S01.E04: Boundaries

[doodlebug]

1 hour ago, eel2178 said:

That's interesting. The state I live in prefers electronic scripts on the theory that they are harder for the patient to forge. Also, with a written script, the patient has to present photo ID at the pharmacy to have it filled. It has to have patient's name, DOB, patient's address and phone number on it, but a diagnosis is only necessary in the chart to justify it to the insurance company.

We can and do e-script everything else which tends to reduce a lot of opportunity for human error in prescribing or filling prescriptions, but no Schedule II meds for the reasons I stated above.  If the patient has a paper script, it is essentially proof that he or she was seen by the doctor (or at least was in the doctor's office).  The diagnosis and code are required on the script or the pharmacy cannot fill it. We do use the e-script software to 'write' the prescription, it just won't automatically send it to the pharmacy when it is signed; it goes to the printer in my office. If I haven't completed the diagnosis section, it won't print and I get a message to put the dx on it.  The computer has all the diagnostic codes, of course, and does that part for me.  I practice in Ohio where there has been massive issues with opiate abuse and this is part of the plan to eradicate it.  BTW, I don't have any paper prescriptions in my office, so they cannot get stolen, everything is done via computer and rx's for narcotics are printed on special paper with a specific blue watermark.  At the bottom of the script, there is a warning not to fill it if it isn't on the right paper.

If our computers go down, there are some pads locked up in the office manager's locked office.  Two sets of keys to get in.

Many years ago, someone managed to use one of my prescriptions to forge an rx.  I'd given out an rx for birth control or something and the crooks used that rx as a template to get a printer to make up a pad of rx's with my name on them.  I never put my DEA on non-narcotic rx's, so they obtained that elsewhere (it's not hard to do).  Back in those days, the usual MO for fraudulent rx's was to present to a pharmacy with a prescription for narcotics just before closing and claim that the recipient had terminal cancer or something.   A smart pharmacist was suspicious when a guy brought in an rx for 100 oxycontin 10 minutes before closing and told him his wife was dying of cancer and needed her pills.  He told the guy he didn't have enough on hand, but would give him 3 pills and he could come back the next day for the rest.  The pharmacist called me and I verified that I didn't know the patient, hadn't written the rx.  He called the cops who arrested the guy when he returned the next morning.

[twoods]

On 10/23/2018 at 1:45 PM, martha21 said:

As someone who was briefly married to an Adderall addict, it is extremely easy to get from a doctor. He had his doctor completely fooled and went through a month's worth of medication in less than a week, repeatedly. I met with his doctor to report this but if I hadn't it would have continued. It did result in psychosis and it was a horrible experience. If I had to guess I would say he probably found a new doctor and is getting it prescribed again. IMO, it should not be repeatedly prescribed without checking with loved ones to ensure it's not being misused. I'm hoping for a resolution to this issue in the show and that it is handled properly.

There is a resolution in California. All doctors that prescribe narcotics for their patients have to log into a website operated by the DOJ so we can see all the narcotic prescriptions under patients prior to prescribing. We can get audited and fined if we don’t do this on patients every three months, and they can track all this through the website. I hope other states follow suit.

[starri]

On 10/23/2018 at 4:47 PM, doodlebug said:

I practice in Ohio where there has been massive issues with opiate abuse and this is part of the plan to eradicate it.  BTW, I don't have any paper prescriptions in my office, so they cannot get stolen, everything is done via computer and rx's for narcotics are printed on special paper with a specific blue watermark.  At the bottom of the script, there is a warning not to fill it if it isn't on the right paper.

New York basically went in the opposite direction. We're only allowed to use the scrip printers under extreme situations. Every time you prescribe something controlled, you have a second factor to confirm that it's actually you prescribing it.  I have a fob on my keychain that spits out a six-digit code for a few minutes, so I have to enter that to complete the process.  Each unit has its own prescription printer in cases where we can't get it to go through, but to the best of my memory, there's only one in the entire hospital that actually works.  And we have to check the state database as well.

Thing is, the last time I looked up the numbers, overdose deaths have actually gone up since we started the program.  All it's done, at least to me reading of it, is shift the problem from prescription pills to heroin.

[doodlebug]

1 hour ago, starri said:

New York basically went in the opposite direction. We're only allowed to use the scrip printers under extreme situations. Every time you prescribe something controlled, you have a second factor to confirm that it's actually you prescribing it.  I have a fob on my keychain that spits out a six-digit code for a few minutes, so I have to enter that to complete the process.  Each unit has its own prescription printer in cases where we can't get it to go through, but to the best of my memory, there's only one in the entire hospital that actually works.  And we have to check the state database as well.

Thing is, the last time I looked up the numbers, overdose deaths have actually gone up since we started the program.  All it's done, at least to me reading of it, is shift the problem from prescription pills to heroin.

