Hello all. I work in a smaller town (around 60,000) and my competition hospital just opened up a "walk in pain clinic". Yes, it is as bad as it sounds as I have reviewed some of the notes from this place. Without a ton of details it is mainly staffed by two FP docs and a PA. They see highly complex patients for 10-15 minutes and eventually write a ton of opioids. There is more to it of course but in the interest of time I will keep that part short. I personally have not seen any of these patients on my doorstep. However, a few PCP's that I work with called me Friday afternoon and are livid with this. They see these patients come back to their office and even they realize it isn't right. They are asking who they should complain to in the state? I guess that would be my question as well. Who should I refer them to with complaints regarding this practice? I don't know of anything illegal by any means but it is horrible medicine and all of this will eventually trickle down to myself and all the medications out there are only going to cause problems in this already plagued town. I recommended writing a letter to the hospital CEO to start with but probably sending the same letter to a state level. Anyways, any ideas would be appreciated.
Complaint
- Thread starter craigkes
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(space holding because the answer interests me)
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Medical board and DEA can be tipped off for ethics standards, and suspicion. No harm in looking to see if it is legal. Thats their job.
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Arrange a meeting with the administrator over the clinic.
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Who should I refer them to with complaints regarding this practice?
Refer them to the medical board. And keep detailed notes and dates of your conversations.
The hospital CEO will get even with anyone who brings this issue to him.
Refer them to the medical board. And keep detailed notes and dates of your conversations.
The hospital CEO will get even with anyone who brings this issue to him.
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It's embarrassing how conflict-averse physicians are...the grieved PCP's should pick up the phone and call their peers at the other clinic--you all work in the same small town, right? You see each other at soccer games and birthday parties, right? It's going to be a little awkward socializing with your colleagues when you're complaining to the medical board and DEA about them...
A GROUP of concerned MD's should arrange a meeting with the clinic administrator or hospital CEO. The PCP's should tell their patients, "I can't let myself, in good faith, be your doctor when you're getting this kind of treatment somewhere else." You said these are medically-complex patients, right? The PCP's should tell them that good medical advice would be to not go to that clinic...
On the other hand, if the other clinic **WANTS** to manage their patients' opioids I would imagine that the community PCP's would see that as a potential benefit so long as it was done correctly. Why not ask the administrator of the clinic to improve the level of service so that it was a resource and not a burden to the community?
A GROUP of concerned MD's should arrange a meeting with the clinic administrator or hospital CEO. The PCP's should tell their patients, "I can't let myself, in good faith, be your doctor when you're getting this kind of treatment somewhere else." You said these are medically-complex patients, right? The PCP's should tell them that good medical advice would be to not go to that clinic...
On the other hand, if the other clinic **WANTS** to manage their patients' opioids I would imagine that the community PCP's would see that as a potential benefit so long as it was done correctly. Why not ask the administrator of the clinic to improve the level of service so that it was a resource and not a burden to the community?
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IMHO you should keep your keep your mouth shut. do not tip off anyone, just try to get along with them as best you can.
my reasoning is as follows.
1. whomever these Docs are i guarantee you they have friends in the community. some of these friends are powerful. one or two of them may be really evil.
if you burn them, they may come back at you, and it might be way worse than you might expect ( an asymmetrical response so to speak).
2. nothing is confidential in a small town. nothing. that is why many people will not live in small towns.
3. these questionable docs might send referrals to you eventually. OTOH, if you piss them off, they might just bring in a competitor to your practice.
(another high end pain doc, with good credentials, so to speak). the current situation might work in your favor - a small town with a good pain clinic (you) and a crummy one (them). that does not leave much room for anyone else if you all get along , which is a good thing for you. savvy?
4. but what if you want to make the world a better place, and it is your moral responsibility to turn these people in? well Joan of Arc thought the same way.
GL.
my reasoning is as follows.
1. whomever these Docs are i guarantee you they have friends in the community. some of these friends are powerful. one or two of them may be really evil.
if you burn them, they may come back at you, and it might be way worse than you might expect ( an asymmetrical response so to speak).
2. nothing is confidential in a small town. nothing. that is why many people will not live in small towns.
3. these questionable docs might send referrals to you eventually. OTOH, if you piss them off, they might just bring in a competitor to your practice.
