Alcohol is a drug?
I thought you were arguing for free love for all, now you want to restrict prescribing more? I'm an ER doc, I don't prescribe long-term narcotics or benzos to anyone. I will do a few refills on BP meds or psych meds if they don't have insurance to bridge them a bit to find another prescriber.
Here's how I handle things...
Patient: 39 year-old in the ER with chronic back pain, helped a friend move a couch five days before and flared up his back pain. Has a family doctor, has not called them about the increased level of pain and comes to see me at 6pm (after PCPs office closes for the day). I ask about prescribing history of drugs, recent doctor and hospital visits, the nature of the back pain,why didn't you call your family doctor, etc... I search to see if you've been to other ERs in the city recently. I look at your narcotic history on the state's website. If the data I discover is inconsistent with the history you provided, I inform you of that and question why you are lying to me and you get nothing. I then follow the visit up with a letter to the PCP informing them of the deceit attempting to obtain narcotics from me (which is a felony BTW). If your provided history matches your statement and you do not have a history of chronic narcotics, I offer a day or two of pain control and recommend exercises, stretches, PT, etc as better treatment options. If your history matches but you DO have a history of chronic narcotics, then I need to determine if you should have pills available or not. If you should, I reassure you that you have no serious, emergent condition and you can simply increase the dosing frequency of your existing pill supply. If you tell me that you are out of your pills early because the pain got too bad, I tell you that is a budgeting issue and you should have notified your prescriber of the increased usage. You had a week to tell you were running low and now have been out a week. I do not prescribe meds for chronic pain, which this is. If you are out of pills but on a chronic regimen from a prescriber and just haven't had a refill yet, I inform you that unfortunately you have a chronic pain condition and that is not treated in the emergency department. you need to call your PCP in the morning to obtain a refill. I'll give you a pill in the ED or maybe two to go home with too to tide you over until your doctor's office opens.
If you want pills from me you are going to be nice to me and my staff. If you swear at the nurses and complain the whole time about how long it took to be seen, you can follow-up in the morning and take some Motrin.
All of that takes an extraordinary amount of time to do the research and document everything. I can't stand it. Then there's a good chance you'll get pissed at the lack of meds, yell at me, curse me, sometimes take a threatening posture, call my hospital administrator, threaten to call the department of health (i have no idea what that would accomplish) and call my boss (self-employed).
There you go. How to save money and have appropriate expectations from your ER visit if I'm working.
And ^^^This^^^ sounds completely reasonable to me. It's the "dragnet" approach that I have a problem with. Again, that's not directed at you or the medical profession in general. It's directed at people (legislators) that make laws that make them feel like they've done something, efficacy of that something be damned.
