RE: Controlled Substance Prescriptions

[Guest guest]

Hi Rian!I asked the head of the RI medical licensure board about this, because I had a patient on oxycontin for chronic pancreatitis and I was reading the DEA verbiage about what you could and couldn't do and it isn't clear. The patient lived about 45 minutes away and I didn't want to make him come down every month to get a new prescription - seemed like a waste of his and my time - chronic, stable no change in dose, no suspicion of abuse. He looked into it, with regard to DEA regulations etc., and what he said was, it was NOT illegal to mail him a presciption every month, without seeing him. The patient would call and leave me a message about a week before he was going to be out and I would mail him a rxn. He came down every 4-6 months for a visit.But you are perfectly within your right to do it the way you please - the way I did it, I was working for free. I didn't mind with this patient and it streamlined his care, BUT If you don't want to work for free, or you don't feel comfortable, have her come in. Depends on your comfort level. I got bored of having the patient come in so much, so I devolved to the method above which worked for us and apparently is not illegal (at least via RI law interpretation). Lynn HoTo: From: mintek@...Date: Sat, 29 Nov 2008 10:31:07 -0500Subject: Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone

prescription. A new patient calls, and requests a call-back before

scheduling appointment, so that she won't waste a trip. She explains

that she is suffering chronic pain, despite surgery (diskectomy and

fusion procedure, for cervical disc disease), 6 years ago. She has

been to the Chronic Pain Management consultants (45 minutes drive from

our little town), and has tried numerous drugs, and is now relying on

Methadone. She is disabled by her pain, and driving to that chronic

pain clinic is a hassle. A few months ago, she pushed the Chronic Pain

Management specialist to agree that the patient would only need to

drive that far once a year, and that the responsibility to write the

Methadone prescriptions could be carried by the patient's local family

doctor (a member of a group practice, here in our small town.)

Actually, most of the time those prescriptions would be written-out

by hand on paper prescription, by that family doctor, and just left

for the patient at the reception desk; the patient would just stop

over to the F.P. clinic and pick-up her prescription right there at

the desk, without needing to fork-out a co-pay, or waste time with

scheduling appointment, waiting in the waiting room, bothering with

the nuisance of vital signs, interval history, or exam ...

Now, she has learned that the family doctor in that scenario is

leaving our town. So, the patient (who used to see me, like 11 years

ago, when I used to work like a cog in that same machine), calls and

says how much she always used to like me, and please wouldn't I help

her, the way Dr. X. was helping her ...

My answer was that I would be happy to see her again in my little

solo office, but I would need to review her records, and repeat the

history/physical about her pain, and I would generally require visits

every time she needed a new prescription for Methadone. That hit a

stalemate.

So, to get back to the general question: if a Schedule II Controlled

Substance is regulated with rules that disallow telephone

prescriptions, FAX'ed prescriptions, or refills, and instead requires

that every single prescription must be hand-signed in ink by

prescribing physician, doesn't that imply that the physician is

seeing that patient that often ? ...

Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-

serve with a new computer, and typing speed finally fast enough to

pose a question; sorry if this issue has already been addressed by the

I.M.P.'s ...

Windows Live Hotmail now works up to 70% faster. Sign up today.

[Guest guest]

agree with lynnOf courseCertainly with someone new to you for this care it is prudent to see them every month It is your license after all An appropriate h a nd p of course , urine drug test go over a c ontract- no replacments if the dog eats teh script or th epills are opened over th e toilet etc

It is legal to give someone or mail to someone two or threemonths of scripts that are for fill when due( this changed back to this agian this year For a while you could not do it) For adhd kids I do this by e-visits and charge 25.00 for 3months' worth- and I mail to the pharmacy no tthe patietn- for my chronic pain patients i am more likely to see them so i can do the ocaisional urine drug test

besdies you know they need ammorgams, Bps et c!It's your livlihood and your iicenseJean

Hi Rian!I asked the head of the RI medical licensure board about this, because I had a patient on oxycontin for chronic pancreatitis and I was reading the DEA verbiage about what you could and couldn't do and it isn't clear. The patient lived about 45 minutes away and I didn't want to make him come down every month to get a new prescription - seemed like a waste of his and my time - chronic, stable no change in dose, no suspicion of abuse. He looked into it, with regard to DEA regulations etc., and what he said was, it was NOT illegal to mail him a presciption every month, without seeing him. The patient would call and leave me a message about a week before he was going to be out and I would mail him a rxn. He came down every 4-6 months for a visit.

But you are perfectly within your right to do it the way you please - the way I did it, I was working for free. I didn't mind with this patient and it streamlined his care, BUT If you don't want to work for free, or you don't feel comfortable, have her come in. Depends on your comfort level. I got bored of having the patient come in so much, so I devolved to the method above which worked for us and apparently is not illegal (at least via RI law interpretation).

Lynn HoTo: From: mintek@...

Date: Sat, 29 Nov 2008 10:31:07 -0500Subject: Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone

prescription. A new patient calls, and requests a call-back before

scheduling appointment, so that she won't waste a trip. She explains

that she is suffering chronic pain, despite surgery (diskectomy and

fusion procedure, for cervical disc disease), 6 years ago. She has

been to the Chronic Pain Management consultants (45 minutes drive from

our little town), and has tried numerous drugs, and is now relying on

Methadone. She is disabled by her pain, and driving to that chronic

pain clinic is a hassle. A few months ago, she pushed the Chronic Pain

Management specialist to agree that the patient would only need to

drive that far once a year, and that the responsibility to write the

Methadone prescriptions could be carried by the patient's local family

doctor (a member of a group practice, here in our small town.)

Actually, most of the time those prescriptions would be written-out

by hand on paper prescription, by that family doctor, and just left

for the patient at the reception desk; the patient would just stop

over to the F.P. clinic and pick-up her prescription right there at

the desk, without needing to fork-out a co-pay, or waste time with

scheduling appointment, waiting in the waiting room, bothering with

the nuisance of vital signs, interval history, or exam ...

