Pain control; patient compliance; dangerous patients
While reading your article on pain control ["Treating pain without fear," July 4, 2008], I was reminded of my experience. I was a family practice physician in a small town several hours' drive from the nearest pain specialist. I wrote for large amounts of narcotics for patients who were in need and so was looked upon with suspicion by the other physicians in town. I was reported for overprescribing not once but twice in 10 years.
The first time, the Drug Enforcement Agency performed the investigation and concluded that I was not guilty, but suspended my narcotic-writing privileges for six months at the behest of its new attorney, who concluded that I needed some punishment (despite the fact that the head of the state DEA did not agree).
Unfortunately, when they restricted my privileges, I lost my hospital privileges, my insurance contracts, and my call partners, leading up to losing my malpractice insurance and eventually my entire practice, causing me to declare bankruptcy. When I went back to the board for follow-up, I told them what they could do with my license.
The thing that stung the most, however, occurred when I passed a kidney stone late one night and went to the ED. One of the people I had thought of as a friend said that he did not believe me and that I would not receive any narcotics for pain (I had not asked for any).
When the IVP showed that I did indeed have a stone, the man did not apologize for the remark and did not even come back into the room to speak to me. So my thought is that physicians who write large amounts of narcotics should not fear the DEA as much as the people they sit next to in medical staff meetings.
LUANN WOODS, FORMER DO
I was appalled by physicians' comments about patient compliance [Talk Back, June 20, 2008]. One even said that if patients are noncompliant, he drops them because of "liability" reasons.
I understand we need to clearly document our discussions with patients when they choose not to follow our medical advice, but to expel them from the practice seems totalitarian to me. I don't think "my way or the highway" really fits in with the new doctor-patient paradigm, which was well-reviewed later in the journal, or is a positive step toward collaborative medicine.
TIFFANY J. GULINSON, DO
CALLING OUT OUTBURSTS
Concerning Dr. Mansfield's frightening episode in the exam room with the violent patient: I cannot believe he let that patient go without repercussions ["Dangerous patients in the exam room," July 4, 2008].
When a patient is threatening in any way, I take immediate steps to protect myself and my staff, so the staff can feel safe in their workplace. These patients can never come back to my office. I send them notice to that effect via registered mail, and I document the behavior in all my notes. I cancel all prescriptions within the guidelines of my board regulations.
In my state, it is illegal to be violent with a health-care professional doing his or her work, and I would not hesitate to prosecute a patient who assaulted me or a staff member in the way Dr. Mansfield described. When this kind of policy is consistently enforced by health-care workers, word spreads, and we will not be seen as sitting ducks for assault.
I have had two physician friends die over the past 20 years, killed by patients for different reasons. In both cases there were warning behaviors, and the patients were allowed into buildings at times and in places they should not have been. The patient Dr. Mansfield saw should never be al-lowed into another physician's office alone and should be accompanied by staff anywhere he is sent throughout the VA hospital, for the safety of those who help our veterans with their many health-care needs.