Monday, September 03, 2007

Cold Busted!

Technology has made it very difficult for drug seekers to fool us physicians. In the past, though, this was not the case. Prior to advent of the CT scan, drug seekers had somewhat of a golden age. During this gilded age, these addicts could go into any ER, or call any urologist on-call, give the doctor a history suggestive of kidney stones and renal colic, state that they were allergic to IV contrast, and that their stones were uric acid, so not visible on regular x-rays, and then they would receive their fix. The more ERs they went to, and the more doctors they called, the more drugs they would receive, and perhaps even sell on the street to other narcotic addicts. I came out of medical school and became an intern on the urology service in 1994, just prior to the era of the ubiquitous ER CT scan, and I learned fast how to differentiate drug seekers from true renal colic patients. I still use those skills today.

Now, life has become difficult for drug seekers because technology is readily available that allows us doctors to catch the drug seekers in their own lies. Yesterday, I achieved what I would characterize as a pinnacle moment in my on-going game of out-wit-the-drug-seeker. A person claiming to be my patient called me Sunday ~9AM, and stated that I saw him 2 weeks previously both at the hospital and in my office and that he was still in pain from a kidney stone that he had not yet passed. I did not recognize his name. This would be somewhat usual for a kidney stone patient in my practice, because I have few of them. Red flag number one, but still possible. He when on to say that he was taking oral toradol--a medication that I have never prescribed because it is ineffective for pain--and that the toradol was not helping him. Red flag number 2, but still possible. I then asked him if he would like me to call in something stronger, and then I asked him what has helped in the past, an old urologist trick to smoke-out the seekers, since they always have their preferred drug and will often tell you not only the name of the drug, but their desired dose, potency, and quantity. He stated he wanted hydrocodone 7.5mg. Boom, red flag number 3. I then asked him for his pharmacy, and he stated that it was closed for the holiday, but that I could try this "24 hour" pharmacy. OK, red flag 4, but still I was giving him the benefit of the doubt. I asked him for his phone number and for him to spell his name out for me, and then I said that I would call in the prescription. And here is where the fun began.

I have an EMR and can access my entire office network, both EMR and PM software, from my house. I logged into my network and searched through the patient names in my PM software, looked through the charts, and even looked for a copy of his drivers license, which we always scan into our system on the patient's first visit. Low and behold, he was not a patient in my practice. I even typed in a variety of permutations for possible spellings of his name, and still, no patient by his name, or anything even close to it. As I was trying to find any evidence that he was in fact my patient, he called back, 5 minutes later, to find out why I had not yet called his pharmacy. I told him that I was having difficulty verifying that he was my patient, at which point he seemed to become annoyed. He swore that I had seen him in my "Smithtown office" 2 weeks ago, and that he had received a letter from my office in the past few days, only that his name was severely misspelled on the letter and "was not even close to my name." I asked him how we spelled it on the letter, and he stated that he forgot and that he "lost" the letter and could not remember what it said. At this point he was really irate and was trying to put me on the defensive--how could I not remember my patients! This is a good technique used my many drug-seekers and often they threaten to "tell" your senior partner, or attending, or boss, or "the medical board" and to have you fired, or worse. Now that I am the boss, this just pissed me off, and I decided to end the conversation. I told him that if his pain was severe, he could go to the ER, but that I would be unable to prescribe the narcotic for him without verifying that he was an established patient of mine, then I hung up on him. This is the first time I so competely, efficiently, and undeniably caught a drug seeker as they tried to defraud me. Un-@#$%-believable!

Drug seekers are really a bain in our collective exhistences. They will lie and cheat--even steal--to get what they need, the drugs, and we the doctors, are the victims. Their behavior puts us doctors in a precarious position, for if we deny them the drugs, we risk negative word of mouth and damage to our reputations and practices. Yet if we acquiesce, we risk providing poor medical care at the least, and being accused of malpractice and possibly criminal offense--diversion--at the worst. Many drug seekers have successfully sued the very physicians to whom they lied when the doctors yielded, gave them their candy, and then damages ensued.

Attempting to obtain a narcotic prescription under false pretenses is a crime, and if the physician facilitates it, then he/she may be committing a crime as well. I always give my patients the benefit of the doubt and err on the side of trying to alleviate their suffering. But when I diagnose them as a drug seeker, I cut them off mercilessly, and if I can prove they lied to me, I'll contact the authorities and report the crime. I did so on this patient.

If you are a drug addict and are reading this blog entry, be forwarned. There is a new sheriff in town. And his name is The Independent Urologist.


The IU.