Now, she has learned that the family doctor in that scenario is

leaving our town. So, the patient (who used to see me, like 11 years

ago, when I used to work like a cog in that same machine), calls and

says how much she always used to like me, and please wouldn't I help

her, the way Dr. X. was helping her ...

My answer was that I would be happy to see her again in my little

solo office, but I would need to review her records, and repeat the

history/physical about her pain, and I would generally require visits

every time she needed a new prescription for Methadone. That hit a

stalemate.

So, to get back to the general question: if a Schedule II Controlled

Substance is regulated with rules that disallow telephone

prescriptions, FAX'ed prescriptions, or refills, and instead requires

that every single prescription must be hand-signed in ink by

prescribing physician, doesn't that imply that the physician is

seeing that patient that often ? ...

Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-

serve with a new computer, and typing speed finally fast enough to

pose a question; sorry if this issue has already been addressed by the

I.M.P.'s ...

Windows Live Hotmail now works up to 70% faster. Sign up today.

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

The DEA allows writing prescriptions to be filled at a later date, 1 and 2 months in addition to the current appointment date.Ultimately it is your decision, I would not feel comfortable stretching the visit interval longer than 3 months.

As mentioned, you are a Physician taking care of the whole person, in addition you need to make sure that the narcotics are not masking symptoms of a treatable medical condition. I would not want to be just a legal drug source (dealer?).

If the patient cries and complains that coming for a medical visit every 3 months is a hardship, I would let them know that I would forward copies of the chart to the new practitioner. We all are responsible for our decisions, if a patient lives too far away, then they can move closer, they need to fill the prescription at a pharmacy every month anyhow.

There are some patients that should be seen every month in spite of the DEA rules; the DEA allows, not forces writing prescriptions for 3 months at a time.-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

I agree basically. I would have her establish care with a new patient visit, because that is what it is. 11 years ago is a long time, no matter how much she liked you; you have a lot of records to review, etc. Then I would refill prescriptions "for free", having her come pick them up or give her them ahead of time with the appropriate dates on them or mail them to her or whatever for two more months, and have her come back every 3 months for a while (maybe a year) until I felt comfortable. Then, I'd stretch those visits out to every 4-6 months. LonnaSubject: RE: Controlled Substance

PrescriptionsTo: practiceimprovement1 Date: Saturday, November 29, 2008, 8:01 AM

Hi Rian!I asked the head of the RI medical licensure board about this, because I had a patient on oxycontin for chronic pancreatitis and I was reading the DEA verbiage about what you could and couldn't do and it isn't clear. The patient lived about 45 minutes away and I didn't want to make him come down every month to get a new prescription - seemed like a waste of his and my time - chronic, stable no change in dose, no suspicion of abuse. He looked into it, with regard to DEA regulations etc., and what he said was, it was NOT illegal to mail him a presciption every month, without seeing him. The patient would call and leave me a message about a week before he was going to be out and I would mail him a rxn. He came down every 4-6 months for a visit.But you are perfectly within your right to do it the way you please - the way I did it, I was working for free. I didn't mind with this patient and it streamlined

his care, BUT If you don't want to work for free, or you don't feel comfortable, have her come in. Depends on your comfort level. I got bored of having the patient come in so much, so I devolved to the method above which worked for us and apparently is not illegal (at least via RI law interpretation) . Lynn HoTo: Practiceimprovement 1yahoogroups (DOT) comFrom: mintekcharter (DOT) netDate: Sat, 29 Nov 2008 10:31:07 -0500Subject: [Practiceimprovemen t1] Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone

prescription. A new patient calls, and requests a call-back before

scheduling appointment, so that she won't waste a trip. She explains

that she is suffering chronic pain, despite surgery (diskectomy and

fusion procedure, for cervical disc disease), 6 years ago. She has

been to the Chronic Pain Management consultants (45 minutes drive from

our little town), and has tried numerous drugs, and is now relying on

Methadone. She is disabled by her pain, and driving to that chronic

pain clinic is a hassle. A few months ago, she pushed the Chronic Pain

Management specialist to agree that the patient would only need to

drive that far once a year, and that the responsibility to write the

Methadone prescriptions could be carried by the patient's local family

doctor (a member of a group practice, here in our small town.)

Actually, most of the time those prescriptions would be written-out

by hand on paper prescription, by that family doctor, and just left

for the patient at the reception desk; the patient would just stop

over to the F.P. clinic and pick-up her prescription right there at

the desk, without needing to fork-out a co-pay, or waste time with

scheduling appointment, waiting in the waiting room, bothering with

the nuisance of vital signs, interval history, or exam ...

Now, she has learned that the family doctor in that scenario is

leaving our town. So, the patient (who used to see me, like 11 years

ago, when I used to work like a cog in that same machine), calls and

says how much she always used to like me, and please wouldn't I help

her, the way Dr. X. was helping her ...

My answer was that I would be happy to see her again in my little

solo office, but I would need to review her records, and repeat the

history/physical about her pain, and I would generally require visits

every time she needed a new prescription for Methadone. That hit a

stalemate.

So, to get back to the general question: if a Schedule II Controlled

Substance is regulated with rules that disallow telephone

prescriptions, FAX'ed prescriptions, or refills, and instead requires

that every single prescription must be hand-signed in ink by

prescribing physician, doesn't that imply that the physician is

seeing that patient that often ? ...

Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-

serve with a new computer, and typing speed finally fast enough to

pose a question; sorry if this issue has already been addressed by the

I.M.P.'s ...

Windows Live Hotmail now works up to 70% faster. Sign up today.