Any prescription  I write requires me to answer a specific ID question before the script is sent or it doesn’t send it. For controlled substances, I have to answer 2 questions before it will print.  And, of course, I have to log into the system and into the patient record using 2 different screen names and 2 separate passwords first.  The system where I work is moving towards fingerprint ID at some point. We used to have random number generator fobs for remote access, but they’ve dispensed with them due to so many getting misplaced, lost or otherwise disappearing.

We’ve seen the same thing in Ohio. As doctors are educated about narcotic prescription as well as oversight gets tighter; it has become much harder for addicts to get prescription meds.  Also, heroin is way cheaper than anything a doctor can prescribe.  I think the theory is that, if we are careful with prescribing narcotics, there will eventually be fewer addicts, since a goodly portion of addicts started it with prescription meds.

[Sake614]

I genuinely love reading posts from the real-life doctors  on this board. Im fascinated to learn that the things I always thought were fairly realistic on medical shows really aren’t! but since I’m not s Doctor, just a lay person, I don’t watch these shows for realism. 

My jaw did drop when not one but two people walked into the OR without s mask and when the ER doctor performed surgery with her hair in s very loose ponytail. And sure some of the stories are far fetched. But overall I like the show. I still don’t know all the characters names but I like that it isn’t all gloom and doom. And I love Dr. Kapoor!

[DearEvette]

16 hours ago, Sake614 said:

I genuinely love reading posts from the real-life doctors  on this board. Im fascinated to learn that the things I always thought were fairly realistic on medical shows really aren’t! but since I’m not s Doctor, just a lay person, I don’t watch these shows for realism. 

I know, I am glad I am not a doctor or a lawyer or even a cop who watches tv.  I know that the tv shows take dramatic license with these professions.  On the one hand it makes sense because you have to make a show dramatic to be watchable and entertaining and I am sure that 99% of lawyering is not dramatic last minute witnesses and lawyers yelling "You're out of order!"   But on the other hand I have a personality that if it were my job that was being represented and more than half of it was not accurate, I'd be one of those people who would be just too frustrated to enjoy it wholly.  So I get to enjoy in my ignorance.

[Sake614]

49 minutes ago, DearEvette said:

if it were my job that was being represented and more than half of it was not accurate, I'd be one of those people who would be just too frustrated to enjoy it wholly.  So I get to enjoy in my ignorance.

 

Exactly! I can't imagine being a doctor/lawyer and watching these shows. I think I'd lose my mind. But since I'm not, I can just sit back and enjoy...or not :)

[eel2178]

On ‎11‎/‎5‎/‎2018 at 11:57 AM, Sake614 said:

 

Exactly! I can't imagine being a doctor/lawyer and watching these shows. I think I'd lose my mind. But since I'm not, I can just sit back and enjoy...or not :)

I guess ignorance truly is bliss. I'm okay with poetic license to a point; however, it can go too far. Unfortunately, people really believe all it takes are a few electrical shocks to bring back a dead person. Trying to explain that it doesn't work to a grieving family is always horrible.

Edited November 6, 2018 by eel2178

[Sake614]

@eel2178 I truly don't know how you do it. But IMO, there's a difference between ignorance when it comes to TV and naive when it comes to reality. I do know that things don't work that way in real life. All I'm saying is that as a lay person, it's easier to handwave certain things if I'm otherwise enjoying the show. 

[Dowel Jones]

As a firefighter (retired), I watch fire shows to see if they get at least some of the action correctly, and to laugh when they don't.  And I watch to see who is going to be having sex.

Just as I am sure that attorneys watch legal shows to see if they get some of the action correctly, and laugh when they don't.  And watch to see who is going to have sex.

And everyone else just wants to see who is going to have sex.

[methodwriter85]

On 10/17/2018 at 12:06 AM, catrice2 said:

I know this is based on a true story but if they wanted us to care about the lead actor's wife and child they could have cast an actress that he has chemistry with and they need to do something about the chemistry that he has with the Freema agyeman characte

Oh my god, I thought I was the only person seeing this. Ryan Eggolds has much, much better chemistry with his doctor than he does with his wife.

[doodlebug]

8 hours ago, eel2178 said:

I guess ignorance truly is bliss. I'm okay with poetic license to a point; however, it can go too far. Unfortunately, people really believe all it takes are a few electrical shocks to bring back a dead person. Trying to explain that it doesn't work to a grieving family is always horrible.

Yep, that's the problem I have with many TV medical shows.  While most viewers realize it is all fiction and isn't really applicable to daily life, people in dire circumstances and their families tend to cling to whatever they can, and, when they repeatedly see patients surviving code after code and getting all sorts of miraculous treatment that cures them instantly; it can be hard to understand why it doesn't work that way in real life.