Had several notable histories from patients in pain lately.
One patient with chronic back pain hobbled into a room and said “I better not be waiting here 8 hours like I did last time.”
We looked through her old chart out of curiosity to find out what caused the extended eight hour wait on her previous visit. The longest that she had waited in her prior seven visits before getting her shot of Dilaudid so she could go home and sleep was 2 hours and 15 minutes.
Of course, making comments like that to the staff has no effect on anyone’s passive-aggressive behavior. Really, it doesn’t.
Another patient with chronic back pain had an acute exacerbation and needed pain medication. When he took off his coat, he was wearing a T-shirt that had a logo on the back. At the top was “Stoner Steve’s.” Underneath was a big circle with a line through it. Inside the circle was written “Motrin, Klonopin, Ultram”. The line through the circle was a marijuana joint. Why in this world Stoner Steve decided to advertise his aversion to these three specific medications is beyond me.
Of course, wearing a shirt like that to a hospital emergency department and asking for pain medication has no effect on the doctor’s tendency to prescribe you Motrin, Klonopin, and Ultram. Really, it doesn’t.
Finally, there was a patient with a chronic toothache. He tried taking some Vicodin that he had in a cabinet, but it didn’t taste right and, more importantly, it didn’t work. Then he looked at the bottle and it was a year out of date. And he stored the bottle above his refrigerator, so the heat probably degraded the medication even more. So he dumped the rest of the bottle into the toilet and flushed them. He needs another prescription to replace those pills. And he didn’t bring the bottle, either. He threw that out.
First of all, medications don’t all turn into arsenic the millisecond after their expiration date. Few medications lose much potency after expiration, either. See WSJ article here (full text here).
More importantly, most states have a database that tracks when patients fill prescriptions for controlled substances. Presenting with a history like this doesn’t affect the tendency for a doctor to look up your name on the state database. Really, it doesn’t.
It does make things a little uncomfortable when a patient hasn’t filled an opiate prescription for more than a year and I show them a printout that they have filled five opiate prescriptions from different doctors in the past month.
What? Wait. Where are you going? Why are you leaving? I was going to write you a prescription for Motrin … or Klonopin.
This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.