[Guest guest]

I had posted these links on the AAFP, they may be useful:http://www.treatment.org/http://www.dapaonline.com/

http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf

http://www.whitehousedrugpolicy.gov/http://ncadi.samhsa.gov/http://www.tresearch.org/

http://download.ncadi.samhsa.gov/prevline/pdfs/DTXTIP45(3-30-06).PDFhttp://www.fsmb.org/

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.48302

http://www.aaap.org/buprenorphine/buprenorphine.htmlhttp://buprenorphine.samhsa.gov/bwns_locator/physician_links.htm

http://buprenorphine.samhsa.gov/publications.htmlhttp://buprenorphine.samhsa.gov/presentations.html

-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

I had posted these links on the AAFP, they may be useful:http://www.treatment.org/http://www.dapaonline.com/

http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf

http://www.whitehousedrugpolicy.gov/http://ncadi.samhsa.gov/http://www.tresearch.org/

http://download.ncadi.samhsa.gov/prevline/pdfs/DTXTIP45(3-30-06).PDFhttp://www.fsmb.org/

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.48302

http://www.aaap.org/buprenorphine/buprenorphine.htmlhttp://buprenorphine.samhsa.gov/bwns_locator/physician_links.htm

http://buprenorphine.samhsa.gov/publications.htmlhttp://buprenorphine.samhsa.gov/presentations.html

-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

I would make sure you see her often enough to document that the pain medication is needed with pain scales and quality of life --- i.e. can do ADLs with pain meds on but can't without, as well as sign a contract to use you and only you, check with the DEA to run her name to make sure she's not using other docs and multiple pharmacies. I would see monthly for at least 3 months and then start stretching it out. You can write a script for this month and another dated for one month from now by new DEA regulations. But I think they do want in person visits every 3 month. Having watched a lovely physician get put out of practice for not having enough documentation on chronic pain patients and my own personal experiences of being hoodwinked ( and not finding out I was feeding an addiction for 2 years!) I caution about making things "too

easy". If you are working harder than the patient then something is wrong with the picture. That means sometimes she has to make the drive and be responsible for taking care of her condition with you not only "by" you.

From: Lynn Ho <lynnhrihotmail (DOT) com>Subject: RE: [Practiceimprovemen t1] Controlled Substance PrescriptionsTo: practiceimprovement 1yahoogroups (DOT) comDate: Saturday, November 29, 2008, 8:01 AM

Hi Rian!I asked the head of the RI medical licensure board about this, because I had a patient on oxycontin for chronic pancreatitis and I was reading the DEA verbiage about what you could and couldn't do and it isn't clear. The patient lived about 45 minutes away and I didn't want to make him come down every month to get a new prescription - seemed like a waste of his and my time - chronic, stable no change in dose, no suspicion of abuse. He looked into it, with regard to DEA regulations etc., and what he said was, it was NOT illegal to mail him a presciption every month, without seeing him. The patient would call and leave me a message about a week before he was going to be out and I would mail him a rxn. He came down every 4-6 months for a visit.But you are perfectly within your right to do it the way you please - the way I did it, I was working for free. I didn't mind with this patient and it

streamlined his care, BUT If you don't want to work for free, or you don't feel comfortable, have her come in. Depends on your comfort level. I got bored of having the patient come in so much, so I devolved to the method above which worked for us and apparently is not illegal (at least via RI law interpretation) . Lynn Ho

To: Practiceimprovement 1yahoogroups (DOT) comFrom: mintekcharter (DOT) netDate: Sat, 29 Nov 2008 10:31:07 -0500Subject: [Practiceimprovemen t1] Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone prescription. A new patient calls, and requests a call-back before scheduling appointment, so that she won't waste a trip. She explains that she is suffering chronic pain, despite surgery (diskectomy and fusion procedure, for cervical disc disease), 6 years ago. She has been to the Chronic Pain Management consultants (45 minutes drive from our little town), and has tried numerous drugs, and is now relying on Methadone. She is disabled by her pain, and driving to that chronic pain clinic is a hassle. A few months ago, she pushed the Chronic Pain Management specialist to agree that the patient would only need to drive that far once a year, and that the responsibility to write the Methadone prescriptions could be carried by the patient's local family doctor (a member of a group practice, here in our small

town.)Actually, most of the time those prescriptions would be written-out by hand on paper prescription, by that family doctor, and just left for the patient at the reception desk; the patient would just stop over to the F.P. clinic and pick-up her prescription right there at the desk, without needing to fork-out a co-pay, or waste time with scheduling appointment, waiting in the waiting room, bothering with the nuisance of vital signs, interval history, or exam ...Now, she has learned that the family doctor in that scenario is leaving our town. So, the patient (who used to see me, like 11 years ago, when I used to work like a cog in that same machine), calls and says how much she always used to like me, and please wouldn't I help her, the way Dr. X. was helping her ...My answer was that I would be happy to see her again in my little solo office, but I would need to review her records, and

repeat the history/physical about her pain, and I would generally require visits every time she needed a new prescription for Methadone. That hit a stalemate.So, to get back to the general question: if a Schedule II Controlled Substance is regulated with rules that disallow telephone prescriptions, FAX'ed prescriptions, or refills, and instead requires that every single prescription must be hand-signed in ink by prescribing physician, doesn't that imply that the physician is seeing that patient that often ? ...Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list- serve with a new computer, and typing speed finally fast enough to pose a question; sorry if this issue has already been addressed by the I.M.P.'s ...

Windows Live Hotmail now works up to 70% faster. Sign up today.

[Guest guest]

I would make sure you see her often enough to document that the pain medication is needed with pain scales and quality of life --- i.e. can do ADLs with pain meds on but can't without, as well as sign a contract to use you and only you, check with the DEA to run her name to make sure she's not using other docs and multiple pharmacies. I would see monthly for at least 3 months and then start stretching it out. You can write a script for this month and another dated for one month from now by new DEA regulations. But I think they do want in person visits every 3 month. Having watched a lovely physician get put out of practice for not having enough documentation on chronic pain patients and my own personal experiences of being hoodwinked ( and not finding out I was feeding an addiction for 2 years!) I caution about making things "too

easy". If you are working harder than the patient then something is wrong with the picture. That means sometimes she has to make the drive and be responsible for taking care of her condition with you not only "by" you.

