Friday, January 29, 2010

MAR de Debarquement Syndrome

(When you get dizzy discharging the patient from the hospital). Whenever we go to discharge a patient from the hosital we have to fill out this form that shows all the meds they were on while in the hospital and we have to decide if we want the patient to continue them. The problem is that often we are not the ones who put them on the meds to begin with and further, the list has the meds the patients say they were on before they came in to the hosital. I love it how all the older men always say they are on Viagra and need a script before they go home. I have had anabolic steroids on the list and of course the ever present, I wont be able to go to the pain clinic for a while so I need my Oxy and Percs. I tell the residents the only scripts patients get from us are for the meds that we put them on, none other. When the ever present JACHO form nurse asks about the other meds, I write on the form that "other meds are at the discretion of the original prescribing physician and patient can not be discharged until these medications have been reconciled". I know that by doing this I am "ticking off" alot of the long white coat clipboard carrying administrative types, but it sure does get them moving in a frenzy to check on all the patients medications and make sure that they have someone accountable. Everytime they come back to me and ask me to be the one to approve some of these medications, I explain that I am here to fix the trauma, no be responsible for their their pre-existing narcotic dependence or erectile dysfunction and they can find someone else to admit these patients and I will just consult!


SeaSpray said...

I don't understand why you would be? Staff should know better if that is your policy... but they probably have to ask because they have to look like they are appeasing the patient.

Throckmorton - doesn't the patient just have written on the discharge instructions follow up with ... pcp, specialist ..whoever the original doc is that prescribes the meds?

I have prescriptions that *only my urodoc has prescribed* and I have prescriptions that *only my pcp has prescribed* or *derm doc*.

I would not expect the hospital doc to give me a prescription unless it was specific to the reason I am under their care and thus was put on something new that needs to be continued... but then you always get advised to do follow up with a physician.

I know at work ..the only time the ED docs give out prescriptions is if it pertains to the specific visit and they will send them home with enough until morning and can get to the pharmacy.

I am going to stop here or I won't. This is a *hot button*for me at the moment. TRUST is key for me in a Dr/pt relationship. If I keep writing you WILL get a book in here. :)

I've written 7 looong posts between Monday nite and Thursday, actually posted the 7th one took it right down ..then tried to do a short 8th one added to it today ..published that ..took it back down.

I think I'd explode if I didn't vent my feelings with blogging!

SeaSpray said...

Okay thing..and I thought I was doing a good thing. The doc did tell me once that technically a patient shouldn't do it, but I did forget.

But if anything should prove that my thoughts and actions were in the right place... because God knows ..if I were the type ..I 100% could have taken advantage of several situations over the last few years and *I never did*.

SeaSpray said...

I used to live on I-buprofen for predominantly knee pain, but I was told that Ibuprofen/NSAIDS are bad for the kidneys and so a couple of yrs ago was switched to a mild prescription pain med ..that I only take when pain is extreme... or to head it off if very active. (knees)Other people would be LIVING on NSAIDS 24/7 and I don't/won't even come close to that with the script I have! I won't allow it for myself! You *do* get used to living with a certain level of becomes part of your life and you compensate. But when you can't bend up or down w/o extreme stiffness/pain or you walk with the level of pain you've learned to accommodate anyway ..but you are getting random knives shooting up into your knees or you buckle from the pain..the medicine takes the edge off.Well I had a summer fall like that with 3 extenuating circumstances. One that brought me to an ortho doc and another that after 3 days, I caved and went to the ED. Instead of taking pain meds from those docs ..I say ..I have this med at home and don't need anything. I think I am doing a good thing, being honest also on record not being this patient getting pain meds from this doc and that ..even tho there was reason.

Well,it turns out,a patient is *only* supposed to use medication for a specific condition given *only* by the treating physician.

Throckmorton ..could you please answer a question for me?

*What* is wrong with a pt refusing pain meds from doctors because they happen to have some at home from another doc and can use those?