(another high end pain doc, with good credentials, so to speak). the current situation might work in your favor - a small town with a good pain clinic (you) and a crummy one (them). that does not leave much room for anyone else if you all get along , which is a good thing for you. savvy?
4. but what if you want to make the world a better place, and it is your moral responsibility to turn these people in? well Joan of Arc thought the same way.
GL.
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Refer them to their local medical societies and to each other. The more the word spreads about them, preferably along with word about you as a contrasting quality pain doc, the better. Never say a bad thing about anyone. Just say, "The way I would handle that is..."
Thanks for the help. I agree that direct communication is key. That being said from what I have heard about this board of directors over at my competition they are the malignant type and yes I am concerned about blow back. That being said, it is the PCP's driving this as I personally have not had interactions with these patients or their providers. At this point I personally wouldn't feel good complaining based off of reading a few notes and not discussing this more with the involved parties. That's not to say that I agree with what they are doing by any means. I am thinking I will handle it by keeping my comments neutral and making the appropriate referrals of whom to speak to. Thanks again for the input.
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Keeping your mouth shut is allowing harm in your community.
Keeping my mouth shut until I can personally identify harm is what I am saying. I am not saying I will sit and wait until 20 folks drop over dead from an OD. Having just moved here not long ago it is apparent this has been going on for far longer (a lot of the PCP's here, like other places, are quite liberal in the meds and were taught to be so over a decade ago as others were) than when I just moved here. We will see, it is interesting to me/impressive to me that the PCP's (limited few at this time for sure) are willing to fight so hard. Most I have met are indifferent to it. We will see what happens.
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If you are asked by colleagues, and if you feel the other docs are not practicing good medicine, recommend that the docs seeking your counsel report the matter to the Board.
Unless you have first hand knowledge, it is not your place to address this with the Board directly. Steve may be the moral compass of his community. The rest of us are governed by our individual state's medical practice act.
Unless you have first hand knowledge, it is not your place to address this with the Board directly. Steve may be the moral compass of his community. The rest of us are governed by our individual state's medical practice act.
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It's really about how aggressive your state dea wants to go after these clinics. We had a bunch of chiro owned opioid clinics all closed down the last five years. About a dozen high prescribing pcps were targeted, fined, and one got jail time.... If you have a contact at the dea or simple give a rep a heads up, the practice should be flagged by the state.... These pain clinics need to go period
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The thing is, if you take the conservative pssy approach like I am advocating, you cannot be harmed and will be hard to criticize. If you fight for principle, particularly in the hazy world of narcotics-for-pain, particularly with second-hand info and PARTICULARLY when it seems like you may have something financially to gain from doing so, you are putting yourself at risk. A PCP, who has "standing", when his pts have been harmed is better suited to spread the word and, if aggressive, make a formal complaint.
For the record, I don't practice what I preach and can't keep my mouth shut if I see an injustice or what looks like abuse or impropriety. There's a good chance people will urinate on my grave.
For the record, I don't practice what I preach and can't keep my mouth shut if I see an injustice or what looks like abuse or impropriety. There's a good chance people will urinate on my grave.
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It's a pill mill that will get shut down only after a run of overdose deaths. These rarely ever get shut down before more than a few senseless funerals of otherwise young and healthy people. People do a lot of whispering, but rarely does anyone stop it until it's so far gone, they have no choice. If you can do better than that, then you've done a good thing.
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Unfortunately this is true. Medical boards are complaint driven, there are no prophylatic actions. But, PDMP's can change this. Patterns of dangerous
prescribing - negligence - are archived there, before bad things happen. Somebody needs to be plumbing the depths of our PDMPs to ferret out negligence
before it hurts a patient.
If nothing else, boards should be scrutinizing anyone Rx's > 120MED. That's a start.
prescribing - negligence - are archived there, before bad things happen. Somebody needs to be plumbing the depths of our PDMPs to ferret out negligence
before it hurts a patient.
If nothing else, boards should be scrutinizing anyone Rx's > 120MED. That's a start.
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Pharmacies are taking proactive stance as well in my region... They tend to deny abnormal pill distribution and blacklist some prescribers... You can drop an anonymous message to your local pharmacy. In the end I feel these pain clinics only make your legit practice stronger.... I remember in the distant past worrying about competing with these type of clinics, now most of them are toast...