From: Lynn Ho <lynnhrihotmail (DOT) com>Subject: RE: [Practiceimprovemen t1] Controlled Substance PrescriptionsTo: practiceimprovement 1yahoogroups (DOT) comDate: Saturday, November 29, 2008, 8:01 AM

Hi Rian!I asked the head of the RI medical licensure board about this, because I had a patient on oxycontin for chronic pancreatitis and I was reading the DEA verbiage about what you could and couldn't do and it isn't clear. The patient lived about 45 minutes away and I didn't want to make him come down every month to get a new prescription - seemed like a waste of his and my time - chronic, stable no change in dose, no suspicion of abuse. He looked into it, with regard to DEA regulations etc., and what he said was, it was NOT illegal to mail him a presciption every month, without seeing him. The patient would call and leave me a message about a week before he was going to be out and I would mail him a rxn. He came down every 4-6 months for a visit.But you are perfectly within your right to do it the way you please - the way I did it, I was working for free. I didn't mind with this patient and it

streamlined his care, BUT If you don't want to work for free, or you don't feel comfortable, have her come in. Depends on your comfort level. I got bored of having the patient come in so much, so I devolved to the method above which worked for us and apparently is not illegal (at least via RI law interpretation) . Lynn Ho

To: Practiceimprovement 1yahoogroups (DOT) comFrom: mintekcharter (DOT) netDate: Sat, 29 Nov 2008 10:31:07 -0500Subject: [Practiceimprovemen t1] Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone prescription. A new patient calls, and requests a call-back before scheduling appointment, so that she won't waste a trip. She explains that she is suffering chronic pain, despite surgery (diskectomy and fusion procedure, for cervical disc disease), 6 years ago. She has been to the Chronic Pain Management consultants (45 minutes drive from our little town), and has tried numerous drugs, and is now relying on Methadone. She is disabled by her pain, and driving to that chronic pain clinic is a hassle. A few months ago, she pushed the Chronic Pain Management specialist to agree that the patient would only need to drive that far once a year, and that the responsibility to write the Methadone prescriptions could be carried by the patient's local family doctor (a member of a group practice, here in our small

town.)Actually, most of the time those prescriptions would be written-out by hand on paper prescription, by that family doctor, and just left for the patient at the reception desk; the patient would just stop over to the F.P. clinic and pick-up her prescription right there at the desk, without needing to fork-out a co-pay, or waste time with scheduling appointment, waiting in the waiting room, bothering with the nuisance of vital signs, interval history, or exam ...Now, she has learned that the family doctor in that scenario is leaving our town. So, the patient (who used to see me, like 11 years ago, when I used to work like a cog in that same machine), calls and says how much she always used to like me, and please wouldn't I help her, the way Dr. X. was helping her ...My answer was that I would be happy to see her again in my little solo office, but I would need to review her records, and

repeat the history/physical about her pain, and I would generally require visits every time she needed a new prescription for Methadone. That hit a stalemate.So, to get back to the general question: if a Schedule II Controlled Substance is regulated with rules that disallow telephone prescriptions, FAX'ed prescriptions, or refills, and instead requires that every single prescription must be hand-signed in ink by prescribing physician, doesn't that imply that the physician is seeing that patient that often ? ...Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list- serve with a new computer, and typing speed finally fast enough to pose a question; sorry if this issue has already been addressed by the I.M.P.'s ...

Windows Live Hotmail now works up to 70% faster. Sign up today.

[Guest guest]

I require my chronic pain patients to be seen monthly if they are on

Schedule II medications, it is in their pain contract, and if they are

unwilling to agree to those conditions they can take themselves

elsewhere. No early refills, or relatives picking up their

prescriptions either, unless its a special case such as one of my cancer

patients who sometimes feels too lousy to travel.

Paddy O'Rourke, MD

a Mintek wrote:

>

>

>

> Here is a question: how to deal with a request for Methadone

> prescription. A new patient calls, and requests a call-back before

> scheduling appointment, so that she won't waste a trip. She explains

> that she is suffering chronic pain, despite surgery (diskectomy and

> fusion procedure, for cervical disc disease), 6 years ago. She has

> been to the Chronic Pain Management consultants (45 minutes drive from

> our little town), and has tried numerous drugs, and is now relying on

> Methadone. She is disabled by her pain, and driving to that chronic

> pain clinic is a hassle. A few months ago, she pushed the Chronic Pain

> Management specialist to agree that the patient would only need to

> drive that far once a year, and that the responsibility to write the

> Methadone prescriptions could be carried by the patient's local family

> doctor (a member of a group practice, here in our small town.)

> Actually, most of the time those prescriptions would be written-out

> by hand on paper prescription, by that family doctor, and just left

> for the patient at the reception desk; the patient would just stop

> over to the F.P. clinic and pick-up her prescription right there at

> the desk, without needing to fork-out a co-pay, or waste time with

> scheduling appointment, waiting in the waiting room, bothering with

> the nuisance of vital signs, interval history, or exam ...

>

> Now, she has learned that the family doctor in that scenario is

> leaving our town. So, the patient (who used to see me, like 11 years

> ago, when I used to work like a cog in that same machine), calls and

> says how much she always used to like me, and please wouldn't I help

> her, the way Dr. X. was helping her ...

>

> My answer was that I would be happy to see her again in my little

> solo office, but I would need to review her records, and repeat the

> history/physical about her pain, and I would generally require visits

> every time she needed a new prescription for Methadone. That hit a

> stalemate.

>

> So, to get back to the general question: if a Schedule II Controlled

> Substance is regulated with rules that disallow telephone

> prescriptions, FAX'ed prescriptions, or refills, and instead requires

> that every single prescription must be hand-signed in ink by

> prescribing physician, doesn't that imply that the physician is

> seeing that patient that often ? ...

>

> Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-

> serve with a new computer, and typing speed finally fast enough to

> pose a question; sorry if this issue has already been addressed by the

> I.M.P.'s ...

>

>

[Guest guest]

I require my chronic pain patients to be seen monthly if they are on

Schedule II medications, it is in their pain contract, and if they are

unwilling to agree to those conditions they can take themselves

elsewhere. No early refills, or relatives picking up their

prescriptions either, unless its a special case such as one of my cancer

patients who sometimes feels too lousy to travel.

