Sunday, September 26, 2010

No means no

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Mr. McPayne: "Yeah, are you covering for Dr. Cortex this weekend?"

Dr. Grumpy: "Yes."

Mr. McPayne: "Okay, I need more Vicodin for my pain."

Dr. Grumpy: "What kind of pain are you having, sir?"

Mr. McPayne: "You know, stuff that hurts. I need Vicodin for it. I get it from Dr. Cortex."

Dr. Grumpy: "Is this a new problem?"

Mr. McPayne: "Nope. If I can get some Vicodin I'll be fine."

Dr. Grumpy: "I can't call in narcotics for other doctor's patients on the weekend."

Mr. McPayne: "Why not? It sounds like your phone is working?"

Dr. Grumpy: "I don't know your case at all. You can call on Monday when Dr. Cortex will be back, or go to an ER if you feel this is urgent."

Mr. McPayne: "I ain't going to ER. I just want some Vicodin. Can I come to your office today so you can see me, and I can prove I have pain?"

Dr. Grumpy: "No, sir. My office is closed on Sundays."

Mr. McPayne: "Then can we meet at a McDonald's or something?"

Dr. Grumpy: "Goodbye." (click)


Anonymous said...

So the drug seekers are desperate this weekend! So why didn't you just go to McDonald's and have yourself a Happy Meal --- that seems to be what he was interested in!!!

Mr Mobius said...

You must be a really good neurologist to have seen through this Einstein's act.

Queen of the Road said...

Yeah - meet him at McD's. I bet he'd expect you to buy, too.

Anonymous said...

So how does someone "prove" they have pain, anyway? Besides having a broken bone or bleeding wound?

WarmSocks said...

Stuff like this amazes me! I wouldn't dream of bothering my doctor over the weekend.

Anonymous said...

Yepper, pain is measured like a dipstick level.

Classof65 said...

I hate weekends when my prescriptions are getting low. My pharmacy is not open on Sundays and prescriptions are only written for 30 days -- when 7 out of 12 months have 31 days... My doctor is adamant that my meds overlap so as to maintain a given level in my bloodstream, but at the end of each month's prescription there is a problem, either with the pharmacy being closed or with the prescription saying "do not fill before (a certain date)"

And then there are doctors like yourself who agree to cover for a weekend -- and yet do not cover.

Pain management is a joke. There is no such thing. I hope when you reach my age that you suffer chronic pain and find how it limits your life. Then I hope you remember all the people who had a legitimate reason to ask for a meds refill and you turned a cold shoulder to them because you thought they were all addicts and seekers. And this wish is extended to all your self-righteous readers as well.

Grumpy, M.D. said...

Class of 65- I always cover my own patients when they need me.

I also reserve a healthy degree of caution when I don't know patients.

I checked out to Dr. Cortex an hour ago. He has no patient by the name of the one who called me.

On review of my state's Narc Database, the person who called me has had 17 prescriptions for Vicodin in the last 30 days by scamming 17 less careful doctors- all of them on weekends.

Anonymous said...

Do you report someone to someplace when they fill 17 scripts in 30 days?

Grumpy, M.D. said...

It's hard to do when you don't know the circumstances of the others. I mean, I assume they were all shady, but I don't know.

Anonymous said...

Sorry, Classof65, but in that case, your doc needs to make some kind of provision for you. It is NOT cool to call a covering doc who doesn't know you and expect they refill pain meds. Your doc should know this.

Anonymous said...

Class of 65, here's an idea. Be PROACTIVE! Yes, that means count the pills in your bottle and plan ahead for the weekend so you don't have to bother your poor doctor or nag the pharmacist that has nothing to do with your irresponsibility of not planning ahead. Also, there are plenty of pharmacies that are open on Sundays. Don't let that be an excuse to blame somebody else for your problems.

middle child said...

Mr. Mcpayne is merely one of my alias'. I'll be back!

Mary PharmD said...

To Class of 65: It's because the numerous amounts of drug seekers that people such as yourself who actually have legitimate chronic pain have a hard time obtaining pain meds. If you want to blame someone, blame the druggies. The doctors and pharmacists are using their best judgment and discretion they possibly can to figure out the drug seekers vs. the real ones in actual pain.

Anonymous said...

I think I'm pretty lucky to have a pain management doctor to treat me. It wasn't an easy decision to see a pain doctor, my primary care doctor really encouraged me to get the help I needed for a higher level of functioning.

Charles said...

"gimme my meds, man, I need my meds!"

Amy said...

Wow! The things that shocks me is that he succeeded 17 times with this ploy.

terri c said...

Wow. That database is a wealth of information. Mr. McPayne got 17 prescriptions from 17 *different* doctors? He is a busy boy.

Anonymous said...

After you hung up, your guy started to call 17 pharmacies which were open on Sundays to give them the spiel that his neurologist told him to have the pharmacy call - anytime, weekends included. Nonsense!

