I am worried that I probably violated my contract with my PM doctor and I would like peoples opinion if I should tell my pm doctor. Here is my story.
I have been having pain with muscle spasms in my calf for about a week now. The pain has been pretty bad and it has been up to a 7-8 when the calf muscle spasms. I called my pcp and they told me to go to urgent care because it could be a serious problem. I went to the urgent care last night and I was diagnosed with a blood clot in my leg. The dr put me on blood thinners and I asked for something additional for the pain. I let him know what I was on already and he gave me a 4 day supply of percocet to tie me over till I see my pm doctor this Friday. I know this is probably a violation because the contracts usually say that only the PM doctor can prescribe me opiates. If any of you have had a blood clot before you will understand the pain I am in. I got the prescription filled at walgreens because the cvs I normally go to was closed and no other cvs near me was open.
Should I tell my PM Dr about the meds? I am scared if I did he will drop me. Is there ever a clause that will cover you in emergency situations? Also could he find out that I filled it even though I went to a different pharmacy? Are all pharmacies linked in some way when it comes to opiates. I do want to tell him but I don't want to be screwed so can any of you on this forum help me.
Hey Andrew- I understand your concern, and I can tell you how my PM doctor handles this kind of thing and hope it helps.
My contract states that if there is an urgent care situation (during the night or weekend) and I have to go to the ER and am prescribed any kind of opiate, I must inform my PM doctor the following day. He will then note it in my records, and tell me how to deal with taking the opiates he has prescribed for me. I would assume that for the time I would be taking the other meds from the ER doctor, I would not be taking the ones prescribed by my PM doctor, therefore he would expect my scrip from him to last for that many days longer before I get a refill. He would pull a pharmacy record to be sure.
Now, I can't say this is how your PM doctor works, but I know many other PM doctors handle it this way. Do you have a copy of your contract? If so, read through it again just to be sure what it states.
You had a true urgent situation, and yes blod clots can & do cause extreme pain, so I understand the need for the extra meds. You were open with the ER doctor about the meds you currently take, and it sounds like you were open about the fact that you are a PM patient, so that is a positive in this case.
My humble opinion is that you need to let your PM doctor know ASAP so he can get the records from the ER and put them in your file.
Keep checking back because I'm sure others will have more input.
My Contract states the same as Ozzybug. Ive had lots of dental surgery and never had an issue. My contract actually states I am not to use my CP meds for these types of emergencies. The only problem I could see if he is treating you for a clotting disorder or that's your major PM complaint that he is treating.Good luck, Dave
On 2 seperate occasions I have been prescribed opiates other than from my PM. On time for surgery NOT related to pain and I told PM what was prescribed, where i had it filled ( at hospital ), date amount etc. It happened to be the same med i was prescribed for BT pain but a lower dose.The 2nd time was from dentist after tooth extraction and I did the same. This time the med was NOT the same. I told PM doctor that for the few days supply I had for tooth I did not take my BT meds so therefor this month she could write script for less as I did have those pills left over. Showed good faith and helped build trust but she gave me my normal amount of BT meds. Honesty is definite a good thing
Thanks for the input from everyone, I appreciate it. I wish I could check my pain contract but I either lost it or never received a copy. My problem with the situation is that the meds they gave me are an addition to what I already take. I am currently on 30mg oxycontin twice a day and 3x 10/350 norco per day. I was just about out of the norco because I have been having the pain in my leg for almost a week but I am seeing my PM Dr on Friday for my monthly refill. I have ran out of the norco's early before but itís usually 1 or 2 days before. I just get through the last couple of days without them. I let the urgent care doc know that the pain meds I am on were not providing me enough relef and I needed something additional to help.
I am worried if I tell him about it he will get mad that I did not tell him sooner. I just hope he understands the pain of a blood clot. Itís a type of pain that does not go away and you have to deal with it 24/7. I got a blood clot once before when I was on chemo from a pick line. That pain was also horrible but it at least helped that it was in my arm. The pain is in my leg and it hurts more when I walk. I will tell him about the meds when I see him Friday and I hope I don't get in trouble for it. He has been a nice doctor but all the stories from everyone else with their PM Dr's do not help. It sucks that we have to tip toe with our Dr's because we fear they are going to cut us off. The pain in my lower back is not going to go away and I am probably going to need to be on pain meds for the rest of my life.