Paddy O'Rourke, MD

a Mintek wrote:

>

>

>

> Here is a question: how to deal with a request for Methadone

> prescription. A new patient calls, and requests a call-back before

> scheduling appointment, so that she won't waste a trip. She explains

> that she is suffering chronic pain, despite surgery (diskectomy and

> fusion procedure, for cervical disc disease), 6 years ago. She has

> been to the Chronic Pain Management consultants (45 minutes drive from

> our little town), and has tried numerous drugs, and is now relying on

> Methadone. She is disabled by her pain, and driving to that chronic

> pain clinic is a hassle. A few months ago, she pushed the Chronic Pain

> Management specialist to agree that the patient would only need to

> drive that far once a year, and that the responsibility to write the

> Methadone prescriptions could be carried by the patient's local family

> doctor (a member of a group practice, here in our small town.)

> Actually, most of the time those prescriptions would be written-out

> by hand on paper prescription, by that family doctor, and just left

> for the patient at the reception desk; the patient would just stop

> over to the F.P. clinic and pick-up her prescription right there at

> the desk, without needing to fork-out a co-pay, or waste time with

> scheduling appointment, waiting in the waiting room, bothering with

> the nuisance of vital signs, interval history, or exam ...

>

> Now, she has learned that the family doctor in that scenario is

> leaving our town. So, the patient (who used to see me, like 11 years

> ago, when I used to work like a cog in that same machine), calls and

> says how much she always used to like me, and please wouldn't I help

> her, the way Dr. X. was helping her ...

>

> My answer was that I would be happy to see her again in my little

> solo office, but I would need to review her records, and repeat the

> history/physical about her pain, and I would generally require visits

> every time she needed a new prescription for Methadone. That hit a

> stalemate.

>

> So, to get back to the general question: if a Schedule II Controlled

> Substance is regulated with rules that disallow telephone

> prescriptions, FAX'ed prescriptions, or refills, and instead requires

> that every single prescription must be hand-signed in ink by

> prescribing physician, doesn't that imply that the physician is

> seeing that patient that often ? ...

>

> Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-

> serve with a new computer, and typing speed finally fast enough to

> pose a question; sorry if this issue has already been addressed by the

> I.M.P.'s ...

>

>

[Guest guest]

Rian,

My understanding is that you need a special permit to write for

Methadone. Not everyone can write for methadone.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of a Mintek

Sent: Saturday, November 29, 2008 10:31 AM

To:

Subject: Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone

prescription. A new patient calls, and requests a call-back before

scheduling appointment, so that she won't waste a trip. She explains

that she is suffering chronic pain, despite surgery (diskectomy and

fusion procedure, for cervical disc disease), 6 years ago. She has

been to the Chronic Pain Management consultants (45 minutes drive from

our little town), and has tried numerous drugs, and is now relying on

Methadone. She is disabled by her pain, and driving to that chronic

pain clinic is a hassle. A few months ago, she pushed the Chronic Pain

Management specialist to agree that the patient would only need to

drive that far once a year, and that the responsibility to write the

Methadone prescriptions could be carried by the patient's local family

doctor (a member of a group practice, here in our small town.)

Actually, most of the time those prescriptions would be written-out

by hand on paper prescription, by that family doctor, and just left

for the patient at the reception desk; the patient would just stop

over to the F.P. clinic and pick-up her prescription right there at

the desk, without needing to fork-out a co-pay, or waste time with

scheduling appointment, waiting in the waiting room, bothering with

the nuisance of vital signs, interval history, or exam ...

Now, she has learned that the family doctor in that scenario is

leaving our town. So, the patient (who used to see me, like 11 years

ago, when I used to work like a cog in that same machine), calls and

says how much she always used to like me, and please wouldn't I help

her, the way Dr. X. was helping her ...

My answer was that I would be happy to see her again in my little

solo office, but I would need to review her records, and repeat the

history/physical about her pain, and I would generally require visits

every time she needed a new prescription for Methadone. That hit a

stalemate.

So, to get back to the general question: if a Schedule II Controlled

Substance is regulated with rules that disallow telephone

prescriptions, FAX'ed prescriptions, or refills, and instead requires

that every single prescription must be hand-signed in ink by

prescribing physician, doesn't that imply that the physician is

seeing that patient that often ? ...

Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-

serve with a new computer, and typing speed finally fast enough to

pose a question; sorry if this issue has already been addressed by the

I.M.P.'s ...

[Guest guest]

Rian,

My understanding is that you need a special permit to write for

Methadone. Not everyone can write for methadone.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of a Mintek

Sent: Saturday, November 29, 2008 10:31 AM

To:

Subject: Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone

prescription. A new patient calls, and requests a call-back before

scheduling appointment, so that she won't waste a trip. She explains

that she is suffering chronic pain, despite surgery (diskectomy and

fusion procedure, for cervical disc disease), 6 years ago. She has

been to the Chronic Pain Management consultants (45 minutes drive from

our little town), and has tried numerous drugs, and is now relying on

Methadone. She is disabled by her pain, and driving to that chronic

pain clinic is a hassle. A few months ago, she pushed the Chronic Pain

Management specialist to agree that the patient would only need to

drive that far once a year, and that the responsibility to write the

Methadone prescriptions could be carried by the patient's local family

doctor (a member of a group practice, here in our small town.)

Actually, most of the time those prescriptions would be written-out

by hand on paper prescription, by that family doctor, and just left

for the patient at the reception desk; the patient would just stop

over to the F.P. clinic and pick-up her prescription right there at

the desk, without needing to fork-out a co-pay, or waste time with

scheduling appointment, waiting in the waiting room, bothering with

the nuisance of vital signs, interval history, or exam ...

Now, she has learned that the family doctor in that scenario is

leaving our town. So, the patient (who used to see me, like 11 years

ago, when I used to work like a cog in that same machine), calls and

says how much she always used to like me, and please wouldn't I help

her, the way Dr. X. was helping her ...

My answer was that I would be happy to see her again in my little

solo office, but I would need to review her records, and repeat the

history/physical about her pain, and I would generally require visits

every time she needed a new prescription for Methadone. That hit a

stalemate.

