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  • #31
    I had to start screening out patients on chronic opiates and benzos. Being the new doc, all the beautiful chronic pain abusers had to check me out. I cant recall if it was the 82 year old on 8mg (not kidding) of xanax per day or the several on 250+ MME opiates per day that sent me over the edge.

    This screening process recently was a major problem because a guy in his 80s on chronic long and short acting pain meds for "low back" turned me into the state for discrimination. Of course, the higher ups involved our legal team and are making a big deal out of it. If they tell me to stop this, I'm leaving. My job satisfaction will tank. Most of the "strife" related to my job in some way often relates to a controlled medication.

    Interestingly, I read an article recently that over 80% of primary care docs will not see patients who are on chronic opiates. I could not guess why anyone would do this (sigh)

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    • #32
      Originally posted by ukdoc View Post
      I had to start screening out patients on chronic opiates and benzos. Being the new doc, all the beautiful chronic pain abusers had to check me out. I cant recall if it was the 82 year old on 8mg (not kidding) of xanax per day or the several on 250+ MME opiates per day that sent me over the edge.

      This screening process recently was a major problem because a guy in his 80s on chronic long and short acting pain meds for "low back" turned me into the state for discrimination. Of course, the higher ups involved our legal team and are making a big deal out of it. If they tell me to stop this, I'm leaving. My job satisfaction will tank. Most of the "strife" related to my job in some way often relates to a controlled medication.

      Interestingly, I read an article recently that over 80% of primary care docs will not see patients who are on chronic opiates. I could not guess why anyone would do this (sigh)
      Not sure why you have any legal duty to see a person who is not your established patient? I assume you can't refuse to treat someone for ethnicity, religion etc but last I heard being a drug-seeker isn't a protected class. Obviously IANAL

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      • #33
        Originally posted by ukdoc View Post
        This screening process recently was a major problem because a guy in his 80s on chronic long and short acting pain meds for "low back" turned me into the state for discrimination. Of course, the higher ups involved our legal team and are making a big deal out of it.
        Discrimination for what? Since the higher ups and legal team are making a big deal out of it I'm guessing he's claiming it's because of some protected class. Either way, I know stuff like this can be stress-inducing but let it slide. You've done nothing wrong and it'll go nowhere.

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        • #34
          I know.. preaching to the choir... all the while our neurologists will not see any patients for less common headache diagnoses, intractable migraines, unusual neuropathies, or a myriad of other run of the mill diagnoses yet somehow that is okay.

          They got their feathers ruffled I think because there was some case where the DOJ fined a practice for discriminating under the ADA by turning away chronic pain patients. Probably way more to the story than whatever they read because I don't see how that applies -- everyone does this and those who do not (probably a few exceptions out there), you probably do not want as your doctor.

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          • #35
            Have you ever tried to get someone into Rheumatology without a firm lab based diagnosis?
            I agree that specialists do it all the time but people get up in arms when primary care does it.
            I had my front office read off a script to new patients when they make their initial appointment about how I will not refill chronic pain meds/ other controls. Some hang up but more book the appointment and no show. A few try to plead their case but I can usually find some alternative that was not tried.

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            • #36
              Yep same experience with rheum -- if you have not already done the work for them, often times they will outright refuse to see them. Even then when the clinical picture fits a diagnosis and the labs don't back it up I've had one group refuse several times.
              The no shows would bug me, but nowadays I've always got work I can catch up on (or WCI!) so I don't mind as much as I used to.

              It seems that it is easier to not let them in the front door when you can screen a lot of them out proactively. That avoids you getting "stuck" with them - opiates I will tell them to take a hike but with something like BZD withdrawal I could see that coming back on you. I've successfully used this as reasoning for when the admin's ask for justification.

              I've not (yet?) outright refused all patients on a bzd or opiate. I still take most of the bzd monotherapy because like you said, a lot of times we can find a different plan and still be successful. It's amazing how much change I've seen in my practice and my lack of tolerance for these problems just a few years post-residency. Sometimes I do feel bad for turning people away, but if I tried to fix everyone I know I would lose my sanity.

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