NewFNP's clinic so rarely prescribes scheduled drugs that newFNP always feels a little hesitant to write for them. Of course, there are exceptions to this, but these exceptions tend to occur in established patients with acute pain or anxiety or what-have-you.
Thursday, March 27, 2008
They do not tend to occur with new walk-in patients who are at their third clinic in six months, who slur their speech and who disclose that they have been on SSI and have never worked due to asthma and back pain and knee pain and arthritis. And who need Trazadone and Lorazepam to sleep every night.
Now, newFNP is sympathetic to the fact that people have and need treatment for pain and anxiety. NewFNP is aware that people who are dependent on narcotics often need more narcotics to control their pain. But newFNP's clinic is a) not a pain management clinic and b) situated in a crappy neighborhood with enough of a drug problem.
And this patient was, frankly, just full of red flags.
So newFNP decided that she would refill this patient's lorazepam - it's not oxycontin after all - but that she would only give her 10 tablets while she awaited the medical records from her former provider. Ditto the Trazadone.
Fucking hell, did the encounter ever go to the dogs! NewFNP, apparently, had offended this patient by telling her that she needed to see her voluminous medical record before being able to continue her medical excuse for SSI and that 10 lorazepam was unacceptably stingy. She was quite clear in her dissatisfaction. Her exact words to newFNP were, "I need 10 lorazepams just to deal with people like you!" It was a refreshingly honest statement. She then informed newFNP that she will be no longer seeking care at newFNP's urban community health clinic, or more specifically and pointedly, with newFNP.
NewFNP breathed sigh of relief.
NewFNP probably could have handled this encounter better, but so could have newFNP's patient. Like, for instance, slurring during the encounter generally does not bode well when one is seeking anxiolytics ad libitum.
In retrospect, newFNP is sure that she had judgment in her voice when she told her patient about not freely authorizing SSI and med refills. She feels badly about this and, with the next patient, she will choose her words more carefully. But perhaps this woman has been screwing over the system. NewFNP doesn't know and this patient just didn't seem to warrant the benefit of the doubt today.
Feeling uncomfortable with the secure prescription pad in hand is not a sensation newFNP likes to experience. Would newFNP have killed this woman if she write her for 20 or 30 lorazepam? Doubtful. Would the encounter have been more pleasant for the both of us? Certainly.
But newFNP had to do what she felt was right.