Drug overdose is the leading cause of accidental death in the U.S., and opioids account for over 60 percent of those deaths.1 While opioids are effective pain medications when used in the proper setting, concerns arise when the patient’s condition lasts longer than three months, and prescribing more medication does not necessarily result in better pain control.
Building a strong doctor-patient rapport can help facilitate tough conversations with patients about opioid prescriptions and reduce risks that could lead to malpractice suits. The Doctors Company reviewed 1,770 claims that closed between 2007 and 2015 in which patient harm involved medication factors.2 In 272 of these claims (15 percent), the medications were narcotic analgesics. Sixty-four percent of these claims were in the outpatient setting, including:
The admitting diagnoses for these outpatient narcotic-related claims were pain not otherwise specified (NOS) (24 percent), spine-related pain (22 percent), joint/extremity-related pain (9 percent), mental health issues (6 percent), and drug abuse/dependence (4 percent).
Patient allegations for these claims included improper medication management or treatment (70 percent), wrong dose (9 percent), and wrong medication (3 percent). Final diagnoses in these claims included poisoning by methadone, heroin, and opiates/narcotics NOS (76 percent) and drug dependence (8 percent).
Communication problems are among the patient-contributing factors that lead to injury, appearing in 40 percent of claims.3 Incomplete or unclear communication can compromise patients’ ability to understand the doctor’s instructions and, especially in the case of pain medications, also make them feel as if the doctor doesn’t care about their issues or concerns.
These tips can help when dealing with opioid requests and prescriptions:
Here is a helpful chart on good answers for specific patient questions and situations:
|“Can I have something for pain?”||“Yes, let me check your medical record for the best choice.”|
|“The medicines don’t work.”||“Can you please tell me how you take the prescription?”|
|“My prescription was stolen.”||“Did you file a police report?”|
|“I have chronic pain.”||“For your safety, you need your medications coordinated by one doctor and one pharmacy.”|
|“I received extra pain medications elsewhere.”||“Let’s do a drug specimen today.” |
“I see you received 20 pills from the emergency department, what happened?”
“OK, to stay on the same schedule, this month I will write 100 tablets (120 minus 20).”
|A case of clear doctor shopping||“I am concerned because your medications can be addicting. I am going to refer you to someone who can help with this.”|
|A case of need to stop an opioid prescription||“The medication no longer appears to be as beneficial as it once was. As the benefits of the opioids no longer outweigh the risks, we need to discontinue this approach and together find a safer and more effective means of dealing with your pain.”|
1Increases in drug and opioid-involved overdose deaths—United States,2010-2015. Centers for Disease Control and Prevention. December 30, 2016. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm. Accessed January 26, 2017.
2Analysis of medication-related claims from The Doctors Company. The Doctors Company. http://www.thedoctors.com/KnowledgeCenter/Publications/TheDoctorsAdvocate/Analysis-of-Medication-Related-Claims-from-The-Doctors-Company. Accessed April 17, 2017.
3Patient-centered communications: Building patient rapport. The Doctors Company. http://www.thedoctors.com/KnowledgeCenter/PatientSafety/articles/Patient-Centered-Communications-Building-Patient-Rapport. Accessed January 9, 2017.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.