Good Cover


Speaking about the state database of narcotics prescriptions … there was another patient who came in for chronic back pain. He denied being treated for any previous medical problems, but had allergies to anti-inflammatories and to Tramadol, leaving only narcotic medications to treat his back pain. Happened to be from out of town. Several red flags for drug seeking behavior.

When we went to the state database, we found that he had multiple prescriptions for narcotics from multiple different physicians.

I printed out all of his entries and brought them to the room to confront him.

“So, who’s Doctor Painkill?”
“Beats me.”
“How about Doctor Feelgood?”
“I don’t know.”
“How about Dr. Vicodin?”
“I don’t know. Why are you asking me about all these other doctors?”
“Because prescriptions for narcotics written by these physicians have been filled at several different pharmacies under your name in the past few weeks.”
“It wasn’t me.”
“This print out matches your address and your date of birth. Your name isn’t that common, so I doubt that it would be a mistake with so many different doctors.”
“Someone must have stolen my identity.” He appeared stone-cold serious about it.

That one caught me off guard.

“Tell you what, then, I’ll have the police come down and take a report.”
Then he backpedaled.
“No, that’s OK. I’ll stop at the station on the way home.”
“It’s no problem. Besides, I’ll help you out. I’ll make a statement and give the police a copy of the state print-out.”
“That’s OK. I’ll take care of it myself. I don’t want to wait.”

Rrrrrrriiight. You almost had me there.

Then he called back the ED later on and wanted to know how to get a copy of his records for the police.

Not sure what to believe anymore. I gave him the benefit of the doubt and prescribed a few days of narcotics. If he was seeking, at least he knows someone’s checking on him.

Scary that sometimes we have to go to extremes to discourage drug seeking behavior.

Another reason I’m getting one of those stamps that say not to fill prescriptions without picture identification. Now if I could only find a way to put a patient’s picture on a prescription …

Or how about a national picture ID card that people have to swipe to receive medical services?


  1. I gave him the benefit of the doubt and prescribed a few days of narcotics.


    I’d like to announce a wonderful event—the birth of WhiteCoat on 3/17/2009.

  2. WC
    I’m so mad I almost threw my laptop out my hotel department window. What in the sphincter of hell were you thinking? You had the perfect scenario of a previous post (even Matt felt sorry for us)… you and the seeker… patient against the bureaucratic government computers. You let him off!!

    Just for that, I’m gonna say it. Emergency Room!

    (OK… well.. I probably would have tagged the chingandero with a little spanky to jato him to escape velocity past the carpeted section also. Just don’t tell Nurse K, cause I worship her from afar)

    • Come on –
      You have to admit the story was original. I had to give him the benefit of the doubt.
      In the right frame of mind, I’m a sucker for a good sob story.
      Next time, he’s meat.

      • WC — allow me to translate as I had just eaten a candy bar out of the minibar and realized I’m gonna have to double the number of shifts I work for 2 months… (FYI .. don’t eat anything from the hotel department minibar or your gonna pay…)

        “I probably would have tagged the chingandero with a little spanky to jato him to escape velocity past the carpeted section also”


        I would have given the patient the “You now know what I know you are” number of pills, usually 3-5 pills, to get you out the door so you don’t go to administration because my Press Gaineys suck. I gotta stop watching VH1.

        And Nurse K… I have been a stalk… I mean lurk…I mean an anonymous nonposting surfer of your site. And yes, you melt my iceblocks….

  3. Scary that sometimes we have to go to extremes to discourage drug seeking behavior.

    De rigueur in my daily Tao. And feels more anger-based than fear-based.

    I don’t know you enough, a true newbie here, but it seems your prescription protocol with this patient was out of character, did I get this right? Whatever, I’m with Igloodoc. A few days of opiates? Dude, the?

    • I’m more than willing to help out someone who’s comes to me for pain, but I typically don’t refill prescriptions for chronic pain meds.
      So there were a couple of red flags that this patient was on chronic pain meds, but I gave him the benefit of the doubt.
      Despite my chiseled facade, I have a soft heart. Sometimes.

  4. oh…calling for the records? He was just spinning his story (so you could second guess yourself!)

    crap…I am too bitter to be a social worker

  5. I had a similar patient whom I confronted with a list of narcotic Rx from different doctors that got so upset with me because she said I was accusing her of being a drug seeker. She threatened to report me to the AMA (that got me sweating bullets). So I dialed the AMA and gave the phone to her. She left in a huff..

    They have finger print scanners now. Why can’t we use that instead. Patients put their finger print in the Rx. When the patient comes in to collect the meds he press his thumb to the scanner and if it matches the one on the Rx he gets his meds. That is doable now because the technology is out there already.

  6. Easy way to solve the problem: Implement a pain policy in your ER. Our PROPOSED one is something like this: No narcotics for a painful (non-cancerous) condition lasting longer than 2 months and no narcotics if you have been seen > 3 times in the previous year for any pain-related complaint (how many REAL patients need to see an ER doc > 3 times per year for pain, not many). The policy is handed out in triage, and the patient has the option to stay or go. If they want to go, they get a clinic referral card. So, with our policy, your patient wouldn’t have even made it past triage probably. No matter if his identity was “stolen” or not, it’s still chronic pain and he still gets no narcs.

  7. Hmm… photo ID to access health care… I have one of those! In Ontario it’s called a health card and I have to show it every time I access ‘the system’. We’re not quite there with having to show it to receive prescriptions – unless the government is paying for your prescription (welfare, disability). You can only get so many Rx’s filled from different doctors before the government database kicks back with ‘query double doctoring’. They’ve even started making the system available to ED docs… (really, someone stole your health card with your picture on it and used it to fill prescriptions in your name?). Unfortunately not everyone has the picture version yet though.

    It’s not perfect, but it’s a start.

    Just my 2c. I really enjoy your blog – I don’t envy you the upheaval that ‘the chosen one’ is about to level at your healthcare system though.

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