pain meds and sleeping pills

[Guest guest]

It seems like most of my patients are seeking pain meds and sleeping pills. I have started referring my patients to pain management for pain meds.

What has been your experience as far as prescribing ambien, lunesta or benzos to patients who say they cannot sleep without them and have been on these meds longterm.

After being in practice for one and a half year solo feel I am just a signatureeee (if such a word exists) for writing these meds.

Really getting disillusioned and disheartened with my practice. Most patients are rude when u don't give them what they want. Staff headaches are constant. I have almost 700 patients but still not breaking even. Almost ready to give up and go work for kaiser.

Any words of wisdom will be appreciated.

Mala

Start the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

Bartender is the word you are looking for.How I deal with them depends on the patient. I know some docs have a hard and fast policy that they stick to, but that does not work for me. As with parents who don't want to immunize their children, I'd rather work with the patients, educate them the best I can, and gradually win them over. If people are obviously abusive, of course I won't give them their drugs and they go elsewhere. DocSingh760@... wrote: It seems like

most of my patients are seeking pain meds and sleeping pills. I have started referring my patients to pain management for pain meds. What has been your experience as far as prescribing ambien, lunesta or benzos to patients who say they cannot sleep without them and have been on these meds longterm. After being in practice for one and a half year solo feel I am just a signatureeee (if such a word exists) for writing these meds. Really getting disillusioned and disheartened with my practice. Most patients are rude when u don't give them what they want. Staff headaches are constant. I have almost 700 patients but still not breaking even. Almost ready to give up and go work for kaiser. Any words of wisdom will be appreciated. Mala

Start the year off right. Easy ways to stay in shape in the new year.

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

[Guest guest]

Mala,

Words of advice are … just say “No”.

Being the new kid in town, you will have every addict or reseller of narcotics

knocking on your door as a new source. Word will get out if you are not

an easy pushover. I am sure you are great and have a great reputation for

being a good doctor but ask why they are switching when on chronic narcotics

that no doctor wants to assume being the signatureeee. I am wondering how

many actually follow through with seeing a pain management doctor?

Any, start offering Trazodone or amitryptiline or Remeron for

insomnia and see how many come back. The real ones who actually want help

come back.

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 DocSingh760@...

Sent: Friday, January 04, 2008 2:06 AM

To:

Subject: pain meds and sleeping pills

It seems like most of my patients are seeking pain meds and

sleeping pills. I have started referring my patients to pain management

for pain meds.

What has been your experience as far as prescribing ambien,

lunesta or benzos to patients who say they cannot sleep without them and have

been on these meds longterm.

After being in practice for one and a half year solo feel I am

just a signatureeee (if such a word exists) for writing these meds.

Really getting disillusioned and disheartened with my

practice. Most patients are rude when u don't give them what they want.

Staff headaches are constant. I have almost 700 patients but still not

breaking even. Almost ready to give up and go work for kaiser.

Any words of wisdom will be appreciated.

Mala

Start the year off right. Easy

ways to stay in shape in the new year.

[Guest guest]

I knew that this was going to be an issue in my area when I started. I

made and published my rule: no chronic opioids or benzos. I explain

that they are difficult to administer and that my rule is part of

keeping my overhead low. I think that word is on the street now,

because I get fewer calls from people looking for this. I like the

patient population that I have built this way. Easier for me because I

rent space from a pain mgmt practice, and we share some patients.

Getting there once you're already prescribing a lot of these is tough,

but it can be done.

Mala, 700 patients and not breaking even? I don't remember your

practice setup. What are your total expenses?

Haresch

>

> Mala,

>

> Words of advice are . just say " No " . Being the new kid in town, you

will

> have every addict or reseller of narcotics knocking on your door as

a new

> source. Word will get out if you are not an easy pushover. I am

sure you

> are great and have a great reputation for being a good doctor but

ask why

> they are switching when on chronic narcotics that no doctor wants to

assume

> being the signatureeee. I am wondering how many actually follow through

> with seeing a pain management doctor?

>

>

>

> Any, start offering Trazodone or amitryptiline or Remeron for

insomnia and

> see how many come back. The real ones who actually want help come back.

>

>

>

>

>

> 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

> DocSingh760@...

