I am not a cynical person by nature, but often I worry that working in a doctor's office will make me one. While we often see the best side of humanity, through our ability to care for and nurture others, we also see the worst in people, too. Recently, one of our doctors figured out that a patient we all knew and trusted was using him for medication that she was addicted to, and it was quite a shock.
Of course, it's partly our fault for expecting a drug addict to be obvious, to look a certain way, or behave in some overt criminal fashion. In this case, it was a middle-aged soccer mom type, not unlike myself. In fact, we got along quite well. Every time I saw her in the waiting room, I would take a few minutes to chat and catch up. She seemed to be on top of everything and I know she is a good mother to her two boys.
But there was something off about her continual request for pain medication. When our doctor suggested she see a specialist, she balked, and when he suggested an alternative method not involving a prescribed drug, she flew into a rage and stormed out. She called later that afternoon and apologized to him, and admitted she had a problem.
Often, doctors only have their instinct when it comes to deception. A true addict can con even the sharpest physician. Since this event occurred, I took a brief seminar on the subject, and would like to now share with you some tips that I learned on how to spot potential drug-seeking patients:
Their pain symptoms are vague.
They have conditions which are hard to verify, such as low back pain, neck pain, migraines, or toothache.
Their pain symptoms don't make sense or seem exaggerated.
They request medication by name and dosage.
They have a very extensive, above-average medical knowledge.
They are allergic to everything but their drug of choice.
They speak ill of their past physicians.
They don't want to get a work-up to determine the nature of their problem.
They often lose their medication.
Often, a pharmacy or insurance company will alert you to a patient who is getting meds from a variety of places. It's important when you get a new patient to request thorough documentation, including a list of all previous doctors on the patient intake form, and a medical record release. Let them know that the doctor will be reviewing all previous information.
Obviously, the call is the doctors', regarding possible addiction, but in a busy practice, it is incumbent upon staff to help fit the pieces together. We are there to help gather and maintain information. It's extremely important not to be fooled by appearances, which I realize is an obvious lesson of practicing medicine, but one that sometimes eludes even the most experienced caregiver.
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