Agraphia Medical Tragicomedy

29Mar/13Off

Ripping It Up

One of my favorite things is when patients rip up a prescription - it's just such an unnecessary, childish action. Usually it goes something like this:

Patient: "I need purpleset tens for my back pain. My doctor is out of town."
Me: "That's Percocet, and the fact that you abbreviate the dose 10/325 as 'tens' makes me concerned that you're far too familiar with this medication. We're going to give you some Tylenol today."
Patient: "I can't take Tylenol."
Me: "You know there is Tylenol in Percocet, right? That's the 325. It stands for 325 milligrams of Tylenol."
Patient: "Its a different kind of Tylenol. You don't understand."
Me (sighing): "I know.  These medical degrees, they hand them out like flyers these days, don't they? Doctors just don't understand medications like they used to."

I routinely write prescriptions for Motrin and Tylenol for patients. I'm not trying to be snarky or insulting - I truly want them to take those medications on a scheduled basis for their pain. They may not be prescription-only, but countless studies have shown that they are effective and are an integral part of therapy.  I also write Sudafed prescriptions for sinusitis and otitis, and Prilosec prescriptions for heartburn.  Both of those medications are over the counter, but patients may not know when and how to use them appropriately.

For this patient, though, there is one thing he wants from his ER visit  - opiates. His body has gotten completely hooked on that sweet candy, and when he runs out and start jonesing badly enough... he comes to me.

What drug seekers want is multifactorial.  I've sat down and talked to these guys occasionally and asked them what their gain is.  They hate coming to the ER for the small 12 pill score they might get from us if lucky.  What they really want is to find someone who is going to fund the habit; hopefully a doddering old primary care doc who is loose with his script pads.  From him they can score 120 oxycontins with another 120 morphine sulfate tabs - doses that DWARF what we give from the ER.  We're merely the safety net when their score doesn't come through.

And so, my little Tylenol script tends to make them upset. I've seen more of these ripped up, thrown on the ground, and stomped on in a pique of rage than I care to.  One guy even accidentally ripped up a prescription for Vicodin along with the Motrin prescription I gave him. This will come as a shock, dear readers... but I did not reprint the script for Vicodin.

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