> Sent: Friday, January 04, 2008 2:06 AM

> To:

> Subject: pain meds and sleeping pills

>

>

>

> It seems like most of my patients are seeking pain meds and sleeping

pills.

> I have started referring my patients to pain management for pain meds.

>

>

>

> What has been your experience as far as prescribing ambien, lunesta or

> benzos to patients who say they cannot sleep without them and have

been on

> these meds longterm.

>

>

>

> After being in practice for one and a half year solo feel I am just a

> signatureeee (if such a word exists) for writing these meds.

>

>

>

> Really getting disillusioned and disheartened with my practice. Most

> patients are rude when u don't give them what they want. Staff

headaches are

> constant. I have almost 700 patients but still not breaking even.

Almost

> ready to give up and go work for kaiser.

>

>

>

> Any words of wisdom will be appreciated.

>

>

>

> Mala

>

>

>

>

>

>

>

>

>

>

>

> _____

>

> Start the year off right. Easy

> <http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489>

> ways to stay in shape in the new year.

>

[Guest guest]

,

I have tried for a long time to write down my own personal narcotic

policy (I work in urgent care but am plotting an IMP), but haven't

been able to do it for whatever reason. I have some " typical " pain

contracts as models to use, but like you I'm not really wanting to be

in the chronic pain business at all. I might follow a few complicated

problems for a year or rarely two, but not for " unlimited " time.

Is your personal narcotic policy something you might share or no?

It's one of my New Year's resolutions to write my own formal narcotic

policy soon.

I've been reading that the use of the " top five " narcotics used by the

public (oxycodone, hydrocodone, codeine, morphine, and I can't

remember the 5th they consider to be " top five " ) has more than doubled

in the last 5 years in the U.S.. This is an issue that is not going

away anytime soon.

Jerry

>

> I knew that this was going to be an issue in my area when I started. I

> made and published my rule: no chronic opioids or benzos. I explain

> that they are difficult to administer and that my rule is part of

> keeping my overhead low. I think that word is on the street now,

> because I get fewer calls from people looking for this. I like the

> patient population that I have built this way. Easier for me because I

> rent space from a pain mgmt practice, and we share some patients.

>

> Getting there once you're already prescribing a lot of these is tough,

> but it can be done.

>

> Mala, 700 patients and not breaking even? I don't remember your

> practice setup. What are your total expenses?

>

> Haresch

[Guest guest]

Jerry, I'm afraid what you see is all there is. My phone and web

messages simply indicate that I am not able to prescribe certain

" controlled pain and anxiety medications " long term, translated

opioids and benzos. Don't tell, but I'll ease up on this once the

practice is full and go to a policy more like LL's and will need a

more complete policy then. I just didn't feel I could make it in this

kind of practice without this policy initially.

Haresch

> >

> > I knew that this was going to be an issue in my area when I started. I

> > made and published my rule: no chronic opioids or benzos. I explain

> > that they are difficult to administer and that my rule is part of

> > keeping my overhead low. I think that word is on the street now,

> > because I get fewer calls from people looking for this. I like the

> > patient population that I have built this way. Easier for me because I

> > rent space from a pain mgmt practice, and we share some patients.

> >

> > Getting there once you're already prescribing a lot of these is tough,

> > but it can be done.

> >

> > Mala, 700 patients and not breaking even? I don't remember your

> > practice setup. What are your total expenses?

> >

> > Haresch

>

[Guest guest]

Dear Annie,

The patients come to me on these meds. I have started cutting down on their meds and they get mad. I discharged one patient because she wouldn't come in and wanted me to call in her benzo,, when I didn't fill her prescription she accused me of abandoning her and sent me a nasty letter. I gave her the 30 day discharge letter

I would say 50% of my patients are on some sort of pain or sleep meds.

I am seeing about 40-45 patients a week. The practice is growing.

But the staff headaches are never ending. I have 2 employees. After paying my staff, rent and bills I have nothing left to take home so I am surviving on loans from the bank.. I understand this is a business and initially I have to invest in it but I am getting deeper into debt. Student loans still in deferment so interest accumulating.

I love having my own practice but it seems like a tough market here. Last 2 mos I billed out 37,000 and 34,000 of which I should collect at least 60 % of each.Start the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

Average 9- 12 patients, last 2 days I had 17 and 14 so it really variesStart the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

Hi Mala,

Been one of those days, huh?

