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| Doctor Shopping and Why Physician Assistants and Nurse Practitioners Require Awareness |
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by Bob Blumm, MA, PA-C, DFAAPA - July 12, 2010
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It has become my responsibility to at least share a few thoughts on this subject based on my naivety of the vocabulary, not the subject. Prior to reading a few articles on this practice, I surmised that this is a process whereby patients seek out doctors or any health care providers based on their insurance plans, their co-pays, their standard fees or perhaps the fact that they were “boutique physicians”, and patients who desired this sort of medical relationship would find solace in choosing just the right doctor for their families health needs. “Ignorance is bliss,” says the old maxim, until we happen to engage in a conversation and, in our ignorance, take the wrong side of this issue when the state attorney general is a guest at the cocktail party where this may be discussed. So colleagues, what did Bob learn as he was surfing the net and became knowledgeable concerning this subject?
Perhaps one of my first lessons related to the fact that perhaps I have been an ostrich or a turtle as my head was in the ground or in a shell. As we expend our time in studying our specialty or preparing for family trips, we sometimes lose perspective with other issues that are presenting themselves to the medical community. “Doctor shopping” refers to the practice of a patient requesting care from multiple physicians or other healthcare providers, such as PAs and NPs, often simultaneously, without making efforts to coordinate care or informing the health care provider of the multiple caregivers. This usually stems from a patient's addiction to, or reliance on, certain prescription drugs or other medical treatment. Usually a patient will be treated by their regular clinician and be prescribed a drug that is necessary for the legitimate treatment of their current medical condition. Some patients will then actively seek out other physicians to obtain more of the same medication, often by faking or exaggerating the extent of their true condition, in order to feed their addiction to that drug. Thus they initiate the process of “doctor shopping.” This problem can ultimately create dependence and overdose which can be attested to by the death of prominent figures in the media. We hear about famous people dying prematurely from this problem but we can multiply this by the hundreds to have a true snapshot of reality.
Many doctors recently had a blog discussion on this problem and stated that they have learned to depend on their own judgment and intuitiveness that presents instantly, as they do not have the means to double check each story concerning a patient with a need for a prescription for a drug that can hurt them. Physicians say that they have been trained to practice medicine, not to be “private eyes” and engage in the business of being drug investigators. Doctor shoppers usually visit facilities where they are unknown or where there is a small staff and have surmised that they are unable to verify their stories. Seekers know how to mimic pain and the buzzwords that cause clinicians to perk up and consider a prescription. We are dealing with an intelligent group of people who are experts in the flim flam game. Many of the stories that are presented are not unlike what a teacher hears about a homework assignment. “It got wet,” “the dog ate it,” “I washed my prescription in my pants after falling in the river,” or perhaps, “I was being chased by a purple people eater and the prescription bottle fell from my shorts.” Some of these are tried and true, and one was meant to be absurd as the whole situation can be classified as absurd.
Is doctor shopping the only manner to get drugs? According to David Brushwood, professor of pharmaceutical outcomes and policy at the University of Florida in Gainesville, there are other easier ways to secure the prescription drugs. Some just break into pharmacies or point a gun at a drug store clerk and get their scrip filled. Some will break into warehouses or trucks, while others will pilfer a home where the medication cabinet is chuck-full of goodies. Misuse of drugs is a great concern in the United States, and there have been an increase of hospitalizations and poisonings that has increased 65% from 1999 to 2006 according to a study in the May edition of the American Journal of Preventive Medicine. There are monitoring programs in some states, but many prescribers refuse to take the time to utilize them because they are aware of their limitations.
We are dealing with an issue that looms larger each day and it is our responsibility to be aware of the problem and to become team members in the community actions and alerts so that we can prevent this problem in our practices and simultaneously, save lives.
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| Lois (IN) |
on 17 Jul 2010 at 9:58 am |
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| In our practice we find we must frequently use the state on line search which provides a listing of allprescriptions for controlled substances filled by that patient. It never ceases to amaze me how often patients are receiving the same medications from up to five physicians or NPs... It is a wonderful source and available in several states. |
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