care only then she is dismissed. Jean why are you letting the patient go? you dont like her anymore? grace > > Hi Everyone, > > I need to let a patient go from my practice. > Any expereince with this? Advice? > She has psych issues, see a psychiatrist ( I have read his report) > Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication. > The pharmacy just called to tell me she is a pt at a drug rehab on suboxone. > Thanks > -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2011 Report Share Posted November 4, 2011 let us know:) Thanks Jean. If your state has a prescription monitoring program run it before you give pain meds or at least later so you know and do not continue why not care for her just don;t give narcotics? How does it benefit either of you to throw her away? She will self select out if that is all she wants and she could surpise you and let you take care of her. Addicts lie That is what they do It's the disease. You can stil ltake care of then with boundaries and rules that are clear but be kind. I say the same thing all the time, though I am in a minority This is my approach though other than that, the rules to dismiss are to sned a letter acc. to the advice of your medical association usually ceritfied ,offering 30 days emergency care only then she is dismissed. Jean why are you letting the patient go? you dont like her anymore?grace >> Hi Everyone,> > I need to let a patient go from my practice. > Any expereince with this? Advice?> She has psych issues, see a psychiatrist ( I have read his report)> Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication. > The pharmacy just called to tell me she is a pt at a drug rehab on suboxone.> Thanks> -- MD ph fax -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2011 Report Share Posted November 4, 2011 Thanks Jean. If your state has a prescription monitoring program run it before you give pain meds or at least later so you know and do not continue why not care for her just don;t give narcotics? How does it benefit either of you to throw her away? She will self select out if that is all she wants and she could surpise you and let you take care of her. Addicts lie That is what they do It's the disease. You can stil ltake care of then with boundaries and rules that are clear but be kind. I say the same thing all the time, though I am in a minority This is my approach though other than that, the rules to dismiss are to sned a letter acc. to the advice of your medical association usually ceritfied ,offering 30 days emergency care only then she is dismissed. Jean why are you letting the patient go? you dont like her anymore?grace >> Hi Everyone,> > I need to let a patient go from my practice. > Any expereince with this? Advice?> She has psych issues, see a psychiatrist ( I have read his report)> Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication. > The pharmacy just called to tell me she is a pt at a drug rehab on suboxone.> Thanks> -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2011 Report Share Posted November 4, 2011 Agree with Jean. Our office policy is no long-term narcotics (we have multiple pain specialists in the area), no narcotics the first 6 months as a patient without outside records indicating the necessity, except in the case of acute injury. Sometimes Steve will do a 30 day supply to give them time to get to a pain specialist. Good luck, let us know:) Thanks Jean. If your state has a prescription monitoring program run it before you give pain meds or at least later so you know and do not continue why not care for her just don;t give narcotics? How does it benefit either of you to throw her away? She will self select out if that is all she wants and she could surpise you and let you take care of her. Addicts lie That is what they do It's the disease. You can stil ltake care of then with boundaries and rules that are clear but be kind. I say the same thing all the time, though I am in a minority This is my approach though other than that, the rules to dismiss are to sned a letter acc. to the advice of your medical association usually ceritfied ,offering 30 days emergency care only then she is dismissed. Jean why are you letting the patient go? you dont like her anymore?grace >> Hi Everyone,> > I need to let a patient go from my practice. > Any expereince with this? Advice?> She has psych issues, see a psychiatrist ( I have read his report)> Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication. > The pharmacy just called to tell me she is a pt at a drug rehab on suboxone.> Thanks> -- MD ph fax -- MD ph fax -- Pratt Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2011 Report Share Posted November 4, 2011 Thanks Agree with Jean. Our office policy is no long-term narcotics (we have multiple pain specialists in the area), no narcotics the first 6 months as a patient without outside records indicating the necessity, except in the case of acute injury. Sometimes Steve will do a 30 day supply to give them time to get to a pain specialist. Good luck, let us know:) Thanks Jean. If your state has a prescription monitoring program run it before you give pain meds or at least later so you know and do not continue why not care for her just don;t give narcotics? How does it benefit either of you to throw her away? She will self select out if that is all she wants and she could surpise you and let you take care of her. Addicts lie That is what they do It's the disease. You can stil ltake care of then with boundaries and rules that are clear but be kind. I say the same thing all the time, though I am in a minority This is my approach though other than that, the rules to dismiss are to sned a letter acc. to the advice of your medical association usually ceritfied ,offering 30 days emergency care only then she is dismissed. Jean why are you letting the patient go? you dont like her anymore?grace >> Hi Everyone,> > I need to let a patient go from my practice. > Any expereince with this? Advice?> She has psych issues, see a psychiatrist ( I have read his report)> Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication. > The pharmacy just called to tell me she is a pt at a drug rehab on suboxone.