Tell him the truth... U don't have copy of contract, wasn't sure if you needed to call immediately or if waiting for this visit was OK. You may get a warning but it isn't like you did an illegal drugs or literally went Doctor shopping. I think you will be fine.
but you mentioned runing out a day or 2 early in the past. If you take your medications more than what is prescribed, that in itself is a violation but we all do it. ( At least I do ). Some days i need more, sometimes less. I always make sure i have enough to last the entire 30 days. It is miserable to go 1 day much less 2 without these meds after being on them for years.
I agree but going without the norco is 100 times easier than the oxycontin. I usually only take the extra meds after doing something really physical like after the gym. A single norco does not really work anymore and I usually have to take 2 to get any relief. I would ask for a stronger break through med but I don't want to push my luck.
Well, a blood clot is a very severe condition and very painful (my brother had one and said it was unbearable pain). I would think in this situation the additional medication is understandable and pain contracts usually allow for documented medical emergencies or surgeries. However, I do think it is imperative you call you're PM doctor immediately and let him know about the diagnosis and give him the Doctor's name and number so he can contact him.
I have to agree with everyone else, but I would call his office today, rather than wait until you see him. You can bring him the records and discharge instructions from the urgent care you went to on Friday to document what you tell them but in the mean time you do not want them to pull your pharmacy records and see that you filled a prescription from an urgent care for another pain med and didn't tell them until you got there. It is far better to call your doctor in events like these, as soon as possible after they happen- the next morning if at all possible.
Most PM contracts have a stipulation that in the event of an emergency, you are to notify them the next morning/business day. And since you already filled that prescription, you want to make sure that you inform them before they find out or drug test you when you walk in.
Protect yourself and be proactive. Make sure to bring up the issue when you do see the PM doctor Friday and give him the paperwork documenting the blood clot and treatment.
I would definately tell your pm doc as he probably knows already as most ER's share info with your PCP. My main concern would be that they would want to do a random urine test and should other pain meds show up rather than what he prescribed he may think your trying to hide something. Chronic pain and Acute illness/pain are two seperate issues. Not all pain management docs feel the same way but most do. I don't think you violated a contract based on the fact that your have a dx requiring intervention. I'm not sure what you are on from your PM doc. Was it another opiate that should have taken care of the pain or was it something that is not a controlled substance ie: Tramadol or something like that? Good luck, hope all goes well for you. In my opinion though you did not break a contract as long as you tell them.
I took everyones advice and told my doc on Friday. He did not even care and he documented what happened with the blood clot. He asked me if the perocet helped and i let him know it was a little bit. He then proceeded to increase my 40mg oxy to 60mg to help with the pain. I asked him to do 3x 30mg which I have been wanting for a while. The oxy only really last me 8 hours instead of 12 and in the past he kinda blew if off. He also increased my BT norco from 3x pd to 6x. Next month I hope I can get him to keep the oxy the same but I don't care about the norco. Going from 2x 40mg to 3x 30mg is only a 10mg increase.
Thanks again for the input. Honesty is always best. I have always followed my PM Dr's orders and never asked for a early refill so I am sure that helped. It just sucks that so many have gotten dicks for PM Dr's and have been cut for some of the lamest reasons. In the future its only going to get worse because of all the drug problems in society.
I'm glad that it worked out. Being honest is the only way to handle our relationships with our PM doctors. If we aren't, we can throw away a relationship that tooks us months and in some cases years to make. It's not worth it to take that kind of chance.
The increase, should help manage the pain better-2-60 mg Oxycontin, might help better manage the pain, and the fact that he also increased breakthrough meds is a bonus. Most PM doctors only increase one or the other at a visit.
You may find that the new increase helps you far more than you think. It's a 40 mg increase, and you may find that the pain relief is more consistent for that 12 hours, or at least I hope so in your case.
Take care and hope things all work out well,