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Document a patient's pain very carefully

One of the quickest ways to endanger your medical license is to fall victim to a drug diversion scam or a patient who is abusing your services in order to fuel his or her addiction. That's why it's imperative to be particularly sensitive to the warning signs of drug-seeking behavior -- and particularly conscientious about documenting your efforts to validate a patient's legitimate need for pain medication.

The nation's Drug Enforcement Administration (DEA) offers numerous tips to help medical professionals recognize drug abuse and drug-seeking behavior, including things like:

  • Patients who seem to exaggerate their symptoms (claiming pain is always a "9" on a scale of 10)
  • Patients who demand specific pain medication and reject any suggestion of alternative therapies without even trying them
  • Patients who seem to be reciting symptoms from a list (textbook-style)
  • Patients who are overly-assertive and seem to have an agenda
  • Patients who claim allergies to all nonnarcotics
  • Patients who seem to have only vague medical complaints that aren't supported by objective tests or clinical history

For example, a patient that approaches you about his migraines may immediately ask for Vicodin and claim that it is the only thing that works for the pain. Your suggestion that he try a prophylactic drug to prevent the migraines is rejected outright. He also claims that he's had an adverse reaction from every other drug you mention, including triptans. Upon further inquiry, you find out that he's not been treated regularly by any physician for at least five years and has not undergone any neurological testing.

Naturally, drug seekers aren't always this obvious. That's why it's important to carefully document the objective findings and clinical history of every patient you treat for pain. For example, you should:

  • Request MRIs, CAT scans or other diagnostic examinations to look for evidence of physical sources of pain
  • Document the patient's previous clinical history, using whatever records are available, in order to show when a condition developed and whether or not other treatment efforts have been tried in the past
  • Make use of psychological screenings, blood tests, saliva tests and urine tests to rule out drug addiction whenever there is a doubt
  • Document your own physical examination of a patient and findings

Given the amount of attention being focused these days on prescription drug addiction, the best way to defend your medical license is to practice an abundance of caution.

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