Medical Office Quandaries #3

You Have to TAKE the Medication

I really don’t understand a lot of patients.  The longer I do this, the more confused I get.  Maybe you can explain this to me:

I had a patient who came in recently with pelvic pain and period problems.  I’m sure she wanted narcotics.  I explained that she had to try other things first.  This ain’t my first rodeo, folks.  To make a long story short, I did the usual: a complete history and physical including Pap smear, sent for old records, gave her a prescription for birth control pills and for a NSAID (medications in the Motrin family). 

I also ran a urine drug screen on her.  I ask all the women I do this for EXACTLY what controlled substances I’m going to find in the urine.  I tell them not to lie to me, or they will not be able to get anything stronger than NSAIDS.  Do they listen? 

This patient’s urine had two drugs she had “forgotten” to tell me about.  Strike 1.

Her records didn’t exactly tell me the same story that she did.  She had gotten controlled substances at two of the places she had been before she came to me.  Strike 2.  She also has a low potassium level that could cause a heart irregularity.  This is in her records from an ER visit.  We tried to get in touch with her to tell her about this, but none of her phone numbers worked.  She gave us six numbers. 

When she came back for her follow-up visit, she said she gave her prescriptions to her mother to fill.  Her mother lost them, so she had not taken them.  Strike three. 

What did I do?

First, I gave her a lecture.  I was mad.  I gave her a list of high potassium foods and told her she needed to see her medical doctor.  I rewrote the prescriptions.  I explained that she had to take them and see what happened.  I refuse to “throw narcotics” at a problem that we have not defined.  Besides, she could have a major heart problem with the narcotics and the low potassium together. 

Do I think she will listen?  I doubt it.  She didn’t get what she wanted.  She got what she needed, but that doesn’t always matter to patients these days.