I'm the pharmacist in charge & I tell all the staff to not call any physician on the weekends. A few dentists are open on Sats, but not many.

All others can seek assistance with the two EDs in our area.

Pisses them off, but I've dumped a lot of drug seekers with this.

Anonymous said...

Argh! I had same thing this weekend. But the patient won. She wanted Vicodin, no Rx, went to ER, left with (& got filled!) 15 HYDROMORPHONES. that just peeves me off.

Anonymous said...

'65 lurks again

ER's Mom said...

I NEVER call in narcs for my patients without an office visit. If you are in pain on the weekend you have several choices: NSAIDS, ER, or office visit Monday. Notice that pain will be treated, but I'm not going to use big guns in a patient whom I have not examined.

Sorry, but diversion is a huge problem in my community (town of around 20K with multiple deaths of 20-somethings in the last year) and I'm not going to contribute.

And to echo earlier comments, you can't figure out on the Thursday before you run out that you are low? Give me a break! I too use a pharmacy that is not open on weekends and I can figure out if I need to call in my pain pills earlier in the week. It's not a pretty sight to see me without my Celebrex. ;)

watercolordaisy said...

You know sometimes you aren't running low, sometimes the dog trips you up and you drop the bottle in the toilet. Or you sneeze just as you are getting a pill out and spill out just enough down the sink so now you ARE low. And the pharmacy won't refill earlier than a few days. Things really do happen and we AREN'T drug seeking.

I *know* a lot of people are drug seekers but *a lot* of us AREN'T.

I happen to have the personal cell phone of my neurologist to be able to call her in such times when she isn't the one on call. I've never used it. And won't except in emergencies. I've just gritted through the pain and she has chewed me out. But I do not want to abuse this privilege.

Seems like there should be a better way to handle this....

The Bus Driver said...

I bet next weekend he'll be saying "dr grumpy is my neurologist and he......" to the next oncall doc.

Anonymous said...

I've been a pharmacist for 33 years & it just amazes me the things people say. Watercolor, do you really think people believe you (even your neurologist??)

Oddly, this only happens to CII-III's, sometimes IV (zolpidem). You never trip over the dog while taking your sumitriptan & sneezes never happen while you're opening your propranolol.

EVERYONE knows what you take. Folks on chronic pain meds (for whatever reason, headaches to cancer) just share what they are on, because friends, family, etc care & want to know what is working. Its similar to having your brand new Mercedes that doesn't have plates yet rear ended. The story gets around. Sadly, the information falls upon some no so caring ears.

So, do what the very best pain management clinics advise: 1) invest in a small safe 2) keep only 1 weeks worth of meds in a 7 day dispenser that you don't keep in an obvious place (like the medicine cabinet - the worst place for any med, btw) 3) if you need double bottles for travel - one large & one small, ask your pharmacist & we're happy to oblige.

Just don't tell me you tripped over your dog & it flushed down the toilet. I've heard that one waaaaaaayyyy too many times!

Anonymous said...

Anonymous don't you think thats a little bit unfair. I've had mishaps with other meds it just wasn't made into a huge deal to get replaced. Last month my pharmacy gave 30 of the antidepressant I'm on instead of 60 I didn't even notice for a week, went back expecting to be told "tough luck" instead they checked my script counted the stock in less then 10 mins I walked off with the other 30 pills. Compared to when I counted the xanax at the pharmacy was 10 short and was treated like I swallowed them right there. Was told they would check and call me if they had extra inventory. Never did get that phone call. I have one time drowned one days of meds but that wasn't enough to have to call anyone, but accidents do happen.

watercolordaisy said...

Yes, I once dropped a whole open bottle in the toilet when the dog got tangled in my feet. I was putting the top back on to put it back and the timing was the worst.

I have *never* given any of my pain meds to ANYONE. Not even one dam pill. I haven't even shared any of my ALLERGY MEDS. Good grief. Not everyone is a hooligan. Most of us are good God fearing folk doing the best we can.

I've had a bottle of benadryl tablets slip out of my hands when I was putting the cap back on and hit the floor and little pink pills everywhere. IT HAPPENS.

And yes, my neurologist believes me because in the six years she's seen me it has happened TWICE. Once the bottle in the toilet. Once my luggage was lost by an airline. All my meds were gone, not just that one. Not to mention my clothes and shoes and gifts bought on vacation... And I didn't even freaking call her for a few days until I couldn't stand it anymore and she reamed me out for not calling sooner. Because she knows me very well and happens to believe being in pain is not acceptable for someone working full time with a chronic illness.

So stuff it and grow some empathy. Heaven help anyone around you in real distress.

Anonymous said...

Watercolor, you called your own neurologist who knows you, not another doctor who was covering and didn't know you at all. There is a difference there. And you waited! You didn't want to meet the doctor at McDonalds! And...did you read where he looked up this person and found he had called 17 different doctors and had 17 different scripts filled in 30 days? I'd say Dr. Grumpy was right in being suspicious.

Anonymous said...

