Many of our chronic dental painters / narcotic entrepreneurs have horrible teeth, no doubt about it. While their "horrible pain and can't afford a dentist" will probably be treated without suspicion initially, the subsequent 6 or 7 visits a month for 10/10 pain smack of insincerity and scamming behavior. Most dental pain is treated with antibiotics and pain medication. The more visits, the less likely it is that percocet will be on the discharge menu. After a few of these visits, the savvy patient starts adding allergies; first ibuprofen, then tramadol. Then tylenol, which would then eliminate percocet as a choice. Clever seekers will say they have no trouble with the oxydocone, but that effectively shoots them in the foot since we never, ever give out plain oxy's in the ER.
When the patient is diagnosed with abcess, sometimes they get IV antibiotics. Mostly they leave with a script for penicillin and pain meds. Some doctors will write notations on the script numbering the penicillin "1 of 2". When only script #2 is presented at the pharmacy (the pain med) this prompts a call from the pharmacist asking what the 1st script was, because the patient can only afford one of them. Definitely needs antibiotics, they are told; maybe they should buy that instead of cigarettes. The patient usually just goes away, to try and play us another day.
Why not just combine the antibiotic AND the pain med? Percocillin! Everybody is happy!
5 comments:
Love it! Definitely feeling your pain. Pun intended.
Recently may (or may not, attention HIPAA police!) have had to babysit a pregnant patient in the ED. She whined over and over again for pain medication. Hx of abuse of pain meds. Her reason for her visit was relatively minor, minimal ED type of visit. She absolutely threw a tantrum (full on cursing) when she didn't get any narcotics for her "pain".
Guess what? Tantrums, complete with cursing, gets you NOTHING.
I know, I know! Acting out, creating a scene, and faking unconsciousness and/or seizures will not get narcotics!
I LOVE that my ER prints all our prescriptions on one paper. That way when these fools try to only fill the pain med, the pharmacy calls the MD and they're like, "Ah, you know what, fuck it, just cancel both of them."
can't wait until we catch up to the rest of the world with e-scripts
you can go to the ER for dry sockets? Dude! The last two times I had dry sockets over the weekend I rode it out with tons of Advil and Tylenol. I never would have thought to go to the ER!
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