Is it because if something went wrong ..the original prescribing doctor could be blamed for something going wrong in a case that isn't even his specialty because of the med connection? Everything was clear cut and documented what was going on.

or is it because docs have the DEA looking over their shoulders and whereas the doc might have prescribed 60 pills for 4-6 mos average ..the pt now twice injured )is using up his script and then refilling more quickly because of events that have nothing to do with his care.

*Except ..that
if a doc gives the script knowing the patient takes I-buporfen, but shouldn't to avoid kidney damage and knowing they have knee pain and the *occasional* headache , and so is why they take it and doc wrote the script.

But I guess when I fell off the deck stairs ..flat on my back.I should've gone right to the ED and accepted the script from the dr? i put it off 3 days and on the 2nd my pcp called in a muscle relaxant. My PCP (who didn't see me either) didn't have any problem with me refusing ED meds after seeing the ED doc. *I am confused.* ??? I know going to the ED 3 days AFTER the fall makes me one of "those" patients. But you also know when you've worked at a hospital..the last place you want to go is to the hospital. :)

And went into an extreme oa flareup both knees in July,put off going to ortho until couldn't walk (stupidly stubborn..AGAIN!) and then subsequent flare up in the fall when cortisone wore off and busy with memorial..then just never got much better ..I should've gone to ortho doc again.

I knew I'd go back to ortho, but knew I was going in for surgery and wanted to get that out of the way.

But what is the issue for docs??

You...are on one end of the spectrum ..aggravated because you are expected to dole out meds for patients you won't be seeing again and need to follow up with their own physician of choice. And ...I was on the other end of the spectrum as a patient using her doc's prescription (because of it's purpose)while being treated by other docs.Can you please clarify?

Isn't it better for a patient not to collect medications from various docs..especially if they have something at home that will work and not be as strong?
My doc is a great doc & it's killing me to think he had any angst over this and I also feel hurt and misunderstood.

Throckmorton said...


I think the best solution is for each patient to have a PCP who helps them manage all their medications. Too many doctors writing too many prescriptions is like too many chefs making the soup. You dont know what the other has already added and how it will alter the whole thing.

Another issue is keeping track of the original problem for which the medication was originally prescibed for.

As too the patient having to follow up with the doc who prescribed the meds, I think that this is how it should be. JACHO doesnt think so as they want a written form that states what meds the patient should continue to take and what dose. I have argued til I'm blue about this. Even worse, they want the supplements and herbals listed.

SeaSpray said...

I am fortunate in that I have 2 main docs that are in control of my scripts ..uro and pcp and both offices always want to know what meds are being taken. PCP could do all of it ..but I prefer and I think urodoc would too to keep his scripts with him ..pertaining to uro since I have hydronephrosis in one kidney and then a couple other things hopefully will be healed/corrected and I'll get past them. I think it would be weird to go to pcp and say my urodoc thinks I need this can you prescribe? He would ..but I agree with you..original scripts with original Doc for better tracking. Both docs are good but I know urodoc extra attentive and things don't slide by as I sometimes see with my other doc ..who is wonderful though ..just different in their methods. I never have to remind uro... which gives me a lot of confidence in care...which is a good thing considering my hx.
And so the idea they think you should give them meds that *they (the patients) say* their doc's give them seems ludicrous!

How do you know the patient is truthful, or accurate and you don't know what considerations the original prescribing docs based their patient's med decisions on... OR if they would continue said treatment. Seems like flawed thinking on JACHOS part.

Is it so it looks like there aren't any gaps in continuity of care that the hospital is then potentially liable for? I would think *you* could be liable if you are the last prescribing doc and I don't see why when documented in chart that you wrote follow up with physician, continue with meds at home etc.. why that doesn't cover it.

Okay ...herbal remedies and supplements ..which aren't even FDA approved sometimes can you get involved with that if not a follow-up patient you see?

OVERKILL! and time eater when you could be with another patient.