Friday, October 9, 2009
Saying no to drugs
I remember when I was a kid hearing Nancy Reagan saying "Say No to Drugs." I deal with this every day in clinic. I'm not even talking about ice, smack, weed, crack, bumpin' a rail, etc. I mean the honest to goodness, legal prescription stuff. Every day I have to talk with patients who are abusing there benzos. Residency training programs are a great place for benzo abusers, because the residents cycle in and out, and nobody takes ownership of bad situations, therefore problems just get passed along. Even though our patients sign medication contracts, they still try to abuse the system.
Since I have recently begun clinical rotations, I have been stuck in numerous predicaments such as this. Patients abusing their priviledges. Psych Doc draws a line in the sand. Patient retaliates. Some examples.
Patient #1 presents for refill on her valium. She was fired from another clinic in our system for repeatedly overusing valium, calling for early refills, and on one occasion, showing up totally stoned on weed. My attending physician told me that I got to be "the bad guy" and take her off valium. We had a fairly pleasant discussion, however she did inform me that if I didn't prescribe it, she would send her grandpa to Mexico or Canada to get it. She also told me she should be able to smoke weed whenever she wants. On the way out of clinic, she screamed "Psych Doc is a Demon from Hell!" That didn't exactly brighten my day, but it did provide the name for my fantasy football team this year.
Patient #2 I inherited on Klonopin 1mg TID. She insists that it is QID, though it's been prescribed TID for > 6months. She ran out early. She could barely stay awake during the nursing assessment. Once again, I get to be the bad guy, cuz nobody else wants to set limits. I tell her we're going to taper her off Klonopin over 4 months because she's been abusing it. She asked, "Is there a higher authority than you?"
I resisted the urge to answer, "Maybe God would qualify" but decided I would leave that to my surgical colleagues. Instead I replied, "Do you mean like a patient advocate?" to which she answered in the affirmative. As she wrote down the advocate's name and phone number that I provided, she was so stoned that she couldn't operate a standard ballpoint pen. She then slammed the door on the way out, went into the waiting room and told the other patients, "Good luck with Dr. Asshole."
I am so frustrated with the users. As one of my attendings used to say to these patients, "Excuse me, but do I look like a vending machine?" I really try to do what's in the patients' best interests. Use the lowest possible dose (all meds, not just benzos). Avoid polypharmacy. Prescribe high risk meds when appropriate.
Some days I wonder why I went to med school.
Say "Thank you" to your doctor today.
Dr. Asshole aka Demon from Hell aka Psych Doc
Posted by SerenityNow at 10:18 PM