So, to get back to the general question: if a Schedule II Controlled

Substance is regulated with rules that disallow telephone

prescriptions, FAX'ed prescriptions, or refills, and instead requires

that every single prescription must be hand-signed in ink by

prescribing physician, doesn't that imply that the physician is

seeing that patient that often ? ...

Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-

serve with a new computer, and typing speed finally fast enough to

pose a question; sorry if this issue has already been addressed by the

I.M.P.'s ...

[Guest guest]

You can write for methadone for pain control, not for opiate addiction. Methadone is relatively inexpensive and patients can save a lot of money.If you need or want to treat opiate addiction you need to take a buprenorphine course, pass the test and apply for the waiver,

Refer to previous links-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

You can write for methadone for pain control, not for opiate addiction. Methadone is relatively inexpensive and patients can save a lot of money.If you need or want to treat opiate addiction you need to take a buprenorphine course, pass the test and apply for the waiver,

Refer to previous links-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

Rian,I would like to point out that you also have the option of declining to treat this patient for chronic pain. Just because you saw her 11 years ago doesn't put any obligation on you. In fact, that "she says she always used to like you" raises a red flag to me. Does she really remember you from 11 years ago, or is she being manipulative? I would also feel uncomfortable with having her pick up a prescription without being seen as she is requesting. If you feel comfortable treating chronic pain in this situation, then by all means, do it under your own terms and not hers. However, if you don't feel comfortable, you can politely decline and she will move on to another doctor. SetoSouth Pasadena, CAI require my chronic pain patients to be seen monthly if they are on Schedule II medications, it is in their pain contract, and if they are unwilling to agree to those conditions they can take themselves elsewhere. No early refills, or relatives picking up their prescriptions either, unless its a special case such as one of my cancer patients who sometimes feels too lousy to travel. Paddy O'Rourke, MDa Mintek wrote:>>>> Here is a question: how to deal with a request for Methadone> prescription. A new patient calls, and requests a call-back before> scheduling appointment, so that she won't waste a trip. She explains> that she is suffering chronic pain, despite surgery (diskectomy and> fusion procedure, for cervical disc disease), 6 years ago. She has> been to the Chronic Pain Management consultants (45 minutes drive from> our little town), and has tried numerous drugs, and is now relying on> Methadone. She is disabled by her pain, and driving to that chronic> pain clinic is a hassle. A few months ago, she pushed the Chronic Pain> Management specialist to agree that the patient would only need to> drive that far once a year, and that the responsibility to write the> Methadone prescriptions could be carried by the patient's local family> doctor (a member of a group practice, here in our small town.)> Actually, most of the time those prescriptions would be written-out> by hand on paper prescription, by that family doctor, and just left> for the patient at the reception desk; the patient would just stop> over to the F.P. clinic and pick-up her prescription right there at> the desk, without needing to fork-out a co-pay, or waste time with> scheduling appointment, waiting in the waiting room, bothering with> the nuisance of vital signs, interval history, or exam ...>> Now, she has learned that the family doctor in that scenario is> leaving our town. So, the patient (who used to see me, like 11 years> ago, when I used to work like a cog in that same machine), calls and> says how much she always used to like me, and please wouldn't I help> her, the way Dr. X. was helping her ...>> My answer was that I would be happy to see her again in my little> solo office, but I would need to review her records, and repeat the> history/physical about her pain, and I would generally require visits> every time she needed a new prescription for Methadone. That hit a> stalemate.>> So, to get back to the general question: if a Schedule II Controlled> Substance is regulated with rules that disallow telephone> prescriptions, FAX'ed prescriptions, or refills, and instead requires> that every single prescription must be hand-signed in ink by> prescribing physician, doesn't that imply that the physician is> seeing that patient that often ? ...>> Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-> serve with a new computer, and typing speed finally fast enough to> pose a question; sorry if this issue has already been addressed by the> I.M.P.'s ...>>

[Guest guest]

Rian,I would like to point out that you also have the option of declining to treat this patient for chronic pain. Just because you saw her 11 years ago doesn't put any obligation on you. In fact, that "she says she always used to like you" raises a red flag to me. Does she really remember you from 11 years ago, or is she being manipulative? I would also feel uncomfortable with having her pick up a prescription without being seen as she is requesting. If you feel comfortable treating chronic pain in this situation, then by all means, do it under your own terms and not hers. However, if you don't feel comfortable, you can politely decline and she will move on to another doctor. SetoSouth Pasadena, CAI require my chronic pain patients to be seen monthly if they are on Schedule II medications, it is in their pain contract, and if they are unwilling to agree to those conditions they can take themselves elsewhere. No early refills, or relatives picking up their prescriptions either, unless its a special case such as one of my cancer patients who sometimes feels too lousy to travel. Paddy O'Rourke, MDa Mintek wrote:>>>> Here is a question: how to deal with a request for Methadone> prescription. A new patient calls, and requests a call-back before> scheduling appointment, so that she won't waste a trip. She explains> that she is suffering chronic pain, despite surgery (diskectomy and> fusion procedure, for cervical disc disease), 6 years ago. She has> been to the Chronic Pain Management consultants (45 minutes drive from> our little town), and has tried numerous drugs, and is now relying on> Methadone. She is disabled by her pain, and driving to that chronic> pain clinic is a hassle. A few months ago, she pushed the Chronic Pain> Management specialist to agree that the patient would only need to> drive that far once a year, and that the responsibility to write the> Methadone prescriptions could be carried by the patient's local family> doctor (a member of a group practice, here in our small town.)> Actually, most of the time those prescriptions would be written-out> by hand on paper prescription, by that family doctor, and just left> for the patient at the reception desk; the patient would just stop> over to the F.P. clinic and pick-up her prescription right there at> the desk, without needing to fork-out a co-pay, or waste time with> scheduling appointment, waiting in the waiting room, bothering with> the nuisance of vital signs, interval history, or exam ...>> Now, she has learned that the family doctor in that scenario is> leaving our town. So, the patient (who used to see me, like 11 years> ago, when I used to work like a cog in that same machine), calls and> says how much she always used to like me, and please wouldn't I help> her, the way Dr. X. was helping her ...>> My answer was that I would be happy to see her again in my little> solo office, but I would need to review her records, and repeat the> history/physical about her pain, and I would generally require visits> every time she needed a new prescription for Methadone. That hit a> stalemate.>> So, to get back to the general question: if a Schedule II Controlled> Substance is regulated with rules that disallow telephone> prescriptions, FAX'ed prescriptions, or refills, and instead requires> that every single prescription must be hand-signed in ink by> prescribing physician, doesn't that imply that the physician is> seeing that patient that often ? ...>> Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-> serve with a new computer, and typing speed finally fast enough to> pose a question; sorry if this issue has already been addressed by the> I.M.P.'s ...>>

