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  • #46
    Originally posted by TheDangerZone View Post
    Prescribing months of narcotics for your partner without an exam at the behest of your administration? Eff that noise, it’s your DEA number on those prescriptions. You and your partners absolutely right to push back.

    PS hope your household is recovering well from last weeks events.
    I've considered in the past and more seriously recently just not renewing my license. It would be sucky for my patience though when they have acute needs of those kinds of medications. And unfortunately I think being licensed is probably in my contract. I should check.

    Our family has recovered well. No symptoms in the past 5 days. Today is the first day that we are all released from quarantine. Took the kids to a playground this morning already because they've been bugging me for the past week. Thanks for asking!

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    • #47
      Originally posted by billy View Post

      There's FIRE, but there's also having what I call miniFU money- enough that worst case you can easily sit around for a few months until having to locums or perdiem while waiting for a new job. Ideally you have a new job lined up before presenting your current job with an ultimatum or threat to leave.

      Anyway, good luck with the next few months. But for sure take care of all the medicolegal stuff to protect yourself. Admin's response will be "we dont tell drs what to prescribe" if any legal questioning occurs.
      Oh I get you. I have a 6-month emergency fund and the taxable account could last a few years if really needed. It would throw a big wrench into my financial future plans but we would not starve if I took a few months to find a different position.

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      • #48
        I feel for you Lordosis, sounds like a crappy situation but not crappy enough to make you want to leave an otherwise fulfilling job. I'm sure you will work your way through it over time.

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        • #49
          Will just reinforce the idea of trying to maintain a consistent restrictive policy among all remaining physicians, and justify it (to patients and admin) in terms of greater govt oversight with risk of unintentional overdose (since this person’s patients may not otherwise accept it as a better way to practice given their experience with the other guy). hope these problematic patients leave for another practice but never express this desire to the involved parties.
          “. . . And the LORD spake, saying “First shalt thou take out the Holy 401k. Then shalt thou save to 20%, no more, no less. 20% shall be the number thou shalt save, and the number of the saving shall be 20%. 25% shalt thou not save, neither save thou 15%, excepting that thou then proceed to 20%. 30% is right out . . .””

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          • #50
            Originally posted by CordMcNally View Post
            As I tell patients when they say "Dr. So And So would always do this", I can't control how other physicians practice but I can control how I practice. You feel like this isn't good patient care and you're right.
            100%

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            • #51
              Glad you have financial contingents I'm place and opportunities to bail if needed.

              This is where trying to make the office a better place takes etakes and an opportunity for you and colleagues to improve the admin relationship. It is your licenses and you have their attention because they have no power to make you see patients and the patients want something that the hospital needs to provide.

              Rec.
              -all clinicians in clinic agree on a concerted presentation to admin

              -Draft letter to patients to explain situation and have admin approve it (great idea Johanna earlier)

              -make your agreed requirements for taking care of these patients in writing and become standard work for the office

              -meet with risk management and admin to explain your reasoning and have them sign off on it

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              • #52
                this happened to someone i know when she did a peds locum.

                very rural area w massive narc use. she was filling in for an NP and an old ped who had retired.

                tons of the kids (12-15 or so) were on chronic narcs for things like chronic back pain or headaches.

                oh and by the way she noticed right away that Junior usually showed up to the appointment for the 90 day refill of oxy that they very frequently had a few uncles with them who made it clear that this was the way Doc had always done things and didn't she understand?

                needless to say she didn't finish out that assignment.

                i had a pt complaint once when i was staffing an immediate care b/c i wouldn't give abx to a 4 year old with minor URI sx. the mom was furious and said "my pediatrician always gives us amoxicillin." i said something like "i think that's horrible care and if that's what you want you should go back to them." this was in my younger days when the blood ran hot. definitely heard about it from pt relations.

                Lordosis i agree with the idea about the letter -- "need to do a full assessment... records will be reviewed.... policy for refills... non-narcotic pain options.... blah blah blah." i suspect that your problem will decrease by at least a third.

                as an ER doc, i really feel for you folks who have to manage chronic pain. may Zeus/the Great Spirit/Cthulu bless you.

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                • #53
                  New attending here...

                  From some of the replies, it isn't normal to fill controlled meds for another doctor in your group if they are on vacation? OP's situation is different because it's multiple months, but my above scenario seems like usual practice I thought.

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                  • #54
                    Originally posted by Lordosis View Post

                    I honestly don't think it's going to get to that level. At least I hope not. I have basically flat out refuse to do anything I am uncomfortable with and I don't see a way that they can force me. I guess they could fire me but I really don't see that happening either. However I keep getting requests for things and we have to deal with it Case by case. It's going to be a real slog to get through the next couple of months. And I don't expect any help from higher up.

                    No, unfortunately I'm not nowhere near fire. Only in my 30s
                    Funny thing would be admin trying to terminate for cause. Reason: Would not prescribe narcotics! I do thing a written set of guidelines that the whole group agrees to adopt would be a real benefit. Word gets around and you may see the rough seas settle more quickly than anticipated. Word of mouth travels fast. "Dr. XXXX is not there and I can't get my meds!." Guess what? Dr, XXXX, if he ever returns, needs to follow the written protocol. Sometimes peer pressure is best. It would be much better to fix a problem than punitive measures from your point of view I would assume. Strength in numbers. There is no reason to quit and they won't fire you.

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                    • #55
                      Originally posted by Lordosis View Post

                      No, unfortunately I'm not nowhere near fire. Only in my 30s

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                      • #56
                        After inheriting a bunch of regular nacs. A few years ago , I sent out a certified letter stating as of this date, due to changes in the laws, I would not be prescribing any long term narcotics prescriptions. I gave a 3m window of time. Patients could either wean off under direction or transfer their records to another physician, it was their choice. Surprising , several went to rehab , some weaned off, but most moved on to find another physician.

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                        • #57
                          At this point I have basically said I am willing to see any patient that has any problem but I am going to treat them the same way I treat all my patients. I do not care who they "belong to"

                          I asked to bump this up a level and bring in the CMO. I felt having a physician with authority hear the case could be beneficial. Fortunately he is a reasonable and thoughtful person who still spends half his time clinically. Unfortunately he is not in an office based practice so probably will not appreciate the long term nature of acquiring these patients. Any ideas how to word my concerns in a way an ER doc would best understand?

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                          • #58
                            This is a tough position be put in without knowing IF the other physician is returning. As a family practice physician I would recommend you review and share this with your CMO:

                            IndianaPainManagementPrescribingFinalRuleSummary.p df (ismanet.org)



                            Good Luck

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                            • #59
                              Honestly it is super odd that your administration is directly telling you to prescribe controlled substances. Is the physician that is out a big wig in the system or something? How did they even know this was happening, a complaint from a patient or something? Also suspicious that the time line for the physician out to return is unclear. Wouldn't be interesting if they were out due to a substance abuse problem?

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                              • #60
                                Originally posted by Sampter View Post
                                Honestly it is super odd that your administration is directly telling you to prescribe controlled substances. Is the physician that is out a big wig in the system or something? How did they even know this was happening, a complaint from a patient or something? Also suspicious that the time line for the physician out to return is unclear. Wouldn't be interesting if they were out due to a substance abuse problem?
                                Yeah, I cant believe you'd get any pushback on this at all?

                                I'd state things frankly, and in email if it wasnt taken appropriately verbally. "you want me to prescribe narcotics without seeing a pt"?

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