Tell more. Of the 700, what percent really are using

narcotics and benzos? Do they come to you asking for those from the

get-go, or do they drift that way after a time?

How many visits per week are your 700 generating? If you

pissed off the seekers by cutting them to smaller quantities, how many would be

left?

Sounds like you are at a crossroads. Me too. But I

keep turning away from taking an employed doc…..give me liberty or give

me death ….

Or something like that…

Annie

From:

[mailto: ] On Behalf Of DocSingh760@...

Sent: Friday, January 04, 2008 2:06 AM

To:

Subject: pain meds and sleeping pills

It seems like most of my patients are seeking pain meds and

sleeping pills. I have started referring my patients to pain management

for pain meds.

What has been your experience as far as prescribing ambien,

lunesta or benzos to patients who say they cannot sleep without them and have

been on these meds longterm.

After being in practice for one and a half year solo feel I am

just a signatureeee (if such a word exists) for writing these meds.

Really getting disillusioned and disheartened with my

practice. Most patients are rude when u don't give them what they want.

Staff headaches are constant. I have almost 700 patients but still not

breaking even. Almost ready to give up and go work for kaiser.

Any words of wisdom will be appreciated.

Mala

Start the year off right. Easy

ways to stay in shape in the new year.

[Guest guest]

docsingh

40-45 patients a week is like 9 patients a working day.

Are you sure that you need 2 employees??

>

>

>

>

>

>

>

> Dear Annie,

> The patients come to me on these meds. I have started cutting down on their

> meds and they get mad. I discharged one patient because she wouldn't come

> in and wanted me to call in her benzo,, when I didn't fill her prescription

> she accused me of abandoning her and sent me a nasty letter. I gave her the

> 30 day discharge letter

>

> I would say 50% of my patients are on some sort of pain or sleep meds.

>

> I am seeing about 40-45 patients a week. The practice is growing.

>

> But the staff headaches are never ending. I have 2 employees. After paying

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

[Guest guest]

Sorry

for going a little off topic here, but by my calculation you are billing about

$200/encounter and collecting $120. That’s pretty good as I average

closer to $115/visit in billing and $80/visit in receipts. Why do you have 2

employees if you are only seeing 45 patients/week? Can

you possibly go to one and then absorb that person’s salary (it might

help a little in getting you off the loan thing)? What are your overhead

expenses? Your overall overhead seems pretty high if you can’t pay

yourself on $17,000/month income, maybe there is a way to automate a little

more to cut some corners to decrease the overhead.

About the sleep meds and benzos—just have hard rules that are fair and even

across the board. If a patient doesn’t like it, they can go somewhere

else. Remember, the patient is the one with the disease. Don’t fret if

you are doing the right thing. Many times, especially if they are addicted,

patients do not know what is good for them. They pay you for good medical advice.

Sometimes this does not make them happy. Well luckily you are not getting paid

to be their friend. J Good luck!

Re:

pain meds and sleeping pills

Dear

Annie,

The

patients come to me on these meds. I have started cutting down on their

meds and they get mad. I discharged one patient because she wouldn't come

in and wanted me to call in her benzo,, when I didn't fill her prescription she

accused me of abandoning her and sent me a nasty letter. I gave her the

30 day discharge letter

I would

say 50% of my patients are on some sort of pain or sleep meds.

I am

seeing about 40-45 patients a week. The practice is growing.

But the

staff headaches are never ending. I have 2 employees. After paying

my staff, rent and bills I have nothing left to take home so I am surviving on

loans from the bank.. I understand this is a business and initially I have

to invest in it but I am getting deeper into debt. Student loans still in

deferment so interest accumulating.

I love

having my own practice but it seems like a tough market here. Last 2 mos

I billed out 37,000 and 34,000 of which I should collect at least 60 % of each.

Start

the year off right. Easy

ways to stay in shape in the new year.

[Guest guest]

Thanks to all who responded regarding the above. I do feel better and have hope now that if I stand my ground things will get betterStart the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

ANNIE- IT'S LIVE FREE OR DIE

NEW HAMPSHIRE STATE MOTTO.

NOTE THAT THIS MOTTO DOES NOT INCLUDE PAYING THE RENT.

