Having had years of experience as an employed physician and an ER doc, when I opened my solo practice in the middle of my career in a suburban area, it didn’t surprise me that I was targeted. I was new, eager for business, and when the modest announcement was put in the local papers, they came.
I was an easy target, pretty open schedule, anxious for business and happy to schedule with whoever called.
Not the drug reps, nor the vendors, eager to ply me with their wares – no, I’m talking about the drug seekers.
I was prepared. I had controlled substance contracts, knowledge of the tactics and tricks, and a wealth of knowledge gained from working ERs and in employed practice. I also had records releases ready to rock and roll.
And they came.
“Doc, I’ve had this chronic back pain, and the only thing that works is …”
“I had an injury at work, and I’m allergic to everything except …”
“You seem like a really nice doctor, and you understand what a patient with chronic pain lives with, so you know I can’t survive without …”
“I’ve got no dental insurance, and just need some … to get through till I can get some money together to get this tooth taken care of.”
I dutifully listened, examined, poked and prodded, and got contracts signed, records releases sent, and enough of whatever was needed or being requested to get that data together for a second visit. I resisted ordering tests (usually not asked for), because I tried to get a complete history. But some did present with “new” complaints that just weren’t responding to over-the-counter medications, and, “Doc, you just gotta get me something so I can .,.”
Some were easy, like if they refused to sign the controlled substances contract. Or if they refused to sign records releases from the prior physicians they would admit to. I always got releases for the local emergency rooms, as they were often telling. Refusing to sign those was always a bad sign.
I especially remember the woman who was wearing long sleeves on a hot summer day, when I exposed her antecubital track marks while doing her physical exam (“Doc, I’m too shy to put on a gown.”). They got offered addiction programs, help with referrals, but no narcotics.
Some never came back, and the flood of records then came afterward, creating a paperwork nightmare when it became obvious they had been to every ER and physician in the area with their tale of woe.
One did come back, and boldly explained his route, when I refused to give him more. He spent his days on a rotation from office to office, getting a 30-day supply, sometimes more, if he was lucky, from the two, three or more physicians he saw every day. He had a schedule he kept. “Thanks, Doc, you caught me, and it was nice meeting you. I won’t be back.”
If only, I had had access to a controlled substances database currently in the process of being legislated into existence in Pennsylvania, I might have caught a few who made the mistake of using their real name in filling prescriptions.
If only, I had had instant access to a health information exchange, I might have caught a few who could have been easily identified as doctor shoppers because they had seen every other doctor in town and within a 100-mile radius for the same problem.
If only their insurance plans had given them a medical home, so I could know that I was their designated primary care physician, and not just one on a long list of physicians they visited on a regular basis.
If only, so many of the things currently in process and “coming soon to a town near you” had actually existed then. Soon, I hope.