Class of'65.
The pharmacy isn't filling 30 pills for a month (some of which are 31 days, another is 28). The pharmacy is filling a 30 day supply. Plus, most insurances will allow the refill to be a day or so before you should be out. If you run out early, you are probably taking to much. Or you are simply to irresponsible to take care of yourself.

Anonymous said...

watercolor- your venom rings untrue

watercolordaisy said...

I didn't say Dr. Grumpy wasn't right. I said I wished there was a better way for patients who legitimately need help when their doctors aren't available.

The ER is a joke. They always assume you are drug seeking. Even if you are in tears you are in so much pain. So those of us in real pain just suffer through rather than be subjected to the indignity of the scorn of doctors, nurses, and pharmacists who assume they know what we want when they don't even know us. sigh

Those who abuse the system have made it impossible for those truly in need to get help. And that is sad. And dangerous.

Sorry if "my venom rings untrue" to you. I worked all day at my full time job after getting up at 5:20am after not sleeping well because my head is killing me. The irony. lol I have a friend with Crones who puts up with this same attitude from folks. May you never know what it is like to live on this side of the line. Really.

I don't understand the lack of empathy for people who live daily in pain. Yes, lots of people abuse pain meds. But the drugs exist because lots of people require their help to live life. I don't take them all the time. Only during periods when the pain intensifies to levels I can't push through.

My initial point was simply that there should be a better way for patients to get what they need without feeling like a criminal when they aren't.

ERP said...

Yeah, that was my guy. I told him you run a narc clinic at the McDonald's to keep your expenses low.

Kat's Kats said...

Before I went back to my current pcp (I lost her due to insurance change & then back & then moved & then went back due to... see below!) I had a pcp in a clinic. Oh what a wonderful clinic! A baby clinic in the front for walk-ins lalala. But whenever I wanted to see my pcp about my pain issues etcetera she wasn't available due to a,b,c,d, or e-all of the above. grrrr

As a result, I ended up seeing every other doctor, np, & pa in the clinic (minus the specialists until I got referred to neuro for migraines but that's another story). Evidently, someone got it into their head that I was doctor shopping.

Hello?? I would call asking for an appointment with my doctor so I could get my meds refilled. Then I would be told that was impossible but I could see 1,2, or 3 and would that be okay? Well, sure. I would presume that they would have access to my records since they share the same office. After having one of them go "Are you sure you really need these?" I closed my eyes and said, "Well, considering the fact that taking those medications when my pain levels are at 9-10 drops it down to 5-6. Yeah. But don't worry about it. I'll just go back to the pcp I've seen for 10 years."

::puckerface:: "Well, why didn't you just stay with them?!" ::trying not to kill:: "Because she doesn't practice here, her office is 45 minutes away and a 10 minute drive is much easier on my knees." ::head:laptop::

The Mother said...

Do you have any idea how much money there is to be made in the Sunday Refill Clinic at McDonalds?

Your integrity causes you to miss such wonderful opportunities.

(Oh, and probably your intent to stay out of federal prison.)

Classof65 said...

There are many people my age and older who just want to make it through the days we have left without pain at level 8-9...

I do check my meds BEFORE the weekend arrives. I do not take any more meds than prescribed. However my pharmacy will not fill prescriptions even a day in advance. I live in a small town thirty miles away from a larger town. It's silly to get all my meds filled in the large town just so I can once in a while solve this problem. Driving 60 miles to get my meds filled every month -- not to mention the fact that not all my meds are due to be filled at the same time. I am a legitimate, responsible old person who is not a drug-seeker and I resent being grouped in with the "druggies." I would rather not have to take any medications.

Anonymous said...

A few bad apples ruin it for the whole bunch. It's the same with everything else so you'll have to deal with it. Airline pilots land planes successfully every day but one mistake and the whole industry takes a hit. Look at airport security. A few bad apples spoil it for the rest of the bunch. Look at airport security. The average person just wants to get from point A to point B without any hassle but because of the fear of another 9/11 we all have to go through extra security checks and restrictions in our carry ons. It's a part of society and it affects everybody. It's the impact that those few people make on the rest of us that creates the need for extra precaution. If a physician or a pharmacist are providing unecessary controlled substances to a drug abuser even if they have no knowledge of it they can still be held accountable. So I am sorry that you are treated differently but blame those who abuse the system not us.

Anonymous said...

Sorry if there are repeats in the above comment still trying to figure out this damn touch screen

GetYourHeadOutofYourAss said...

The MEDICAL DOCTOR did not call in a prescription for a patient HE HAS NEVER SEEN!

Pain is subjective? Sure. I can agree - to an extent.

But the subject matter of pain is irrelevant!

An MD cannot call in a script for a patient whom he has never assessed!

Classof65 you need to think out of your "grouped in with druggie" box and realize the bottom line problem - caaaaannnnottt trreeaattt ppaaattiiieennntt hhaaavveeenn'ttt assesssseeddd.
(spoken in REtard voice - such as that of Borat)


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