LOVE JEAN

pain meds and sleeping pills

It seems like most of my patients are seeking pain meds and sleeping

pills. I have started referring my patients to pain management for pain

meds.

What has been your experience as far as prescribing ambien, lunesta or

benzos to patients who say they cannot sleep without them and have been

on these meds longterm.

After being in practice for one and a half year solo feel I am just a

signatureeee (if such a word exists) for writing these meds.

Really getting disillusioned and disheartened with my practice. Most

patients are rude when u don't give them what they want. Staff headaches

are constant. I have almost 700 patients but still not breaking even.

Almost ready to give up and go work for kaiser.

Any words of wisdom will be appreciated.

Mala

_____

Start the year off right. Easy

<http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489>

ways to stay in shape in the new year.

[Guest guest]

It’s going to take time to get rid

of the drug seekers. My experience is that it takes three years to weed

those folks out, keep a few that you’re comfortable

with, and grow a panel of people you actually like seeing.

My first practice out of residency was a hospital

owned rural clinic with a PA who had very loose prescribing habits. We

clashed within the first two months over the sheer number of narcotics and

benzos being written. He had started practicing alone at the clinic, with

an off-site supervisor at another location, for a year before I came.

Within six month, I insisted that he leave. It took three years to get

rid of the drug seekers. He had them coming

from two counties away; oxycontin three or four times a day, xanax for

everybody, disability forms if you said you wanted them. While some cases

had merit, of course, I was fresh from residency and entirely uncomfortable. I became the ‘bad guy’

in the small town because I wasn’t as accommodating.

The clinic lost that kind of patient, but we grew and got a nice panel of

patients in about 3 yrs. I stayed there for five years.

When I opened up my own solo practice, many

of these ‘good’ patients came with me. But I’ve

had the same thing happen all over in my new location as I’m again the ‘new

guy’. Requests for chronic benzos (xanax is the biggest problem,

but also valium), oxycontin for back pain, Duragesic, ambien, psych meds etc. I

manage my patients’ chronic pain issues when I feel I can trust the

patient, they have an appropriate medical reason, and agree by my rules. Although

it’s hard to believe some days, you can have stable, compliant pain medicine-requiring patients. That’s

not to say that I haven’t been duped; two cases I’ve sent to the

SBI due to doctor shopping. Those are the days they didn’t tell you

about in residency; it’s frustrating and scary when it happens. Some

I refer to pain management until they are stabilized; when they don’t

need escalating doses and are controlled then I will continue the med at that

dose.

It’s difficult to set hard and fast

rules about never prescribing something but I personally refuse to write for

methadone and any diet pills. While it’s tough at the time, I’ve

never regretted not writing these. I have loosened my habits and do have

patients on prn hypnotics, especially shift workers. And many of my

elderly patients have been on benzos for over 10 years; I don’t think I

can safely get them through withdrawal so I limit doses, decrease when I can,

and document the heck out of it. Just yesterday my receptionist,

who worked with me at both practices, commented

about how it was getting easier because we got rid of all the grumpy and rude people.

We opened 3 years ago this month.

My advice is to hold your ground.

You are the one with the knowledge, the training and the responsibility to keep

these people from hurting themselves. You don’t have to sacrifice

your integrity to keep yourself afloat. There are lots of people who need

good basic healthcare. Remember, first do no harm.

Hope next week is better for you,

TSLittle, MD

From:

[mailto: ] On Behalf Of DocSingh760aol

Sent: Friday, January 04, 2008

2:06 AM

To:

Subject:

pain meds and sleeping pills

It seems like most of my patients are

seeking pain meds and sleeping pills. I have started referring my

patients to pain management for pain meds.

What has been your experience as far as

prescribing ambien, lunesta or benzos to patients who say they cannot sleep

without them and have been on these meds longterm.

After being in practice for one and a

half year solo feel I am just a signatureeee (if such a word exists) for

writing these meds.

Really getting disillusioned and

disheartened with my practice. Most patients are rude when u don't give

them what they want. Staff headaches are constant. I have almost 700

patients but still not breaking even. Almost ready to give up and go work

for kaiser.

Any words of wisdom will be appreciated.

