BACK PAIN, MEDS, AND NONCOMPLIANCE

I listened to a phone call between a patient and our secretary last week. The patient wanted to come in a week before she was due for a refill of her Methodone and Dilaudid as she would be on vacation the next week. She was informed that this was fine, but that she would need to bring in her two bottles of narcotic to confirm that she had a week's worth left. She was told that this was standard policy. We did not refill patients early if they ran out of their narcotics early. The patient was outraged. She stated that this had never been required before and demanded to know why she was being singled out. She railed against the possibility that we did not believe her. She yelled at our secretary that we were being unfair, unreasonable, and unprofessional. She demanded that she be able to speak to the office manager, and aggressed against her as well - for almost 20 minutes. Eventually, she refused to come in early if we could not trust her, and stated she would see us after her vacation. Clearly, she expected to remain a patient even after her tirade.

These interactions happen all the time in a typical pain clinic, but patients almost never see them. Everybody is special, everybody is trustworthy, everyone should get special treatment. Patients should be able to structure their treatments, refills, etc., any way they want. Everybody thinks we should break the rules just for them. This patient demanded that we refill the two strongest narcotics in the history of the world 7 days early out of 28 simply because she wanted us to. The common sense, minimally important request to bring in her bottles outraged her. Objectively, this was not a big deal - if she had the last week of her meds. We'll never know since she felt too outraged and betrayed to bring her meds in and so will fill her script after her vacation - the clear implication being, it will be our fault when she goes through withdrawal.

This patient's behavior was completely inappropriate, aggressive, and rude, and demonstrated grossly poor judgement. She yelled at the secretary and office manager for 30 minutes combined and expects to remain a patient of this clinic. She would probably threaten malpractice if we terminated her over this incident, which in fact we have every right to do.

Your doctor is not your mother, father, best friend, or priest. We don't have to care why you're being noncompliant, or inappropriate, or having a bd day - just that you are. The purpose of rules is to prevent us from having to figure out if you're telling the truth or not - that's for criminal courts and parents. We're neither. And we absolutely have the right to terminate your care if you act out. Always. The next time, you get angry because the doctor or staff won't bend the rules for you, remember this blog. And knock it off.

Dr. Tim