> Thanks> -- MD ph fax -- MD ph fax -- Pratt Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2011 Report Share Posted November 4, 2011 I have the same philosophy as Jean. Set clear boundaries -- they will self select out most of the time. I don't dismiss for psych or for lying unless it's repetitive regarding treatment. However, I did dismiss one patient who insisted she had breast cancer but despite my work up and a specialists there was no indications of such. Referral for counseling refused. She then went to a second and then a third specialist saying I referred her. She was running through medicaid specialist after specialist. I had only sent her to one. She scheduled the second and third on her own. I sent her a letter that her behavior indicated she didn't have a relationship with me that seemed conducive to her health and I instructed her to find another doctor and a counselor. I simply wasn't comfortable with her going to more and more specialists and she had agreed after the 2nd one to work with me on her anxiety. Sent letter regular and registered (often patients won't pick up registered mail) and informed her I would give 30 days emergeny care. I provided her with 3 local doctors names and phone numbers. I do believe that if you have a patient you would dread coming in then it's not a good match. This one is more ominous -- either she was not taking the suboxone or she wasn't taking the pain meds as taking them together would be useless. Diversion would be a reason to dismiss in my book. Only a drug test including the components of Suboxone would tell you. I would recommend telling the drug rehab program as well. If she is on Medicaid she may need to be on restricted Medicaid such that she can only see one doctor. Good luck. To: Sent: Friday, November 4, 2011 2:45 PMSubject: letting a patient go Hi Everyone,I need to let a patient go from my practice. Any expereince with this? Advice?She has psych issues, see a psychiatrist ( I have read his report)Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication.The pharmacy just called to tell me she is a pt at a drug rehab on suboxone.Thanks Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2011 Report Share Posted November 5, 2011 well, if you felt manipulate and lied to, then that is not a relationship anymore. everytime she is earnest in trying you will always think there is some gain to her end, just discharge her if you feel you cant give her anything more. grace > >> > > >> > Hi Everyone, > >> > > >> > I need to let a patient go from my practice. > >> > Any expereince with this? Advice? > >> > She has psych issues, see a psychiatrist ( I have read his report) > >> > Then they had neck pain :had cervical disc compression with > >> radiculopathy. I gave her pain medication. > >> > The pharmacy just called to tell me she is a pt at a drug rehab on > >> suboxone. > >> > Thanks > >> > > >> > >> > > > > > > -- > > > > > > > > MD > > > > > > ph fax > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2011 Report Share Posted November 5, 2011 She lied. Tell her you can see her but no longer for pain management...that should give her the message and most pts leave under these circumstances. Matt in Western PA Re: Re: letting a patient go She never informed me she was beening treated for opiate addiction and requesting opiate pain medication. She has been manipulating me. I don't feel I have a theraputic relationship with someone who is manipulating why are you letting the patient go? you dont like her anymore?grace >> Hi Everyone,> > I need to let a patient go from my practice. > Any expereince with this? Advice?> She has psych issues, see a psychiatrist ( I have read his report)> Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication.> The pharmacy just called to tell me she is a pt at a drug rehab on suboxone.> Thanks> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2011 Report Share Posted November 5, 2011 RE dismissing for lying. If pt lies, think you can dismiss immediately... Re: Re: letting a patient go If your state has a prescription monitoring program run it before you give pain meds or at least later so you know and do not continue why not care for her just don;t give narcotics? How does it benefit either of you to throw her away? She will self select out if that is all she wants and she could surpise you and let you take care of her. Addicts lie That is what they do It's the disease. You can stil ltake care of then with boundaries and rules that are clear but be kind.I say the same thing all the time, though I am in a minority This is my approach though other than that, the rules to dismiss are to sned a letter acc. to the advice of your medical association usually ceritfied ,offering 30 days emergency care only then she is dismissed.Jean why are you letting the patient go? you dont like her anymore?grace>> Hi Everyone,> > I need to let a patient go from my practice. > Any expereince with this? Advice?> She has psych issues, see a psychiatrist ( I have read his report)> Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication.> The pharmacy just called to tell me she is a pt at a drug rehab on suboxone.> Thanks> -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2011 Report Share Posted November 5, 2011 I am a physician faculty member and interim Program Director at a Family Med residency where we have a strict and detailed controlled substances policy (contract, informed consent, SOAPP, DIRE, COMM, perioidic UDS, no CS at first visit and until previous records reviewed, if then and only if truly indicated, review of state prescription monitoring program, consideration of alternative tx for problem, etc). Agree with most here--pts likely to trip on our policy and procedures do indeed self-select, as repeated experience has shown us. Even then, however, we continue to provide medical care for other problems, just no controlled substances, tapering off when indicated. Donal Hi Everyone, I need to let a patient go from my practice. Any expereince with this? Advice? She has psych issues, see a psychiatrist ( I have read his report) Then they had neck pain :had cervical disc compression with radiculopathy. I gave her pain medication. The pharmacy just called to tell me she is a pt at a drug rehab on suboxone. Thanks Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.