Thursday, March 27, 2008

"Not Even When Pigs Fly", Says The Nurse Practitioner

When a new patient calls for an appointment, the secretary screens by asking what types of medications that they are on. I also tell my secretary to ask about chronic use of Xanax, Ativan, or other controls for anxiety and depression, and pain medications. Why do we do this? My branch does not do chronic pain management because I cannot write controlled substances. If the patient isn't honest with the front desk, I still screen for use during the establishing visit. Even if there is no report of using chronic pain meds or controls, I still tell the patient our policy which is the following:

I CANNOT WRITE CHRONIC CONTROLLED SUBSTANCES..No.. really.. not for any reason.. not every now and then, just when you need them, or once in a blue moon or when pigs fly or when hell freezes over. YOU WILL BE REFERRED TO PAIN MANAGEMENT OR TO A MENTAL HEALTH SPECIALIST..NO EXCEPTIONS.

Sounds harsh? Too bad. I'm tired of patients of other MDs and NPs offices coming through looking for pain meds and Xanax. The story usually goes something like this..

"That OTHER health care provider is soooo bad, terrible, too fast, a quack etc.. and I'm sure that you will be the best one to take care of...wait for it.... wait for it..........

My bad back, shoulder, neck pain and arthritis (all at the ripe old age of 20's to 30's with no documentation of course) The other doctor or NP just doesn't understand that I need Lortab 7.5mg PO QID just to get through the day. No.. I don't have a job. I'm on Medicaid and I can't afford to have the testing done to see if I really have a legitimate condition. I just want pain meds. You really can't give me anything???? Really???"


Don't worry about your hypertension, diabetes, gout, high cholesterol, bleeding ulcer or rectal bleeding that may be endangering your health. Don't worry about the escalating need for Xanax that eventually will make you into someone who looks like they are coming off crack cocaine. Don't worry about the chronic constipation and ulcers that taking chronic pain meds will give you.

The terrible husband, wife or kids that drive you crazy, the aggravating job, or the road rage that consumes you will not go away by masking them with controls. If you truly need help, I will find every resource that I can to help you. I will prescribe anti-anxiety and anti-depressants and I will counsel you in order to help make things tolerable. I will refer you to pain management so that they can use every method to help control the pain including injections, massage, acupuncture, stretching exercises, and yes, even oral meds if you need them. I will give you the phone number of a shelter for abused men, women and children.

But... I will not write you a prescription for controls. I just can't..

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