Friday, February 18, 2011

Letter From an ER Doctor

Today my inbox has proven to be a valuable source of information that I want to pass along to all of you. Below is a copy and paste of a letter received after a presentation to Emergency Room personal concerning narcotics. This is a doctor frustrated with the current state of affairs. This letter is worth the read.

This letter was sent to me from the the leader of the Parent Ambassadors of The Partnership. She OK'd that I pass this along for you all to read.

Received by Alliance for Global Narcotics Training, Inc.
2/2/2011 – 930p
Approved by SK for release

Dear Ms. K*****,

Thanks for your lecture today. As I briefly explained, doctors and midlevels are in a miserable position in terms of not been able to deny drug seekers their narcotic requests. As with the war on drugs, the war on narcotic abuse and narcotic street sales will not be won by fighting in the streets alone. It starts at the very top with our current health care reform. There needs to be a stop to the medicaid/medicare reimbursement based on customer satisfaction.

This is a crazy rule. I am all for treating others as I would like to be treated. However, while medicare/medicaid reimbursements decrease and focus on pt satisfaction instead of proper medical service provided, hospitals are under worsening pressure to increase patient volume. Even hospital CEO's get bonuses based on patient satisfaction scores. It is ridiculous, when patients arrive at the emergency room nowadays. One of the first things they get is a survey and a phone number to call and complain if things don't go their way. As you know, the majority of the drugs seekers are medicaid patients, who know how to work the system. These are the same patients that hospitals and clinics want to return to their facilities for additional services. The moment one denies their drugs, they get on the phone and call hospital administration. When they call, they do not state that they were there for their weekly high and narcotic refill, but instead complain that their provider was rude, careless, did not listen to their needs, etc. All it takes is 2 or 3 calls like this, before you are standing in front of the board of directors with a "patient satisfaction" problem and your job on the line.

As a midlevel in the ER, I see roughly 35 - 40 patients a day. On average, 4 - 5 are really sick, the rest are there for their fix or supply with complaints ranging from chronic back pain to my Dr. wont refill my Lortabs. Each of these patients walks out of the ER with a prescription for 10 - 15 "Hydro's or Perc's". I work 3 - 4 days a week. I did the math, and I hate myself for it knowing that a good number of these narcotics will end up on the streets and possibly in the hands of a child or a teenager who could be your child or my child.

What can I do? I have a $60,000 student loan bill, mortgage, and a family that needs my financial support. My choices have been made pretty simple. I can stick to my values and principles, do the right thing, and find myself jobless in a few weeks, or go along with the patient satisfaction wave, give the patients what they want, as inappropriate as it may be, and continue to feed my family. It is kind of difficult for a Dr. or midlevel to find a job at another hospital after being fired from a hospital. That stuff follows you around.

The choice is not that difficult. In the middle of my professional life and in no financial shape to start all over, I find myself miserable in my profession as a mid-level provider. I originally got into this field because I had a good heart and wanted to help others. However, now I am ashamed of having to do what I do every day. I pray that that my child does not have to do what I do for a living.



Anonymous said...

well I understand the author of this letters dilema but this is also a cop out. I am the parent of an addict and work for a major healthcare provider so I see alot of information. I understand that a patient can not be denied but what about those doctors that let a patient walk out with 3 prescriptions that make the best cocktail to any addict. It is not only for a few of each but sometimes up to 30 tablets. The emergency room is designed to treat the patient with enough meds until they can get to doctor. I also believe that once a patient becomes known as a frequent flyer of the e/r room those doctors have an obligation to not become part of the problem! I have notified my prescription carrier of my son's problem and how they need to limit the prescriptions that he has filled but they say that they can't. It is his right. I explained that he has been to rehab. They start sputtering HIPPA and I tell them that I also know the rules and that there is nothing illegal about me telling them that he is an addict. It's all about the mighty dollar so no one wants to step up and stop the train wreck from happening. This doctor can step up and notify the authorities of questionable behavior in the hospital setting. There are confidential numbers to report these things.
Sorry about the ranting but I besides the addict these doctors need to accept some responsibility because they are the one's prescribing most of these drugs.