[Guest guest]

Right as Pedro says You must write " for pain " on the script for methadone You cannot use it for withdrawal but ok for pain.Long half life must be very careful using it starting out can make people a littel drowsy

they FEEL better on oxycontin but that stuff costs a million dollars. Methadone and long acting morphine are cheap and work pretty wellsometimes of course you need lots of tricks treat the depression use lidoderm patches,

tens unit, PT, etc etcJean

You can write for methadone for pain control, not for opiate addiction. Methadone is relatively inexpensive and patients can save a lot of money.If you need or want to treat opiate addiction you need to take a buprenorphine course, pass the test and apply for the waiver,

Refer to previous links-- Pedro Ballester, M.D.Warren, OH

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Right as Pedro says You must write " for pain " on the script for methadone You cannot use it for withdrawal but ok for pain.Long half life must be very careful using it starting out can make people a littel drowsy

they FEEL better on oxycontin but that stuff costs a million dollars. Methadone and long acting morphine are cheap and work pretty wellsometimes of course you need lots of tricks treat the depression use lidoderm patches,

tens unit, PT, etc etcJean

You can write for methadone for pain control, not for opiate addiction. Methadone is relatively inexpensive and patients can save a lot of money.If you need or want to treat opiate addiction you need to take a buprenorphine course, pass the test and apply for the waiver,

Refer to previous links-- Pedro Ballester, M.D.Warren, OH

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

It is also very important to review and understand the pharmacology of methadone, there is a long list of interactions that can be life threatening because the levels can be raised unintentionally and cause death from respiratory depression:

http://pain-topics.org/opioid_rx/#MethadoneRx-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

It is also very important to review and understand the pharmacology of methadone, there is a long list of interactions that can be life threatening because the levels can be raised unintentionally and cause death from respiratory depression:

http://pain-topics.org/opioid_rx/#MethadoneRx-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

Also be cautious about educating pts on risks of overdosing, easily done.

Right as Pedro says You must write " for pain " on the script for methadone You cannot use it for withdrawal but ok for pain.Long half life must be very careful using it starting out can make people a littel drowsy

they FEEL better on oxycontin but that stuff costs a million dollars. Methadone and long acting morphine are cheap and work pretty wellsometimes of course you need lots of tricks treat the depression use lidoderm patches,

tens unit, PT, etc etcJean

You can write for methadone for pain control, not for opiate addiction. Methadone is relatively inexpensive and patients can save a lot of money.If you need or want to treat opiate addiction you need to take a buprenorphine course, pass the test and apply for the waiver,

Refer to previous links-- Pedro Ballester, M.D.Warren, OH-- If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

Also be cautious about educating pts on risks of overdosing, easily done.

Right as Pedro says You must write " for pain " on the script for methadone You cannot use it for withdrawal but ok for pain.Long half life must be very careful using it starting out can make people a littel drowsy

they FEEL better on oxycontin but that stuff costs a million dollars. Methadone and long acting morphine are cheap and work pretty wellsometimes of course you need lots of tricks treat the depression use lidoderm patches,

tens unit, PT, etc etcJean

You can write for methadone for pain control, not for opiate addiction. Methadone is relatively inexpensive and patients can save a lot of money.If you need or want to treat opiate addiction you need to take a buprenorphine course, pass the test and apply for the waiver,

Refer to previous links-- Pedro Ballester, M.D.Warren, OH-- If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

Myria,

How can we get the DEA to give us that information? I understood there was no national clearinghouse because of HIPAA rules? Can you give me any suggestions?

Thanks!

From: Lynn Ho <lynnhrihotmail (DOT) com>Subject: RE: [Practiceimprovemen t1] Controlled Substance PrescriptionsTo: practiceimprovement 1yahoogroups (DOT) comDate: Saturday, November 29, 2008, 8:01 AM

Hi Rian!I asked the head of the RI medical licensure board about this, because I had a patient on oxycontin for chronic pancreatitis and I was reading the DEA verbiage about what you could and couldn't do and it isn't clear. The patient lived about 45 minutes away and I didn't want to make him come down every month to get a new prescription - seemed like a waste of his and my time - chronic, stable no change in dose, no suspicion of abuse. He looked into it, with regard to DEA regulations etc., and what he said was, it was NOT illegal to mail him a presciption every month, without seeing him. The patient would call and leave me a message about a week before he was going to be out and I would mail him a rxn. He came down every 4-6 months for a visit.But you are perfectly within your right to do it the way you please - the way I did it, I was working for free. I didn't mind with this patient and it

streamlined his care, BUT If you don't want to work for free, or you don't feel comfortable, have her come in. Depends on your comfort level. I got bored of having the patient come in so much, so I devolved to the method above which worked for us and apparently is not illegal (at least via RI law interpretation) . Lynn Ho

