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.