Gledwood said...

ok this seems to be far more of a problem stateside than it is here. in the uk if you want an opiate you score heroin, nobody bothers much with the weak in between stuff. the pharmaceuticals that are traded are valium-type drugs, prescribed in profusion to many who don't take them and purchased by those whose drs won't give them but who feel they need them

i really doubt somebody with a prescription for 15 opiate pills is going to sell them on the street. addicts TAKE drugs, they only sell surplus or stuff they just don't want. e.g. weak opiates like codeine/dihydrocodeine

from what i hear the problem works much more in reverse: that people are denied drugs they need because they're "drug seeking"... don't you pay for American prescriptions? being as heroin is $10 or $15 a bag why on earth go to hospital when you can go to a dealer? that makes no sense

i'm going to stop talking now because i don't want to get into territory where i'm just annoying y'all. i'm just trying to give an alternative view

Gledwood said...

ps by "drugs they need" i'm thinking of a couple of cases i heard of where people had had accidents, had obvious injuries, were in obvious pain, had gone to the ER and were written off as "drug seekers"..! however much fantasy had intruded into the stories by the time they got to me, i do suspect a grain of truth lies in these tales, y'know...

Fractalmom said...

@Gledwood. Here in the U.S. most addicts start out snorting Oxycontin. So, yeah, there are an awful lot of 'drug seekers' out there going to the E.R. with 'back pain, or some such.

They don't cross the lines into shooting heroin until their Oxy habit hits usually about $800.00 a day which is a pretty strong habit. That's 10 80mg Oxy's crushed and snorted. (most of them do in fact deal whatever drugs they can get extra), for money to live on. Also, we have a large population of the elderly who get prescribed Oxy's for pain, turn them over to their grandkids who then sell them. It's quite a business. An elderly person living on Social Security maybe getting 1200 a month to live on, and also gets a scrip for 60 80mg Oxy's a month stands to make about $4,000 a month. Big incentive to break the law! And, the judges aren't putting a bunch of senior citizens in jail for drug supplying either. When the grandchild is caught, the old person says their junkie grandchild stole the pills.

Anyway...I digress LOL.

Then, finally, they figure out that they can get the same amount of heroin for about 1/10 of the price, and start snorting heroin, which then becomes too expensive, so they start shooting it up.

No one said American kids are all that smart. The thing is, they are pretty much all afraid of HEROIN at first. But Oxycontin? Not so much. So they get hooked on Oxy's because everyone is doing it....

Weird. So then, the parents go and blame the drug company that invented and markets Oxycontin for getting their little babies hooked on opiates. I don't understand the rationale, but whatever.

My daughter's first was snorting Oxy. She told me her back hurt and a friend gave it to her and she didn't know it was bad.

I was like, yeah, you know? I've had that happen to me to but NOT ONE TIME DID I EVER CRUSH THE PILL AND SNORT IT UP MY F'ING NOSE...

LOL. They think we are SOOOOO stupid!

Syd said...

It seems that the docs need to prescribe less meds in the ER. I don't have the answer but it is unlikely there is just one variable that is the problem.

LisaC said...

The addiction world is complex; loving an addict is complex; sorting out healthcare is complex; being a good parent and a good spouse is complex.

A new mom to the world of addiction was telling me how she is calling the local police and she is calling the owner of Jack in the Box, where the kids hook-up for drugs. And really, all I could tell her is that I'm exhauseted with dealing with my son's addiction at a personal level, so it is complex and difficult to take on the entire system. So it is clear to me that I am coping out too! :(

Polly said...

Wow, what a great topic here! I don't think most can even imagine what a terrible problem these pills are among young people.

This is very seductive - scripts must be ok - you know what is in it (unlike a baggie off the street) and it comes from a doctor. Why not? Also, no smell like alcohol.

I have twice recently been offered a script for Hydrocodone after dental surgery. Guess what? I took one OTC pain reliever and I was fine.

Our local DEA had a "bring your unused scripts for disposal" day and they reported they were shocked at how much was brought in - 10 or 20 times more than they expected.

There are certainly other parts to this equation, but the medical profession needs to wise up and first, do no harm before we end up with a "Generation Rx".