To: Practiceimprovement 1yahoogroups (DOT) comFrom: mintekcharter (DOT) netDate: Sat, 29 Nov 2008 10:31:07 -0500Subject: [Practiceimprovemen t1] Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone prescription. A new patient calls, and requests a call-back before scheduling appointment, so that she won't waste a trip. She explains that she is suffering chronic pain, despite surgery (diskectomy and fusion procedure, for cervical disc disease), 6 years ago. She has been to the Chronic Pain Management consultants (45 minutes drive from our little town), and has tried numerous drugs, and is now relying on Methadone. She is disabled by her pain, and driving to that chronic pain clinic is a hassle. A few months ago, she pushed the Chronic Pain Management specialist to agree that the patient would only need to drive that far once a year, and that the responsibility to write the Methadone prescriptions could be carried by the patient's local family doctor (a member of a group practice, here in our small

town.)Actually, most of the time those prescriptions would be written-out by hand on paper prescription, by that family doctor, and just left for the patient at the reception desk; the patient would just stop over to the F.P. clinic and pick-up her prescription right there at the desk, without needing to fork-out a co-pay, or waste time with scheduling appointment, waiting in the waiting room, bothering with the nuisance of vital signs, interval history, or exam ...Now, she has learned that the family doctor in that scenario is leaving our town. So, the patient (who used to see me, like 11 years ago, when I used to work like a cog in that same machine), calls and says how much she always used to like me, and please wouldn't I help her, the way Dr. X. was helping her ...My answer was that I would be happy to see her again in my little solo office, but I would need to review her records, and

repeat the history/physical about her pain, and I would generally require visits every time she needed a new prescription for Methadone. That hit a stalemate.So, to get back to the general question: if a Schedule II Controlled Substance is regulated with rules that disallow telephone prescriptions, FAX'ed prescriptions, or refills, and instead requires that every single prescription must be hand-signed in ink by prescribing physician, doesn't that imply that the physician is seeing that patient that often ? ...Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list- serve with a new computer, and typing speed finally fast enough to pose a question; sorry if this issue has already been addressed by the I.M.P.'s ...

Windows Live Hotmail now works up to 70% faster. Sign up today.

[Guest guest]

Myria,

How can we get the DEA to give us that information? I understood there was no national clearinghouse because of HIPAA rules? Can you give me any suggestions?

Thanks!

From: Lynn Ho <lynnhrihotmail (DOT) com>Subject: RE: [Practiceimprovemen t1] Controlled Substance PrescriptionsTo: practiceimprovement 1yahoogroups (DOT) comDate: Saturday, November 29, 2008, 8:01 AM

Hi Rian!I asked the head of the RI medical licensure board about this, because I had a patient on oxycontin for chronic pancreatitis and I was reading the DEA verbiage about what you could and couldn't do and it isn't clear. The patient lived about 45 minutes away and I didn't want to make him come down every month to get a new prescription - seemed like a waste of his and my time - chronic, stable no change in dose, no suspicion of abuse. He looked into it, with regard to DEA regulations etc., and what he said was, it was NOT illegal to mail him a presciption every month, without seeing him. The patient would call and leave me a message about a week before he was going to be out and I would mail him a rxn. He came down every 4-6 months for a visit.But you are perfectly within your right to do it the way you please - the way I did it, I was working for free. I didn't mind with this patient and it

streamlined his care, BUT If you don't want to work for free, or you don't feel comfortable, have her come in. Depends on your comfort level. I got bored of having the patient come in so much, so I devolved to the method above which worked for us and apparently is not illegal (at least via RI law interpretation) . Lynn Ho

To: Practiceimprovement 1yahoogroups (DOT) comFrom: mintekcharter (DOT) netDate: Sat, 29 Nov 2008 10:31:07 -0500Subject: [Practiceimprovemen t1] Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone prescription. A new patient calls, and requests a call-back before scheduling appointment, so that she won't waste a trip. She explains that she is suffering chronic pain, despite surgery (diskectomy and fusion procedure, for cervical disc disease), 6 years ago. She has been to the Chronic Pain Management consultants (45 minutes drive from our little town), and has tried numerous drugs, and is now relying on Methadone. She is disabled by her pain, and driving to that chronic pain clinic is a hassle. A few months ago, she pushed the Chronic Pain Management specialist to agree that the patient would only need to drive that far once a year, and that the responsibility to write the Methadone prescriptions could be carried by the patient's local family doctor (a member of a group practice, here in our small

town.)Actually, most of the time those prescriptions would be written-out by hand on paper prescription, by that family doctor, and just left for the patient at the reception desk; the patient would just stop over to the F.P. clinic and pick-up her prescription right there at the desk, without needing to fork-out a co-pay, or waste time with scheduling appointment, waiting in the waiting room, bothering with the nuisance of vital signs, interval history, or exam ...Now, she has learned that the family doctor in that scenario is leaving our town. So, the patient (who used to see me, like 11 years ago, when I used to work like a cog in that same machine), calls and says how much she always used to like me, and please wouldn't I help her, the way Dr. X. was helping her ...My answer was that I would be happy to see her again in my little solo office, but I would need to review her records, and

repeat the history/physical about her pain, and I would generally require visits every time she needed a new prescription for Methadone. That hit a stalemate.So, to get back to the general question: if a Schedule II Controlled Substance is regulated with rules that disallow telephone prescriptions, FAX'ed prescriptions, or refills, and instead requires that every single prescription must be hand-signed in ink by prescribing physician, doesn't that imply that the physician is seeing that patient that often ? ...Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list- serve with a new computer, and typing speed finally fast enough to pose a question; sorry if this issue has already been addressed by the I.M.P.'s ...

Windows Live Hotmail now works up to 70% faster. Sign up today.

[Guest guest]

there are guidelines, they are published by the federation of state

medical boards; i'm sure they're available online.

myria is right on; something's wrong with this picture. if this

patient just wants you to continue how another doctor did it, and

you're not comfortable with that, and it doesn't meet required

standards, you not only have no obligation to the patient to do what

they want, rather you are required to uphold the standard of care.

that doesn't mean you play policeman; decline her as a patient, and

let her seek care elsewhere. otherwise, you're only asking for

trouble.

nothing trumps the appropriate practice of medicine, even if it's an

inconvenience or hardship to the patient, economy notwithstanding.

it's your license. another reason to interview potential patients.

in my new position, i just had a patient request a post-dated

prescription for dilaudid. i declined.

some view us as instruments of fulfillment for their desire.

i think of us as doctors, upholding a standard of care with the

purpose of helping our patients achieve a state of good health.

sometimes patients have difficulty seeing that; don't argue with them,

pass on their care, concentrate on those who accept our standard.

LL