Patients Who 'Must Have' Pain Medicine NOW

Michael J. Schiesser, MD


March 25, 2015

In This Article

My Own Experience With "Problem Pain Patients"

Running a busy internal medicine practice 10 years ago, my receptionist would repeatedly interrupt me with patient crises. To him, the patient's description was sufficiently horrific and appeared to warrant the doctor's immediate attention. A typical conversation would go like this:

"Doctor, I must interrupt! Ms Surname, one of Dr Jones' patients, has been robbed at gunpoint!"

"...Umm, I'm a doctor. Perhaps she should call the police."

"I think she did that, doctor. I just thought you should know."

"OK, but I'm with a patient. Please don't interrupt me again unless it's important..." (I'm feeling annoyed.)

Ten minutes later:

"Doctor! I must interrupt again! Ms Surname's prescription was stolen when she was robbed at gunpoint!"

"Really? Are you talking about the paper prescription, or had she already filled it at the pharmacy—you know, the bottle?" (I'm looking for the request, hidden in the drama.)

"I don't know; let me call her."

"OK, but like I said, I'm with a patient. Please don't interrupt me again unless it is important." (I'm still feeling annoyed.)

The telephone rings again:

"Terribly sorry to bother you, but I must take my lunch break, and this is an emergency, because I found out it was all of her medication!"

"Are you saying that Ms Surname wants me to replace her medication?"

"She didn't say that, doctor, but I think that was the point."

"What medication is Dr Jones prescribing this woman?"

"Methadone, 10 mg, three TID #270."

"Dr Jones is giving her 90 mg of methadone a day, and she wants me to replace her stolen drugs?" (Now, I'm feeling contempt, anger, fear, and irritation—and I'm hungry for lunch.)

"I believe that is what she needs, doctor."

"I can't deal with this right now. Can you just leave me to finish with my patient, please?" (I'm visibly annoyed.)

"I'm sorry, sir. I was just trying to help the patient; she's having a terrible time, and she's crying." (My colleague is dejected.)

"I'm sorry; it's not your fault. I'm just a little frustrated."

In those days, the more problems with controlled meds that were thrust upon me by my staff, the more my resentment grew. At some point, I realized this was clearly my problem to deal with.

On the one hand, I felt my staff didn't appreciate how hard I was working, how disruptive it is to get interrupted, and how confusing it felt to be suspicious of my patients (or others' patients) who were showing signs of medication abuse. I felt alone, and even angry, with the patient for the disruption caused by the report and circumstances. I could hardly avoid transferring this experience to those around me, including my staff relaying the message.

Yet, whose fault is it really if I resented the lack of support, when I had not first created clear and unambiguous direction for my staff to follow in these situations? Without a structure for communication designed for my office, the patients' aberrant behaviors were eating away at my quality of life, and that of the people around me.


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