Mala

[Guest guest]

Or it's the famous Henry quotation, attributed to him, but not documented until long after the 1775 speech, so who knows?ANNIE- IT'S LIVE FREE OR DIENEW HAMPSHIRE STATE MOTTO.NOTE THAT THIS MOTTO DOES NOT INCLUDE PAYING THE RENT.:)LOVE JEAN pain meds and sleeping pillsIt seems like most of my patients are seeking pain meds and sleepingpills. I have started referring my patients to pain management for painmeds. What has been your experience as far as prescribing ambien, lunesta orbenzos to patients who say they cannot sleep without them and have beenon these meds longterm.After being in practice for one and a half year solo feel I am just asignatureeee (if such a word exists) for writing these meds. Really getting disillusioned and disheartened with my practice. Mostpatients are rude when u don't give them what they want. Staff headachesare constant. I have almost 700 patients but still not breaking even.Almost ready to give up and go work for kaiser.Any words of wisdom will be appreciated.Mala_____ Start the year off right. Easy<http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489>ways to stay in shape in the new year. 

[Guest guest]

ditto, and ditto.LL"Tonya S. Little" wrote: It’s going to take time to get rid of the drug seekers. My experience is that it takes three years to weed those folks out, keep a few that you’re comfortable with, and grow a panel of people you actually like seeing. My first practice out of residency was a hospital owned rural clinic with a PA who had very loose prescribing habits. We clashed within the first two months over the sheer number of narcotics and benzos being written. He had started practicing alone at the clinic, with an off-site supervisor at another location, for a year before I came. Within six month, I insisted that he leave. It took three years to get rid of the drug seekers. He had them coming from two counties away; oxycontin three or four times a day, xanax for everybody, disability forms if you said you wanted them. While some cases had merit, of course, I was fresh from residency and entirely uncomfortable. I became the ‘bad guy’ in

the small town because I wasn’t as accommodating. The clinic lost that kind of patient, but we grew and got a nice panel of patients in about 3 yrs. I stayed there for five years. When I opened up my own solo practice, many of these ‘good’ patients came with me. But I’ve had the same thing happen all over in my new location as I’m again the ‘new guy’. Requests for chronic benzos (xanax is the biggest problem, but also valium), oxycontin for back pain, Duragesic, ambien, psych meds etc. I manage my patients’ chronic pain issues when I feel I can trust the patient, they have an appropriate medical reason, and

agree by my rules. Although it’s hard to believe some days, you can have stable, compliant pain medicine-requiring patients. That’s not to say that I haven’t been duped; two cases I’ve sent to the SBI due to doctor shopping. Those are the days they didn’t tell you about in residency; it’s frustrating and scary when it happens. Some I refer to pain management until they are stabilized; when they don’t need escalating doses and are controlled then I will continue the med at that dose. It’s difficult to set hard and fast rules about never prescribing something but I personally refuse to write for methadone and any

diet pills. While it’s tough at the time, I’ve never regretted not writing these. I have loosened my habits and do have patients on prn hypnotics, especially shift workers. And many of my elderly patients have been on benzos for over 10 years; I don’t think I can safely get them through withdrawal so I limit doses, decrease when I can, and document the heck out of it. Just yesterday my receptionist, who worked with me at both practices, commented about how it was getting easier because we got rid of all the grumpy and rude people. We opened 3 years ago this month. My advice is to hold your ground. You are

the one with the knowledge, the training and the responsibility to keep these people from hurting themselves. You don’t have to sacrifice your integrity to keep yourself afloat. There are lots of people who need good basic healthcare. Remember, first do no harm. Hope next week is better for you, TSLittle, MD From: [mailto: ] On Behalf Of DocSingh760aol Sent: Friday, January 04, 2008 2:06 AM To: Subject: pain meds and sleeping pills It seems like most of my patients are seeking pain meds and sleeping pills. I have started referring my patients to pain management for pain meds. What has been your experience as far as prescribing ambien, lunesta or benzos to patients who say they cannot sleep without them and have been on these meds longterm. After being in practice for one and a half year solo feel I am just a signatureeee (if such a word exists) for writing these meds. Really getting disillusioned and disheartened with my practice. Most patients are rude when u don't give them what they want. Staff headaches are constant. I have almost 700 patients but still not breaking even. Almost ready to give up and go work for kaiser. Any words of wisdom will be appreciated. Mala

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.